Research

Text Messaging Buprenorphine (Suboxone) Programs Improve Communication with Clinicians

The use of cellular phones is reaching universality, as more than 9 out of 10 Americans own a mobile device.

 WHAT PROBLEM DOES THIS STUDY ADDRESS?

The widespread adoption of cell phones lends itself to the implementation of mobile phone interventions (i.e., mHealth) which are often cost-effective means of improving appointment and treatment adherence, reducing relapse, and strengthening communication between patient and provider.

Despite the potential of such interventions, most addiction treatment settings have yet to adopt these models.

HOW WAS THIS STUDY CONDUCTED?

The authors conducted a descriptive study in a safety net office-based buprenorphine-naloxone (Suboxone) program to assess mobile phone and text message use patterns among patients and to better understand preferences for improving communication with clinicians. The clinic, located in New York City, served uninsured patients and Medicaid beneficiaries with opioid use disorder.

All adult clinic attendees scheduled for an initial or follow-up visit between June and September 2013 were eligible for participation resulting in a sample of 71 participants completing a brief survey available for download here.

WHAT DID THIS STUDY FIND?

Demographic characteristics of the study respondents were similar to the overall population of the clinic, suggesting the sample was representative of patients treated at this clinic. Participants were 83% male, 42% African American, and 46 years old on average. About half had completed high school, one third was dependent on social services, and half lacked permanent housing.

93% reported owning a mobile phone though devices and phone numbers were transient with participants reporting owning 1.9 mobile phones and having 1.6 phone numbers on average over the past year. Mobile phone privacy was not a concern with only 16% reporting that their phone is accessed in a way that invaded privacy, but 40% were “very much” or “somewhat” concerned about text message privacy. All participants with cell phones reported using text messaging and a majority (79%) were comfortable with sending text messages.

Other features used on mobiles phones included: Internet (68%), smartphone applications (63%), e-mail (69%), and social media (68%).

Regarding communication experiences and preferences with the clinic:

 

  • 57% did not receive reminder phone calls from staff prior to appointments
  • 75% made a phone call to their buprenorphine-naloxone provider with an average of 3.3 calls in the past 6 months
  • 17% contacted their provider via text messaging with an average of 3.2 messages sent in the past 6 months
  • 94% preferred having their providers’ phone number, and 75% supported the idea of sending a text message to receive a phone call from their provider in the event of a relapse (other recovery-oriented text message contacts included: 12-step group peers and sponsors (15%), friends (9%), counselors (5%), and family members (3%))

This study supports the potential for implementing mHealth services for office-based buprenorphine-naloxone programs as a vast majority of clinic attendees have mobile phones with text messaging capabilities.

The findings suggests that patients want text messaging and other mobile services to be part of their regular clinical care.

With over 75% of participants reporting use of more sophisticated cell phone features including Internet and smartphone applications, there is potential to augment mobile phone usage beyond text messaging (i.e., recovery-oriented applications and Web-based interventions).

The study provides insights into both policy makers’ and providers’ perceptions of Suboxone. These insights may help inform efforts to enhance the dissemination of medication-assisted treatment through sufficiently addressing these concerns.

 WHY IS THIS STUDY IMPORTANT?

This study is an important first step in incorporating the needs and preferences of patients when determining best methods for developing future mHealth initiatives. It also helps demonstrate feasibility of mHealth interventions in office-based buprenorphine programs.

This survey is important for identifying important considerations such as  the transience of mobile phone numbers in this population. In order for the clinic to maintain contact with patients and retain them in care, it is important to update contact information frequently. This is particularly crucial given the nature of the clinic’s work (i.e., addiction and medication-assisted treatment services) since patients may need more frequent monitoring than in other healthcare fields.

mHealth interventions can traverse the digital divide, making them feasible even in low-income urban populations and settings.

LIMITATIONS
  1. Given the small sample size, the authors were limited in their ability to conduct statistical analyses such as examining differences in mobile phone usage by demographic characteristics. These findings are representative of this specific clinic’s population but may not generalize to all patients using office-based buprenorphine services.

NEXT STEPS

This descriptive survey provided important information on mobile phone use patterns and preferences. Next steps include designing and testing mHealth interventions for this patient population. It is also necessary to assess attitudes and acceptability from the providers’ perspective before adopting mHealth interventions that allow clients to text message or call providers directly.

BOTTOM LINE

  • For individuals & families seeking recovery: Mobile phones and text messaging may make it easier to get in touch with your provider in the event of a relapse. There is also potential to strengthen peer support through text messaging.
  • For scientists: This survey provided insight into mobile phone usage patterns in this setting. Information can be used to inform the development of mHealth programs.
  • For policy makers: mHealth can be a cost-effective means of engaging patients in care. Since many patients already own mobile phones, providers should take advantage of this technology. Funding is needed to develop addiction and recovery-based mobile phone interventions. Policies around privacy implications of mHealth integration into regular clinical care should also be considered.
  • For treatment professionals and treatment systems: If you are comfortable sharing a mobile phone number with patients, text messaging can be a quick and efficient means of communication.

CITATIONS

Tofighi, B., Grossman, E., Buirkle, E., McNeely, J., Gourevitch, M., & Lee, J. D. (2015). Mobile phone use patterns and preferences in safety net office-based buprenorphine patients. J Addict Med, 9(3), 217-221. doi: 10.1097/adm.0000000000000121

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