A researcher who got nearly $1 million to study mHealth for substance abuse explains why it's essential to deploy the apps in primary care.
“Addiction is a huge public health problem and there are effective treatments available, but people don’t seek them, or they’re often not offered them,” Joe Glass, PhD, MSW told Healthcare Analytics News™. “Really only a small fraction ever get treatment.”
Glass, a Kaiser Permanente Washington Health Research Institute, thinks mHealth might be help solve that problem.
There’s a burgeoning app market for patients facing substance abuse, and he highlighted 2 main types: Treatment apps that replicate or supplement cognitive behavioral therapy that helps patients understand and address the underlying causes of addiction; and recovery apps that offer social support and educational tools for patients to maintain their abstinence.
Both types have undergone studies among patients at specialty treatment centers, but only 10% of all patients with substance abuse disorder actually seek specialty treatment. Glass wants to study how whether the apps can reach more people—and be effective—if they were deployed in primary care settings.
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In 2017, he got a 5-year, $960,000 grant from the National Institute of Alcohol Abuse and Alcoholism to research the topic. He recently spoke to Healthcare Analytics News™ about the challenges and potential that come with the technology.
Substance abuse is particularly complex—it’s mental, physiological, and social. How can apps be developed to treat something with that complexity?
Substance abuse is a complex chronic condition, but there are models for addressing other complex conditions in primary care that have been successful. Diabetes is a complex chronic condition, so are heart disease and asthma, and I think that what we have to do is think about these as medical conditions. We need to get away from the historical stigmas where they’re thought of as something completely different.
Why is it so important to get these mHealth interventions in the hands of primary care doctors instead of just treatment specialists?
There’s a lot of barriers to getting treatment, whether they’re practical barriers like transportation to appointments or barriers like the stigma of going to an addiction treatment center. The mobile health treatments are potentially a way to get around those barriers, allowing patients to get treated in their homes. 80% of people with substance use disorder see their doctor, only 10% go to a specialty treatment center. If we can get these apps used in doctors’ offices, they can reach more people.
Are there barriers to integration in primary care?
A typical barrier in primary care is that there are a lot of needs that patients have when they come in for the visit. Someone might have 5 really complex medical conditions and addictions is 1 of them, the patient has to really work with a clinician to figure out what needs they want satisfied in that visit. There’s always a time issue.
I think historically, primary care hasn’t been as cutting edge on behavioral health issues, but now there’s more behavioral health integration in many health systems.
How will your team go about researching this now that you’ve gotten the funding?
We’re going to work with primary care teams to figure out workflows: Who is offering the apps to patients in a primary care setting and how they’re following up, trying to put some perimeters around that.
We’ll also be talking to patients, asking them how they envision using it and how they’d like to interact with their primary care teams around the app. That’s really a needs assessment, as a first step in creating ways to offer them to patients.
Once that’s defined, we’ll be doing a pilot study where we test the effectiveness of these workflows we develop. We’ll do a randomized trial in primary care to see if these apps can be offered in primary care settings, if patients like them, and if primary care doctors think it works well.
Then, the next step will be to do a large trial to verify that these treatments are effective in primary care.
There seem to be some well-developed mHealth therapies going through regulatory pathways, and then this whole landscape of apps just thrown out into an app store. How are they evolving, who is pushing these things forward?
There’s a lot of stuff that you can get out there that are not proven. There’s not great evidence for apps people just download and use on their own. There’s more evidence for the ones you download and use under supervision from a clinician.
From my position, this is a new thing and we’ll need to see how it unfolds. It’s hard to predict what the FDA is going to do. If regulation affects what apps can be offered, that’s really where that would play a role in research considerations and how we can work with health systems in a way that helps them offer new treatment options to patients.
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