Implementing a Mobile Health System to Integrate the Treatment of Addiction Into Primary Care: A Hybrid Implementation-Effectiveness Study.
Implementing a Mobile Health System to Integrate the Treatment of Addiction Into Primary Care: A Hybrid Implementation-Effectiveness Study.
复制标题
DOI：
10.2196/jmir.8928
复制
发表时间：
2018-01-30
影响因子：
7.4
通讯作者：
Shah DV
中科院分区：
文献类型：
--
作者：
Quanbeck A;Gustafson DH;Marsch LA;Chih MY;Kornfield R;McTavish F;Johnson R;Brown RT;Mares ML;Shah DV
尽管移动电话几乎无处不在，但很少有研究对实施移动健康（mHealth）应用程序治疗初级保健患者。虽然初级保健临床医生经常治疗哮喘和糖尿病等慢性疾病，但他们很少治疗成瘾这种常见的慢性疾病。相反，成瘾通常是在美国的医疗保健系统中治疗的，如果有的话，也是在一个单独的行为健康系统中治疗的。移动医疗可以帮助将成瘾治疗纳入初级保健。本文的目的是报告在初级保健中实施移动健康成瘾系统对患者和临床医生的影响。在这项实施研究试验中，一个名为Seva的基于证据的移动医疗系统在36个月的时间里被依次引入到三个联邦合格的卫生中心（FQHCs；为病人提供服务的初级保健诊所，无论他们的支付能力如何），每个中心最多有100名物质使用障碍（SUDs）患者。本文报告了根据Reach，有效性，采用，实施和维护（RE-AIM）框架组织的患者和临床医生结果。RE-AIM框架下的结果如下：适宜患者的Reach-Seva达到8.31%（268/3226）。每个诊所最多只能为100个病人支付电话费和数据费，这限制了我们的服务范围。疗效：服用Seva的患者在危险饮酒天数（减少44%，(0.7-1.25)/1.25，P= 0.04）、非法药物使用天数（减少34%，(2.14-3.22)/3.22，P= 0.01）、生活质量、人类免疫缺陷病毒筛查率和住院次数方面均有显著改善。通过Seva，患者还以初级保健机构中新颖的方式相互提供同伴支持。采用——患者持续高水平使用Seva——在12个月实施期的最后一周，3个地点53%至60%的患者使用了Seva。临床医生对该技术的使用不如患者对该技术的使用强劲，每家诊所只有少数临床医生使用Seva，而行为健康提供者在3家诊所中的2家向Seva提供了大部分转诊。实施——2个站点成功实施计划；他们第三次被耽搁了。维护——当赠款资金停止支付移动电话和数据计划时，Seva的使用减少了。三家诊所中有两家希望继续使用Seva，但他们很难找到资金来支持这一计划。实施移动医疗系统可以改善对患有sud的初级保健患者的护理，并且使用该系统的患者可以在康复过程中相互支持。然而，在临床医生中，实施需要弄清楚来自移动健康系统的信息将如何使用，并使移动健康数据在电子健康记录中可用。此外，支付移动医疗系统的费用仍然是一个挑战。
Despite the near ubiquity of mobile phones, little research has been conducted on the implementation of mobile health (mHealth) apps to treat patients in primary care. Although primary care clinicians routinely treat chronic conditions such as asthma and diabetes, they rarely treat addiction, a common chronic condition. Instead, addiction is most often treated in the US health care system, if it is treated at all, in a separate behavioral health system. mHealth could help integrate addiction treatment in primary care. The objective of this paper was to report the effects of implementing an mHealth system for addiction in primary care on both patients and clinicians. In this implementation research trial, an evidence-based mHealth system named Seva was introduced sequentially over 36 months to a maximum of 100 patients with substance use disorders (SUDs) in each of three federally qualified health centers (FQHCs; primary care clinics that serve patients regardless of their ability to pay). This paper reports on patient and clinician outcomes organized according to the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. The outcomes according to the RE-AIM framework are as follows: Reach—Seva reached 8.31% (268/3226) of appropriate patients. Reach was limited by our ability to pay for phones and data plans for a maximum of 100 patients per clinic. Effectiveness—Patients who were given Seva had significant improvements in their risky drinking days (44% reduction, (0.7-1.25)/1.25, P=.04), illicit drug-use days (34% reduction, (2.14-3.22)/3.22, P=.01), quality of life, human immunodeficiency virus screening rates, and number of hospitalizations. Through Seva, patients also provided peer support to one another in ways that are novel in primary care settings. Adoption—Patients sustained high levels of Seva use—between 53% and 60% of the patients at the 3 sites accessed Seva during the last week of the 12-month implementation period. Among clinicians, use of the technology was less robust than use by patients, with only a handful of clinicians using Seva in each clinic and behavioral health providers making most referrals to Seva in 2 of the 3 clinics. Implementation—At 2 sites, implementation plans were realized successfully; they were delayed in the third. Maintenance—Use of Seva dropped when grant funding stopped paying for the mobile phones and data plans. Two of the 3 clinics wanted to maintain the use of Seva, but they struggled to find funding to support this. Implementing an mHealth system can improve care among primary care patients with SUDs, and patients using the system can support one another in their recovery. Among clinicians, however, implementation requires figuring out how information from the mHealth system will be used and making mHealth data available in the electronic health (eHealth) record. In addition, paying for an mHealth system remains a challenge.
登录
查看更多内容
影响因子：
25.8
作者：
Gustafson, David H.;McTavish, Fiona M.;Chih, Ming-Yuan;Atwood, Amy K.;Johnson, Roberta A.;Boyle, Michael G.;Levy, Michael S.;Driscoll, Hilary;Chisholm, StevenM.;Dillenburg, Lisa;Isham, Andrew;Shah, Dhavan
通讯作者：
Shah, Dhavan
影响因子：
12.7
作者：
Glasgow, RE;Vogt, TM;Boles, SM
通讯作者：
Boles, SM
影响因子：
7.4
作者：
Fiordelli M;Diviani N;Schulz PJ
通讯作者：
Schulz PJ
影响因子：
3.9
作者：
French, Michael T.;Popovici, Ioana;Tapsell, Lauren
通讯作者：
Tapsell, Lauren
影响因子：
3.9
作者：
Glass JE;McKay JR;Gustafson DH;Kornfield R;Rathouz PJ;McTavish FM;Atwood AK;Isham A;Quanbeck A;Shah D
通讯作者：
Shah D