背景:阿片类药物使用障碍(OUD)的自我管理是治疗的重要组成部分。在美沙酮维持治疗环境中接受阿片类激动剂治疗的许多患者受益于咨询治疗,以帮助他们提高恢复技能,但在诊所预约之间无法获得这些治疗。此外,在普通医疗诊所中治疗OUD患者的许多成瘾医学临床医生无法一致地获得患者的咨询转诊.这可能导致治疗保留和患者从物质滥用中恢复的总体进展减少。数字应用程序可能有助于通过指导来弥合这一差距,支持,并加强由其心理社会和医疗提供者发起和指导的行为改变。
目的:本研究旨在获得可接受性,可用性,以及KIOS应用程序的公用事业试点研究,以满足这些临床需求。
方法:我们开发了一种独特的,以患者为中心的计算软件系统(KIOS;生物医学开发公司),以协助管理门诊病人的OUD,美沙酮维持诊所设置。KIOS追踪自我报告的互动症状(渴望,情绪低落,焦虑,烦躁,疼痛,躁动或不安,睡眠困难,旷工,通常的活动有困难,以及与他人的冲突),以确定症状模式随时间的轨迹和严重程度的变化。然后,KIOS根据OUD专家先前建立的模型,应用专有算法来评估个体的症状相互作用模式。经过分析,KIOS提供特定的行为建议,以解决个人不断变化的症状轨迹,以帮助患者自我管理症状。KIOS软件还提供对患者可以使用的自我报告数据的分析,临床医生,和研究人员来跟踪结果。
结果:在为期4周的可接受性中,可用性(平均系统可用性量表-修改分数89.5,SD9.2,最大值10.0),和效用(平均KIOS效用问卷得分6.32,SD0.25,最大值7.0)对15名美沙酮维持的OUD参与者进行的初步研究,用户体验,可用性,软件生成的建议获得了较高和积极的评估分数。KIOS临床变量与渴望自我报告指标密切相关。因此,使用KIOS软件生成的建议管理这些变量可能会对渴望和最终物质使用产生影响。
结论:KIOS跟踪关键临床变量,并产生与患者当前和不断变化的临床状态特别相关的建议。这项试点研究中的患者为KIOS用户体验分配了很高的正值,易用性,以及适当性,相关性,以及他们收到的特定行为指导的有用性,以匹配他们不断发展的经历。因此,KIOS可能有助于增强阿片类激动剂患者的当面治疗,并有助于填补目前在连续护理中存在的治疗空白。国家药物滥用研究所资助的KIOS随机对照试验目前正在进行中,以加强对OUD患者的当面治疗。
BACKGROUND: Self-management of opioid use disorder (OUD) is an important component of treatment. Many patients receiving opioid agonist treatment in methadone maintenance treatment settings benefit from counseling treatments to help them improve their recovery skills but have insufficient access to these treatments between clinic appointments. In addition, many addiction medicine clinicians treating patients with OUD in a general medical clinic setting do not have consistent access to counseling referrals for their patients. This can lead to decreases in both treatment retention and overall progress in the patient\'s recovery from substance misuse. Digital apps may help to bridge this gap by coaching, supporting, and reinforcing behavioral change that is initiated and directed by their psychosocial and medical providers.
OBJECTIVE: This
study aimed to conduct an acceptability, usability, and utility pilot
study of the KIOS app to address these clinical needs.
METHODS: We developed a unique, patient-centered computational software system (KIOS; Biomedical Development Corporation) to assist in managing OUD in an outpatient, methadone maintenance clinic setting. KIOS tracks interacting self-reported symptoms (craving, depressed mood, anxiety, irritability, pain, agitation or restlessness, difficulty sleeping, absenteeism, difficulty with usual activities, and conflicts with others) to determine changes in both the trajectory and severity of symptom patterns over time. KIOS then applies a proprietary algorithm to assess the individual\'s patterns of symptom interaction in accordance with models previously established by OUD experts. After this analysis, KIOS provides specific behavioral advice addressing the individual\'s changing trajectory of symptoms to help the person self-manage their symptoms. The KIOS software also provides analytics on the self-reported data that can be used by patients, clinicians, and researchers to track outcomes.
RESULTS: In a 4-week acceptability, usability (mean System Usability Scale-Modified score 89.5, SD 9.2, maximum of 10.0), and utility (mean KIOS utility questionnaire score 6.32, SD 0.25, maximum of 7.0) pilot
study of 15 methadone-maintained participants with OUD, user experience, usability, and software-generated advice received high and positive assessment scores. The KIOS clinical variables closely correlated with craving self-report measures. Therefore, managing these variables with advice generated by the KIOS software could have an impact on craving and ultimately substance use.
CONCLUSIONS: KIOS tracks key clinical variables and generates advice specifically relevant to the patient\'s current and changing clinical state. Patients in this pilot
study assigned high positive values to the KIOS user experience, ease of use, and the appropriateness, relevance, and usefulness of the specific behavioral guidance they received to match their evolving experiences. KIOS may therefore be useful to augment in-person treatment of opioid agonist patients and help fill treatment gaps that currently exist in the continuum of care. A National Institute on Drug Abuse-funded randomized controlled
trial of KIOS to augment in-person treatment of patients with OUD is currently being conducted.