Implementations of a text-message intervention to increase linkage from the emergency department to outpatient treatment for substance use disorders

Abstract

Aim-To determine acceptability and explore potential usefulness of a text messaging (SMS) program aimed at increasing attendance at outpatient treatment for substance use disorders (SUD) after emergency department (ED) referral.Method-A retrospective analysis of 377 adult patients from 2 urban EDs seeking treatment for SUD (opioids (n=168), alcohol (n=188), benzodiazepines (n=21)) referred to outpatient treatment and offered an SMS program which included daily (1) motivational messages focused on positive thinking, (2) ecological momentary assessments (EMA) related to craving with tailored behavioral strategy messages, (3) EMA of drug use with tailored feedback to reduce abstinence violation effects, and (4) reminders about treatment location and phone number. We assessed acceptability by examining opt-in rates, EMA completion rates over the first week and end-of-program qualitative feedback. We assessed how individuals who opt in differ in outcomes from those who opt out by examining rates of outpatient SUD treatment attendance recorded from the medical record.Results-167 patients (44%) opted in to the SMS program. Over 7 days, around 33% of EMA were completed. Median helpfulness score was 8 (IQR 6 to 10) out of 10 and 84% would recommend the SMS program to someone else. Individuals who opted in to the SMS program had higher rates of SUD treatment initiation than individuals who did not opt-in (70.7% vs. 40.9%) Conclusions-We found evidence supporting acceptability and potential usefulness of an automated text message program to assist treatment attendance for some individuals with SUDs discharged from the ED. A controlled trial is needed to examine whether SMS program exposure is associated with improved treatment attendance compared to standard care.

The Use of Text Messaging to Improve Clinical Engagement for Individuals With Psychosis: Systematic Review

“…The target population in the study by Thomas et al [51] was patients who had not yet had contact with psychosis services, yet the use of SMS text messaging reminders increased the likelihood of clinic attendance two-fold at initial appointments. Similar findings are reported for initial attendance at treatment start in substance use literature [62]. This is notable considering the high rates of disengagement and dropout for patients in early stages of accessing care [14] and, therefore, represent a population at elevated risk of not receiving treatment.…”

Breaching Trust: A Qualitative Study of Healthcare Experiences of People Who Use Drugs in a Rural Setting

“…warm-hand-offs, are especially likely to improve patient follow-up and outcomes (D'Onofrio et al, 2015 , 2018 ; Ahmed et al, 2019 ; Kelly et al, 2020 ). Recent work has also found success in incorporating telehealth and text messaging into referral systems to help with patient follow up, which may be especially useful in rural settings (Kmiec and Suffoletto, 2019 ; Wootton et al, 2019 ). Such approaches could be a major step in fostering therapeutic alliances between providers and people who use drugs.…”

A Multifaceted Intervention to Improve Patient Knowledge and Safe Use of Opioids: Results of the ED EMC2 Randomized Controlled Trial

“…While SMS texting has been used previously in the setting of medication adherence to encourage routine use from the ED (e.g., diabetes, hypertension, antibiotics), the goal of our text messages was not to encourage routine use, but rather to reinforce the salience of educational messages delivered at the time of the ED visit or provide a cue to action. The success of the SMS texting component is one of several recent examples of extending the reach of emergency care into the postvisit time period through technology (text messaging, mobile applications, telehealth), a growing and promising avenue for behavioral interventions . We believe that technology delivered interventions such EMC 2 + SMS have great potential in the context of pain management, not only because of their reach into the postvisit space wherein the patient is less distracted but also because the interventions are scalable and can be delivered at the time of the behavior being targeted (e.g., medication taking, pill disposal) …”