Acceptability, feasibility, and outcomes of a clinical pilot program for video observation of methadone take-home dosing during the COVID-19 pandemic

Hallgren, Kevin A.; Darnton, James; Soth, Sean; Blalock, Kendra L.; Michaels, Alyssa; Grekin, Paul; Saxon, Andrew J.; Woolworth, Steve; Tsui, Judith I.

doi:10.1016/j.jsat.2022.108896

Cited by 11 publications

(6 citation statements)

References 21 publications

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“…Unfortunately, the high demand for personnel and the need for properly operated technical equipment means its use it limited to the few cases where adherence to the therapy regimen is of critical importance and where direct observation by medical personnel is unavailable, as in the case of tuberculosis treatment [52] or buprenorphine [93] or methadone-based take-home opioid dependence treatment programmes [94]. However, recent technological advances mean that photo and video recording and remote transmission with smartphones [95] via telecommunication networks, including the internet, has become inexpensive and easily available to virtually anyone in society, which potentially transforms such therapies into efficient and practical healthcare and public health options [96,97], including in the case of elderly patients with limited selfcare capabilities.…”

Section: Resultsmentioning

confidence: 99%

Modern technologies for improving elderly patients’ compliance

Susło,

Belovičová,

Mizia

2023

fmpcr

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ageing is associated with decreasing psychomotor skills and an increasing dependency upon others. Family bonds in modern societies are often weakened or broken, and thus the traditional primary source of support for the elderly has largely ceased to exist. Progressive multimorbidity means that elderly patients often have to adhere to multiple overlapping drug regimens, involving long-term or even indefinite medication protocols. Such chronic polypharmacy is likely to adversely affect patients' adherence. We performed a literature review with the aim of identifying, first, the problems associated with compliance with medical directions among people 60 years of age and older and, second, the solutions to this problem now available due to modern technological advances. The gold standard of therapy in elderly patients is personally observed or directed therapy, but in practice, this is often unavailable. The phenomenon of the ageing of society challenges the healthcare system with an increasing number of community-dwelling elderly people who are increasingly dependent upon others, which negatively impacts their level of adherence to therapy. Considering the deepening scarcity of medical personnel and the limited availability of caregivers, only broad application of solutions based on modern technologies will be able to significantly improve patients' compliance, and thus the effectiveness of their treatment.

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Section: Resultsmentioning

confidence: 99%

Modern technologies for improving elderly patients’ compliance

Susło,

Belovičová,

Mizia

2023

fmpcr

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“…In a study (Hallgren et al [5]) describing the clinical pilot, we showed that patient adherence to video DOT varied, but on average, video DOT significantly increased the number of days of observed methadone dosing and most patients received increased methadone take-home dosing privileges due to their ability to demonstrate treatment stability. However, the direct usability of the video DOT app has yet to be tested with patients or counselors in methadone treatment settings.…”

Section: Introductionmentioning

confidence: 84%

Workload, Usability, and Engagement with a Mobile App Supporting Video Observation of Methadone Take-Home Dosing: Usability Study

Idrisov¹,

Hallgren²,

Michaels³

et al. 2023

JMIR Hum Factors

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Background Methadone, a cornerstone of opioid use disorder treatments for many decades, is an essential tool for combatting the opioid epidemic. However, requirements for observing methadone dosing in person through direct observed therapy (DOT) impose significant barriers for many patients. Digital technology can facilitate remote DOT, which could reduce barriers to methadone treatment. Currently, there are limited data on the usability of such technology among patients and counselors in methadone treatment settings. Objective The primary objective of this study was to assess the workload, usability, and engagement of a video-based DOT mobile app for patients with opioid use disorder receiving methadone treatment. The secondary objective was to assess the workload, usability, and engagement of the provider-facing app portal used by counselors. Methods Patients (n=12) and counselors (n=3) who previously tried video DOT for methadone through a smartphone app in an opioid treatment program participated in usability testing sessions. Participants completed essential tasks for video DOT, then provided ratings of workload (NASA Task Load Index), usability (modified System Usability Scale), and engagement (modified Engagement Scale) with the core features of the video DOT program Results Patients and counselors reported low mental, physical, and temporal demands, successful performance, low effort, and low frustration associated with activities. Patients reported high usability (mean 85, SD 9.5) and engagement (mean 3.8, SD 1.1); counselors reported moderate usability (mean 43.3, SD 17.7) and engagement (mean 2.81, SD 0.63). Conclusions A mobile health app that facilitates video-based DOT for methadone required a low workload for patients and counselors and was highly usable for patients in an opioid treatment program; however, there are opportunities to improve usability and engagement for the counselor-facing portal.

