Stage-Based Mobile Intervention for Substance Use Disorders in Primary Care: Implementation and Cluster-Randomized Trial

Nearlymillion Americans ageand olderneed treatment for a substance use disorderSUDWhile onlyof individuals requiring treatment for a SUD receive itan estimated two thirds see a primary care or urgent care provider everymonthsPrimary care providers are in a unique position to perform ScreeningBrief Interventionand Referral to TreatmentSBIRTWith Phase I contract fundingPro Change developed and piloted tested a mobiledelivered Substance Use InterventionSURIdesigned to reduce barriers to SBIRT in primary care by delivering universal screening and feedback on SUD risk to patients at home or in the clinicFor patients at riskthe program also deliversa brief intervention based on the Transtheoretical Model of Behavior ChangeTTMto facilitate progress through the stages of change for quitting their most problematic drugand for seeking treatment if indicatedanddays of stage matched text messages and four online activities addressing key topicse gmanaging cravingsFor providersthe intervention prototype includes a Clinical Dashboard that summarizes the patient s SUD risk scores and stage of change dataand provides stage matched scripts to guide a brief in person intervention sessionThe program was wellreceived in a small pilot testThe goals in Phase I of this Fast Track project are to program additional SURI features and functions including Electronic Health RecordEHRintegration required for effective integration into clinical practice and to establish the feasibility of our approach in a clinic wide implementation in one federally qualified health center siteIf feasibility is established the intervention will be tested in a cluster randomized trial amongpatients recruited byFQHCs randomly assigned to treatment or usual careOutcomes will include days of use of the patient s most problematic drug and other measures of substance use and well being atmonths follow up Given their reachprimary care providers are in a unique position to perform ScreeningBrief Interventionand Referral to TreatmentSBIRTto fill gaps in services and facilitate referrals to specialty care for patients who need itPatientand provider facing Substance Use Risk InterventionSURImobile tools have the potential to reduce barriers to SBIRT in clinical practiceand to facilitate positive change among patients with substance use disorders