Background: Delivering prescription digital therapeutics (ie, evidence-based interventions designed to treat, manage, or prevent disorders via websites or smartphone apps) in primary care could increase patient access to substance use disorder (SUD) treatments. However, the optimal approach to implementing prescription digital therapeutics in primary care remains unknown. Objective: This pilot study is a precursor to a larger trial designed to test whether implementation strategies (practice facilitation [PF] and health coaching [HC]) improve the delivery of prescription digital therapeutics for SUDs in primary care. This mixed methods study describes outcomes among patients in the 2 pilot clinics and presents qualitative findings on implementation. Methods: From February 10 to August 6, 2021, a total of 3 mental health specialists embedded in 2 primary care practices of the same integrated health system were tasked with offering app-based prescription digital therapeutics to patients with SUD. In the first half of the pilot, implementation activities included training and supportive tools. PF (at 1 clinic) and HC (at 2 clinics) were added in the second half. All study analyses relied on secondary data, including electronic health records and digital therapeutic vendor data. Primary outcomes were the proportion of patients reached by the prescription digital therapeutics and fidelity related to ideal use. We used qualitative methods to assess the adherence to planned activities and the barriers and facilitators to implementing prescription digital therapeutics. Results: Of all 18 patients prescribed the apps, 10 (56%) downloaded the app and activated their prescription, and 8 (44%) completed at least 1 module of content. Patients who activated the app completed 1 module per week on average. Ideal use (fidelity) was defined as completing 4 modules per week and having a monthly SUD-related visit; 1 (6%) patient met these criteria for 10 weeks (of the 12-week prescription period). A total of 5 (28%) patients had prescriptions while HC was available, 2 (11%) were successfully contacted, and both declined coaching. Clinicians reported competing clinical priorities, technical challenges, and logistically complex workflows in part because the apps required a prescription. Some pilot activities were impacted by staff turnover that coincided with the COVID-19 pandemic. The facilitators to implementation were high engagement and the perception that the apps could meet patient needs. Conclusions: The pilot study encountered the barriers to implementing prescription digital therapeutics in a real-world primary care setting, especially staffing shortages, turnover, and competing priorities for clinic teams. The larger randomized trial will clarify the extent to which PF and HC improve the implementation of digital therapeutics. Trial Registration: ClinicalTrials.gov NCT04907045; https://clinicaltrials.gov/study/NCT04907045

Purpose: Conceptual models provide frameworks to illustrate relationships among patient-, provider-, system-, and community-level factors that inform care delivery and research. Existing models of cancer survivorship care focus largely on pediatric or adult populations whose needs differ from adolescents and young adults (AYAs). We developed a patient-centered conceptual model of AYA survivorship care. Methods: We conducted a narrative literature review of current conceptual and theoretical models of care. We engaged AYA cancer survivors (n = 25) in semi-structured one-hour telephone interviews. Most participants were in their 20s and 30s, and the majority (84%) were women. Recruitment was stratified by age and time since cancer diagnosis. We conducted a thematic analysis of interview transcripts to identify themes that exemplified patient-centered care. Results: Most participants identified as white and female. Leukemia and breast cancer were the most common cancer types. Main themes included the need for (1) care coordination, (2) ongoing mental health support, (3) connection to AYA peer support, (4) support during fertility preservation efforts, (5) support with financial burden, (6) support for quality of life, (7) information about and support with side effects and late effects, and (8) attention to the unique needs of young adults. Conclusions: We present a patient-centered conceptual model of AYA survivorship care needs that can inform future cancer care delivery and research.

Healthcare systems such as Kaiser Permanente are increasingly focusing on patients’ social health. However, there is limited evidence to guide social health integration strategy. The purpose of this study was to identify social health research opportunities using a stakeholder-driven process. A modified Concept Mapping approach was implemented from June 2021 to February 2022. Stakeholders (n=746) received the prompt, “One thing I wish we knew more about to advance my work addressing social health...” An inductive content analysis approach was used to assign topics and synthesize and refine research-focused statements into research questions. Questions were then rated on impact and priority by researcher stakeholders (n=16). Mean impact and priority scores and an overall combined score were calculated. Question rankings were generated using the combined score. Brainstorming produced 148 research-focused statements. A final list of 59 research questions was generated for rating. Question topics were (1) Data, Measures, and Metrics; (2) Intervention Approach and Impact; (3) Technology; (4) Role of Healthcare Systems; (5) Community-Based Organizations; (6) Equity; (7) Funding; and (8) Social Health Integration. On a scale from 1 (low) to 10 (high), the mean impact score was 6.12 (range=4.14–7.79), and the mean priority score was 5.61 (range=3.07–8.64). Twenty-four statements were rated as both high impact (>6.12) and high priority (>5.61). The broad range of topics with high impact and priority scores reveals how nascent the evidence base is, with fundamental research on the nature of social risk and health system involvement still needed.

Evidence-based digital therapeutics are a promising approach for the scale-up of substance use disorder (SUD) treatments. Despite demonstrated efficacy, utilization of digital therapeutics is low. Strategic implementation approaches have potential for increasing digital therapeutic use. Applicability to health systems depends, in part, on the economic costs. The objective of this study was to describe implementation and intervention costs of implementation strategies to increase uptake of an evidence-based digital treatment for SUD. We conducted an economic evaluation alongside a hybrid type III cluster-randomized trial within a large integrated health system. All clinics implemented a standard implementation (SI) strategy, and clinics were assigned using 2x2 factorial randomization to additionally receive practice facilitation (PF) and/or health coaching (HC). Implementation costs included the cost of time devoted to implementation activities and direct operating costs. Time devoted to implementation activities was ascertained through structured meeting logs and time use surveys. Operating costs were captured using project budget reports. Intervention costs included expenses for prescriptions and healthcare encounters related to the digital therapeutic, measured using electronic health record data. Univariate statistics were calculated for cost estimates with comparisons presented by trial arm, implementation activity, staff role and study month. Analyses were conducted from a health system perspective. Twenty-one primary care sites participated in the trial. Over the 50-month study period, the total cost of all implementation activities was $748,088. Implementation costs per clinic were highest in the SI + PF + HC arm ($48,029), followed by SI + HC ($36,544), SI + PF ($30,665) and SI alone ($24,774). Intervention costs were highest in the SI + PF + HC arm ($18,051), followed by SI + PF ($11,492), SI + HC ($967) and SI alone ($1,879). Findings from this study can guide health systems by informing the economic investment required to employ implementation strategies demonstrated to increase uptake of evidence-based practices for behavioral health conditions. Trial Registration: NCT05160233.