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“…We conducted a qualitative evaluation of a clinical pilot program of VOT conducted within three OTPs in Washington State using individual, semi-structured interviews of patients and counselors who participated in the pilot. Details of the pilot program have been previously described [ 17 ]. Between April and August of 2020, 60 adult patients already receiving methadone were offered take-home dosing with VOT using a smartphone application created by emocha Mobile Health ® and were instructed to record and asynchronously transmit videos of the ingestion of all methadone take-home doses.…”

Section: Methodsmentioning

confidence: 99%

“Sign Me Up”: a qualitative study of video observed therapy (VOT) for patients receiving expedited methadone take-homes during the COVID-19 pandemic

Darnton

Bhatraju

Beima‐Sofie

et al. 2023

Addict Sci Clin Pract

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Background Federal and state regulations require frequent direct observation of methadone ingestion at an Opioid Treatment Program (OTP)—a requirement that creates barriers to patient access. Video observed therapy (VOT) may help to address public health and safety concerns of providing take-home medications while simultaneously reducing barriers to treatment access and long-term retention. Evaluating user experiences with VOT is important for understanding the acceptability of this strategy. Methods We conducted a qualitative evaluation of a clinical pilot program of VOT via smartphone that was rapidly implemented between April and August 2020 during the COVID-19 pandemic within three opioid treatment programs. In the program, selected patients submitted video recordings of themselves ingesting methadone take-home doses, which were asynchronously reviewed by their counselor. We recruited participating patients and counselors for semi-structured, individual interviews to explore their VOT experiences after program completion. Interviews were audio recorded and transcribed. Transcripts were analyzed using thematic analysis to identify key factors influencing acceptability and the effect of VOT on the treatment experience. Results We interviewed 12 of the 60 patients who participated in the clinical pilot and 3 of the 5 counselors. Overall, patients were enthusiastic about VOT, noting multiple benefits over traditional treatment experiences, including avoiding frequent travel to the clinic. Some noted how this allowed them to better meet recovery goals by avoiding a potentially triggering environment. Most appreciated having increased time to devote to other life priorities, including maintaining consistent employment. Participants described how VOT increased their autonomy, allowed them to keep treatment private, and normalized treatment to align with other medications that do not require in-person dosing. Participants did not describe major usability issues or privacy concerns with submitting videos. Some participants reported feeling disconnected from counselors while others felt more connected. Counselors felt some discomfort in their new role confirming medication ingestion but saw VOT as a useful tool for select patients. Conclusions VOT may be an acceptable tool to achieve equipoise between lowering barriers to treatment with methadone and protecting the health and safety of patients and their communities.

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Acceptability, feasibility, and outcomes of a clinical pilot program for video observation of methadone take-home dosing during the COVID-19 pandemic

Cited by 11 publications

References 21 publications

Modern technologies for improving elderly patients’ compliance

Modern technologies for improving elderly patients’ compliance

Workload, Usability, and Engagement with a Mobile App Supporting Video Observation of Methadone Take-Home Dosing: Usability Study

“Sign Me Up”: a qualitative study of video observed therapy (VOT) for patients receiving expedited methadone take-homes during the COVID-19 pandemic

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