University of Wisconsin School of Medicine and Public Health researchers have conducted one of the most comprehensive implementation studies examining the use of mobile health technology in the United States’ health care system.
The study aimed to integrate the treatment of substance use disorders into primary care through use of a smartphone application.
Three federally-qualified health centers that serve mainly low-income residents were sites for the study. The sites include a UW Health clinic in Madison, a rural clinic in Missoula, Montana, and an urban clinic in the Bronx, New York, all primary care clinics that treat patients with substance use disorders.
Up to 100 patients were recruited at each of the three clinics to use a mobile health application called Seva, a Sanskrit word that means “selfless service.” The application provides a discussion board, interactive modules to teach problem solving, tools for coping with cravings and high-risk situations, among other features. Clinicians were free to enroll any patients from substance-abuse populations who they thought might benefit from the application. Patients were given phones and data plans that were paid for by a National Institute on Drug Abuse grant (R01DA0342279).
At all three clinics combined, 268 patients were enrolled. Researchers checked results at baseline and at the six-month mark of the 12-month study. All data were self-reported by study participants.
“We found that patients used the application extensively and were able to support one another in a way that is unusual in primary care,” said Department of Family Medicine and Community Health assistant professor Andrew Quanbeck, PhD, a co-investigator of the study and lead author of the published research. “Seva users had significant decreases in risky-drinking days (by 44 percent), illicit drug-use days (34 percent), and improved overall abstinence from both alcohol and drugs.”
Seva users also had 32 percent fewer hospitalizations and 49 percent fewer emergency department visits.
While patient use of the mobile application was extensive, clinician use was comparatively low, in part because Seva data could not be integrated into the electronic health record (EHR). Implementation sites were unable to sustain use of the system after federal grant funding ceased.
While patient use of the mobile application was at a high of 94 percent to 99 percent at the beginning of the study, use gradually dropped to zero when the National Institutes of Health funding (1R34DA036720) ran out. In part, the funding was used to purchase smartphones and data plans.
The study suggests that further work is needed to integrate mobile health data into the EHR and to identify long-term sources of funding to sustain the use of mobile health systems, but that mobile applications hold promise for primary care patients with addiction, and possibly other chronic conditions.
The study was published in the Journal of Medical Internet Research.