The war against opioid addiction is still raging onward, even though it’s taken less of the spotlight lately. The CDC’s most recent numbers indicate that more than 69,000 people still die each year from drug overdose. While the numbers are trending downward, getting patients into care—and keeping them in retention longer—is still a key barrier to winning the battle. But that’s changing, especially in the area of retention. And that’s good news as research shows that longer retention results in more favorable outcomes.
A recent study was conducted to determine the efficacy of using smartphone technology to help in treatment retention. The study, Using Smartphone to Improve Treatment Retention Among Impoverished Substance-Using Appalachian Women: A Naturalistic Study, focused on women since they are shown to adapt to technology more readily than men and because retention is an area of great concern when it comes to treating women for substance use disorder (SUD). Women living with SUD, especially young mothers, often experience worse “drug health, emotional and employment problems.
The study was conducted with 98 women, ages 18 through 40, who lived in southeastern Kentucky and were ordered for SUD treatment. The women were being cared for by Kentucky River Community Care (KRCC), an agency with four clinics throughout an eight-county service area in Appalachia. The study participants had been referred to the KRCC through child welfare agencies, drug courts, or other criminal institutions. All reported having children or being pregnant.
The women were given the CHESS smartphone app from CHESS Health as part of an intensive six-month outpatient treatment service offered through the KRCC Solutions program. CHESS, now known as the Connections app, gives SUD patients access to people and resources whenever and where ever needed through their smartphone.
One of the biggest hurdles researchers faced was that most of the women in the study did not have the financial means with which to purchase a smartphone and most had never used one. They were provided a phone by KRCC and trained on its use, as well as how to use the Connections app. The women’s counselors and case managers received a companion app that allowed them to monitor patients and enabled 24/7 communication with the women.
Another hurdle was internet access. Most of the women did not have WiFi where they were living and access, in general, was scarce in the more rural areas of Appalachia. So researchers partnered with a wireless service provider with the most towers and the largest roaming capabilities.
Through the Connections app, the women and their counselors had access to multiple services, including:
- Communication with addiction experts and peer support groups, including confidential chat rooms and private messaging
- Timely monitoring, feedback-related assessments, and links to interventions addressing relapse risk
- Reminders and alerts to encourage adherence to therapeutic goals
- One-touch communication with the patient’s counselor and/or case manager
- Addiction-related educational materials and tools
- Customizable location-based resources that alerted counselors if the participant came near a high-risk location such as a bar or supplier she had frequented in the past.
A weekly check-in survey was sent to each participant’s phone to collect data on risk factors and recent substance use, information that was then used to determine triage and gain feedback. Counselors and case managers could review the information at any time, especially prior to scheduled appointments or during a relapse.
At the end of the six-month study, Connections data showed that 94 participants had been actively using the Connections app. The other four had never logged in. Researchers believe this is because these four had been the first to enter the program and had received app training prior to receiving the phone. Researchers learned early on that it would be more effective to train the women after they received their phone.
At the end of the study, researchers compared EMR data on length-of-stay and treatment for the study participants to data on 100 other women of the same ages who received similar treatment service but without the Connections app. The goal was to determine whether the use of the app had any significant influence on treatment retention.
The results were conclusive. Participants who used the Connections app stayed in treatment 156.7% longer than patients without the app—or 410 days as compared to just 262 days. Researchers point to the high use of social and communications features as a possible reason for the success. These features allowed participants to connect with their counselors or other participants whenever they needed support. Another factor researchers believe influenced the results was the use of the weekly surveys to inform more effective treatment sessions. Participants also made sustained use of the peer support features, which indicate the importance of camaraderie and group participation.
“CHESS made a major difference for every woman. They always had access to someone to help.” KRCC counselor
The study concludes: “Given associations between retention and positive outcomes, mobile health technology such as CHESS may help improve outcomes among women, especially in settings where access to in-person services is difficult.”