Ellis Samantha, Witzig Jax, Basaldu Diego, Rudd Brittany, Gastala Nicole, Tabachnick Alexandra R, Kang Sungha, Henry Tondalaya, Stackhouse Nathan, Wardle Margaret
University of Illinois at Chicago.
Northwestern University.
Res Sq. 2025 Apr 28:rs.3.rs-6347618. doi: 10.21203/rs.3.rs-6347618/v1.
Contingency management (CM) is an effective yet underutilized behavioral intervention that uses rewards to improve outcomes in medication for opioid use disorder (MOUD) treatment. Prior implementation attempts have focused on specialized addiction clinics, using intensive daily treatment with methadone and high reward values (e.g. >$200 total). However, many people get MOUD from less specialized, more accessible, family medicine clinics. These clinics could also benefit from CM, yet present unique challenges for CM. Family medicine clinics typically use buprenorphine as their primary medication, which requires less intensive dosing schedules and thus provides fewer CM opportunities. They may also have lower institutional willingness to use high-value rewards. As an initial step in user-centered design of a low value reward (<$75 total) CM program for the family medicine context, we conducted qualitative interviews with patients and staff in the buprenorphine treatment program of a family medicine department. We gathered and analyzed qualitative data on CM knowledge, preferred program parameters, and implementation considerations.
Participants ( = 24) were buprenorphine treatment staff ( = 12) and patients ( = 12). Participants completed 30-50-minute semi-structured interviews, analyzed using rapid matrix analysis.
Participants had little experience with CM, but generally viewed CM as acceptable, appropriate, and feasible. Interviewees coalesced around having staff who were not providers with prescription privileges conduct CM, consistent rather than escalating payments, and physical rewards delivered in-person. Potential challenges included medical record integration, demands on staff time, and confirmation of patients' goal completion.
Patient and staff feedback was well-aligned, especially regarding rewards as an opportunity for staff-patient connection and the need for simplicity. Some consensus suggestions (e.g. non-escalating rewards) conflict with extant CM literature. Implications for implementation of CM in this setting are presented. These findings inform user-centered design and iteration of a CM program for this accessible, non-specialized family medicine setting.
应急管理（CM）是一种有效但未得到充分利用的行为干预措施，它利用奖励来改善阿片类药物使用障碍（MOUD）治疗中的药物治疗效果。先前的实施尝试主要集中在专门的成瘾诊所，采用美沙酮强化每日治疗和高奖励价值（例如总计超过200美元）。然而，许多人从专业性较低、更容易就诊的家庭医学诊所获得MOUD治疗。这些诊所也可以从CM中受益，但在实施CM时面临独特的挑战。家庭医学诊所通常将丁丙诺啡作为主要药物，其给药方案不需要那么密集，因此提供的CM机会较少。它们使用高价值奖励的机构意愿也可能较低。作为以用户为中心设计适用于家庭医学环境的低价值奖励（总计低于75美元）CM计划的第一步，我们对一家家庭医学部门的丁丙诺啡治疗项目中的患者和工作人员进行了定性访谈。我们收集并分析了关于CM知识、首选项目参数和实施考虑因素的定性数据。
参与者（n = 24）包括丁丙诺啡治疗工作人员（n = 12）和患者（n = 12）。参与者完成了30 - 50分钟的半结构化访谈，采用快速矩阵分析进行分析。
参与者对CM的经验很少，但总体上认为CM是可接受的、合适的且可行的。受访者一致认为应由没有处方特权的工作人员进行CM，采用固定而非递增的报酬方式，并亲自发放实物奖励。潜在挑战包括病历整合、对工作人员时间的要求以及确认患者目标完成情况。
患者和工作人员的反馈高度一致，特别是在将奖励视为工作人员与患者建立联系的机会以及对简单性的需求方面。一些共识建议（例如非递增奖励）与现有的CM文献相冲突。本文阐述了在这种环境中实施CM的意义。这些发现为在这种可及的、非专业化的家庭医学环境中以用户为中心设计和迭代CM计划提供了参考。
