Development of a text messaging tool to support buprenorphine treatment in primary care

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Project Summary/Abstract: The rising opioid misuse epidemic has intensified efforts to implement cost-effective strategies to expand access to office-based opioid treatment (OBOT). Office-based buprenorphine treatment with elements of patient education, individualized evidence-based care plans, and expert care availability offers a patient- centered approach to reduce the burden of opioid addiction and related comorbidities. OBOT, however, remains underutilized in traditional healthcare settings, and barriers to expansion includes limited clinical and administrative support, particularly during induction and stabilization. Text messaging (TM) offers a low-cost and personalized approach to enhancing buprenorphine treatment in primary care and may address logistical and clinical challenges previously reported by buprenorphine providers. This project investigates the feasibility and clinical impact of a TM intervention to improve adherence to Substance Abuse and Mental Health Services Administration and consensus guidelines to office-based buprenorphine treatment (e.g., adherence to buprenorphine, patient-provider communication, and self-management). The project will develop and conduct preliminary tests of a TM intervention that will improve adherence to buprenorphine treatment, patient-provider communication, and self-management following induction in two phases: 1) identifying key stakeholders (e.g., patients, physicians, and administrators) who will inform the design and delivery of the TM intervention, and 2) assessing the feasibility and clinical impact of this intervention during the first 3 months following induction to buprenorphine. Qualitative and mixed- methods research will explore key stakeholder preferences to intervention design using the Technology Acceptance Model. The TM intervention prototype will undergo usability testing to fine-tune intervention components among patients entering OBOT for induction to buprenorphine. The feasibility and clinical impact of a refined intervention prototype will then be assessed in a pilot randomized controlled trial and identify modifications to optimize the intervention for a future efficacy trial. TM is the most popular mobile phone feature nationally, among patients in addiction treatment, and in OBOT. This low-cost clinical support tool is uniquely positioned to accelerate DHHS and NIDA goals to expand access to substance abuse treatment in traditional healthcare settings. Findings from this project will lead to the development of a patient-centered platform that will: 1) enhance patient-provider communication and solve patient challenges to chronic disease management in primary care including transportation and limited in-person visit slots; 2) improve adherence to buprenorphine treatment by receiving medication reminders; 3) promote self-management through instructions regarding self-administration of comfort medications to quell mild withdrawal symptoms, linkage with psychosocial support, and 12-step group meetings; and 4) integrate with electronic health records and larger-scale adoption in primary care settings nationally.