Provision of Digital Health Technologies for Opioid Use Disorder Treatment by US Health Care Organizations

Abstract

ImportanceDigital health technologies may expand organizational capacity to treat opioid use disorder (OUD). However, it remains unclear whether these technologies serve as substitutes for or complements to traditional substance use disorder (SUD) treatment resources in health care organizations.ObjectiveTo characterize the use of patient-facing digital health technologies for OUD by US organizations with accountable care organization (ACO) contracts.Design, Setting, and ParticipantsThis cross-sectional study analyzed responses to the 2022 National Survey of Accountable Care Organizations (NSACO), collected between October 1, 2021, and June 30, 2022, from US organizations with Medicare and Medicaid ACO contracts. Data analysis was performed between December 15, 2022, and January 6, 2023.ExposuresTreatment resources for SUD (eg, an addiction medicine specialist, sufficient staff to treat SUD, medications for OUD, a specialty SUD treatment facility, a registry to identify patients with OUD, or a registry to track mental health for patients with OUD) and organizational characteristics (eg, organization type, Medicaid ACO contract).Main Outcomes and MeasuresThe main outcomes included survey-reported use of 3 categories of digital health technologies for OUD: remote mental health therapy and tracking, virtual peer recovery support programs, and digital recovery support for adjuvant cognitive behavior therapy (CBT). Statistical analysis was conducted using descriptive statistics and multivariable logistic regression models.ResultsOverall, 276 of 505 organizations responded to the NSACO (54.7% response rate), with a total of 304 respondents. Of these, 161 (53.1%) were from a hospital or health system, 74 (24.2%) were from a physician- or medical group–led organization, and 23 (7.8%) were from a safety-net organization. One-third of respondents (101 [33.5%]) reported that their organization used at least 1 of the 3 digital health technology categories, including remote mental health therapy and tracking (80 [26.5%]), virtual peer recovery support programs (46 [15.1%]), and digital recovery support for adjuvant CBT (27 [9.0%]). In an adjusted analysis, organizations with an addiction medicine specialist (average marginal effect [SE], 32.3 [4.7] percentage points; P < .001) or a registry to track mental health (average marginal effect [SE], 27.2 [3.8] percentage points; P < .001) were more likely to use at least 1 category of technology compared with otherwise similar organizations lacking these capabilities.Conclusions and RelevanceIn this cross-sectional study of 276 organizations with ACO contracts, organizations used patient-facing digital health technologies for OUD as complements to available SUD treatment capabilities rather than as substitutes for unavailable resources. Future studies should examine implementation facilitators to realize the potential of emerging technologies to support organizations facing health care practitioner shortages and other barriers to OUD treatment delivery.

Availability and Opportunities for Expansion of Buprenorphine for the Treatment of Opioid Use Disorder

“…A recent study found that 34% of accountable care organizations servicing persons with OUD used some type of technology, virtual peer support, or digital recovery support services. 72 While many of these programs are not intended to directly expand buprenorphine treatment, they could increase provider confidence with prescribing by improving access to complementary care strategies. Examples include the use of virtual reality-based interventions to support remote counseling or cue-exposure and extinction paradigms 73 74 or chat-bots for counseling or social connection.…”

Digital Phenotyping for Mood Disorders: Methodology-Oriented Pilot Feasibility Study

“…This study focused on a patient population with a previously diagnosed mood disorder for several reasons. There are parallel studies by several members of this research group, and the co-authors on this study have ongoing research and recent published studies involving the MindLAMP app for digital phenotyping investigations that focus on other patient populations, namely those of psychotic disorders [10] and substance use disorders [11]. The existing literature on digital phenotyping of mood disorders is limited and warrants its own dedicated investigation.…”

Closing the Digital Divide in Interventions for Substance Use Disorder

“…The average number of digital health tools used by a physician growing from 2.2 to 3.8 over that same time period [ 2 ]. In a recent cross-sectional study of United States (US) accountable care organizations by Miller–Rosales et al, approximately one-third of the organizations surveyed integrated at least one digital health technology at the system level to support treatment of opioid use disorder (OUD) [ 3 ]. Overall, digital health technologies are being used to improve access, increase quality, personalize medicine, and reduce both costs and inefficiencies [ 1 ].…”