DIGITS: Digital Treatments for Opioids and Other Substance Use Disorders in Primary Care
Study Details
Study Description
Brief Summary
The DIGITS Trial addresses a critical knowledge gap: How to best implement digital treatments for opioids and other substance use disorders in primary care. The DIGITS Trial is a partnership between Kaiser Permanente Washington Health Research Institute (KPWHRI) in Seattle, and Kaiser Permanente Washington, a healthcare delivery system in Washington State.
In this study, the FDA-authorized reSET and reSET-O digital therapeutics will be implemented in Kaiser Permanente Washington primary care clinics. The study will evaluate the extent to which two implementation strategy interventions, health coaching and practice coaching, improve the implementation. Primary care clinics are randomized to receive these implementation strategy interventions. Each clinic will have a 12-month active implementation period beginning on its date of randomization. To study the continued use of reSET and reSET-O after the active implementation period is completed, a sustainment period of up 12 months will follow the active implementation period.
Condition or Disease | Intervention/Treatment | Phase |
---|---|---|
|
N/A |
Detailed Description
Specific Aims of the DIGITS Trial are to:
-
Estimate the effect of practice facilitation and health coaching implementation strategies in increasing the reach and fidelity of a digital therapeutic for substance use disorders in primary care clinics.
-
Compare the population-level cost-effectiveness of each implementation strategy in increasing reach, fidelity, and abstinence.
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
---|---|
Active Comparator: Standard Implementation All primary care clinics will implement reSET and reSET-O using standard implementation approach. |
Behavioral: Standard implementation
Brief clinician training and an implementation toolkit consisting of job aids, patient educational materials, scripted conversations, electronic health record tools, and a population management workbench.
|
Experimental: Standard Implementation Plus Health Coaching The clinics in this arm will implement reSET and reSET-O with a standard implementation strategy and patients at the clinic will receive support from a health coach to help them engage with reSET and reSET-O. |
Behavioral: Standard implementation
Brief clinician training and an implementation toolkit consisting of job aids, patient educational materials, scripted conversations, electronic health record tools, and a population management workbench.
Behavioral: Health Coaching
The clinic is provided access to a health coach who conducts outreach with patients. The health coach facilitates engagement with the digital therapeutic and encourages contact with the care team.
|
Experimental: Standard Implementation Plus Practice Facilitation The clinics in this arm will implement reSET and reSET-O with a standard implementation strategy and a practice facilitator will provide the clinic with support for implementation. |
Behavioral: Standard implementation
Brief clinician training and an implementation toolkit consisting of job aids, patient educational materials, scripted conversations, electronic health record tools, and a population management workbench.
Behavioral: Practice Facilitation
A trained facilitator provides support for implementation by delivering the following interventions to clinic staff: Bolster Education, Audit and Provide Feedback, Support Plan-Do-Study-Act Cycles, Engage Others in Change.
|
Experimental: Standard Implementation Plus Health Coaching and Practice Facilitation The clinics in this arm will implement reSET and reSET-O with a standard implementation strategy and patients at the clinic will receive support from a health coach to help them engage with reSET and reSET-O. Additionally, a practice facilitator will provide the clinic with support for implementation. |
Behavioral: Standard implementation
Brief clinician training and an implementation toolkit consisting of job aids, patient educational materials, scripted conversations, electronic health record tools, and a population management workbench.
Behavioral: Health Coaching
The clinic is provided access to a health coach who conducts outreach with patients. The health coach facilitates engagement with the digital therapeutic and encourages contact with the care team.
Behavioral: Practice Facilitation
A trained facilitator provides support for implementation by delivering the following interventions to clinic staff: Bolster Education, Audit and Provide Feedback, Support Plan-Do-Study-Act Cycles, Engage Others in Change.
|
Outcome Measures
Primary Outcome Measures
- Reach of the digital therapeutic to patients in the primary care clinic [12 months]
The proportion of patients who initiate the digital therapeutic, defined by instances in which patients open the app, enter the prescription code, and use a treatment module.
- Fidelity of patients' use of the digital therapeutic to clinical recommendations [15 months]
Mean number of weeks during patients' 12-week prescription in which patients use 4 app modules/week and have visited a clinician in the past 30 days
Secondary Outcome Measures
- Engagement [15 months]
Mean number of months in which patients make ≥1 visit for substance use disorder
- Economic costs [12 months]
Costs from the perspective of a health system and payer including implementation, direct intervention, operating, and other indirect health care costs. This measure will be used to calculate the population-level cost effectiveness of increasing reach, fidelity, and engagement.
Other Outcome Measures
- Reach-2 [12 months]
The proportion of patients prescribed reSET or reSET-O
- Fidelity-2 [15 months]
Mean number of weeks in which patients use at least 1 module/week
- Sustainment [12 months]
The proportion of patients who are reached during the sustainment period
- Substance use [Up to 18 months from the patients index visit date]
The proportion of patients who are reached and reduce their substance use
- Abstinence [Up to 18 months from the patients index visit date]
The proportion of patients who are reached and are abstinent from substances
Eligibility Criteria
Criteria
Patient Inclusion Criteria:
-
Had a primary care visit in a participating clinic during the active implementation period or sustainment period
-
Screened positive for substance use on the day of the visit or in the prior year
-
Adult aged 18 years or older at time of visit
Clinic Inclusion Criteria:
- At least 1 clinician trained in the use of reSET/reSET-O
Patient Exclusion Criteria:
- Patients who have requested through their health system to opt out of research
Clinic Exclusion Criteria:
- Previously participated in a pilot implementation of reSET/reSET-O
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
---|---|---|---|---|---|
1 | Kaiser Permanente Washington | Seattle | Washington | United States | 98101 |
Sponsors and Collaborators
- Kaiser Permanente
- National Institute on Drug Abuse (NIDA)
Investigators
- Principal Investigator: Joseph E Glass, PhD, MSW, Kaiser Permanente
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- 1794767
- R01DA047954