MHealth Incentivized Adherence Plus Patient Navigation

Not Applicable

Recruiting

Conditions: Medication Adherence
Methamphetamine-dependence
Opioid Use Disorder
Polysubstance Drug Use (Indiscriminate Drug Use)

Brief Summary: Polysubstance use involving opioids and methamphetamine is emerging as a new public health crisis. Patients with opioids and methamphetamine use often experience serious medical complications requiring hospitalization, which provides an opportunity to offer addiction treatment. Yet linkage to outpatient treatment post-discharge is suboptimal and methamphetamine exacerbates outcomes. The investigators propose to pilot test "MHealth Incentivized Adherence Plus Patient Navigation" (MIAPP) to promote treatment linkage and retention for patients with opioid use disorder (OUD) and methamphetamine use who initiate buprenorphine in the hospital. The investigators Aim is to perform a two-arm, pilot randomized clinical trial (n=40) comparing MIAPP + treatment-as-usual (TAU) versus TAU alone on outpatient medication for opioid use disorder (MOUD) linkage within 30 days (primary) and 90-day retention on medications (secondary) among hospitalized patients with OUD and methamphetamine use.

Recruitment & Eligibility

Inclusion Criteria

Adult greater than or equal to 18 years of age
Admitted to Harborview Medical Center (HMC) on any inpatient service
Initiated on buprenorphine for OUD while in the hospital or at the time of discharge and planning to continue outpatient
Used methamphetamine within the past 30 days (any route of administration or frequency)
Willing to be randomized to video-DOT
Willing and able to use a smartphone (study can provide) and work with patient navigator
Discharge setting does not preclude the use of video-DOT (i.e., nursing home, inpatient psychiatry, etc.)

Exclusion Criteria

Unable or unwilling to use smartphone (phones to be provided when needed)
Cognitive impairment (acute or chronic) resulting in inability to provide informed consent
Currently incarcerated and will discharge to jail or prison
Plans to discontinue buprenorphine in the near future (<3 months)
Lives far away such that cannot keep study visit at 30 days post-discharge
Not English speaking
Behavioral risk per discretion of research staff

Arm && Interventions

Group	Intervention	Description
PN+mHealth	Patient Navigation and mHealth (PN+mHealth)	The intervention is patient navigation and mHealth in addition to treatment-as-usual. The intervention consists of a patient navigator (PN) with the mHealth adherence application facilitating telehealth visits, two-way chats, video-DOT, and delivery of financial incentives via smartphone for adherence and linkage to outpatient treatment within 30 days. Participants will be asked to upload medication adherence videos once a day over the 30 days post discharge from the hospital. Patients will be instructed to continue to take their medication as prescribed in any circumstance where they are unable to upload the video for any reason.

Primary Outcome Measures

Name	Time	Method
Patient linkage to an outpatient program that provides medication for opioid use disorder	30 days post-discharge from hospital	Defined as documentation of an outpatient clinical encounter (either in-person or via telemedicine) where a medication for OUD (either buprenorphine, naltrexone, or methadone) was provided or prescribed.

Secondary Outcome Measures

Name	Time	Method
Hospital readmission	90 days post-discharge from hospital	The number of hospital admissions will be extracted from statewide Medicaid claims data.
Retention on medication for opioid use disorder	90 days post-discharge from hospital	This will be measured as the number of days with medication coverage. (buprenorphine, naltrexone, or methadone).
Emergency department visits	90 days post-discharge from hospital	The number of emergency department visits will be extracted from statewide Medicaid claims data.
Past 30-day opioid use	30 days post-discharge	The number of days using illicit opioids in the past 30 days per self-report as collected through the modified Addiction Severity Index.
Past 30-day methamphetamine use	30 days post-discharge	The number of days using methamphetamine in the past 30 days per self-report as collected through the modified Addiction Severity Index.

Locations (1): Harborview Medical Center
🇺🇸
Seattle, Washington, United States