Digital treatments for opioids and other substance use disorders (DIGITS) in primary care: A hybrid type-III implementation trial

Funding has been awarded to principal investigator Edwin Wong by Kaiser Permanente Washington Health Research Institute for "Digital treatments for opioids and other substance use disorders (DIGITS) in primary care: A hybrid type-III implementation trial".

Abstract:

The proposed study addresses a critical gap: how to best implement digital treatments for opioids and other substance use disorders (SUDs) in primary care (PC). In late 2017, the US FDA approved the first ever digital therapeutic for any medical condition, which happens to be for SUD. Pear Therapeutics reSET is a smartphone-based, FDA-approved version of a computerized cognitive-behavioral treatment for SUD, the Therapeutic Educational System (TES). A new version reSET-O is currently under expedited FDA review that can be used with buprenorphine treatment. Therefore, reSET could address a significant barrier to
buprenorphine prescribing in PC: the lack of access to psychosocial treatment. Despite their promise, digital treatments have failed to gain traction in real-world health care. There is a lack of knowledge about how to implement them well.

Our delivery system partners in Kaiser Permanente Washington are committed to collaborating with us to study four approaches to implementing reSET and reSET-O in 25 PC clinics in Washington State using a randomized 2x2 factorial design. These four approaches are (1) “standard implementation”, an evidence-based implementation strategy previously used by our delivery system partners; (2) “standard implementation plus external facilitation”; (3) “standard implementation with a patient coach” to support patient engagement; and (4) “standard implementation with both”. These strategies are proven in PC and address common barriers to addiction interventions and digital treatments.

Specific Aims are to (1) compare implementation outcomes of reach and fidelity of these four approaches for implementing digital treatments in 23 PC clinics, and (2) compare the population-level cost-effectiveness of each implementation approach in achieving reach, fidelity, and abstinence.

IMPACT: Researchers and health systems do not know how to reach large numbers of patients with opioid and other SUDs. Digital treatments are promising, but there is no evidence to guide their implementation. Costly implementation strategies are not always superior. The current study will provide health system leaders with data on how to best implement digital treatments.