Contingency management, an incentive-based intervention, boasts a massive research base and has beendemonstrated efficacy in increasing drug abstinence and medication adherence in people with opioid usedisorder. There is a huge gap between the evidence in support of this approach and its dissemination inpractice. A digital health program that surmounts most of the barriers to dissemination has been developedthat collects all the relevant data and implements all of the contingency management proceduresautomatically. This program has been shown to be efficacious in several peer-reviewed studies. However, onekey barrier to dissemination remains. In order for contingency management to become truly impactful on anational scale, providers must actively engage patients by informing them about it, encouraging them to use it,assisting their enrollment, and then using the data generated by the platform to inform their ongoing care. Thebest way to surmount this final barrier is to use the motivational technique of contingency management itself;incentivize the necessary provider behaviors. Thus, this SBIR Fast Track application proposes to develop andevaluate a novel incentivized collaborative care model for the delivery of contingency management servicesfor buprenorphine pharmacotherapy patients with opioid use disorders. We believe this model will have theimportant secondary effect of increasing access to buprenorphine pharmacotherapy, as prescribers will beindirectly incentivized to maximize the number of buprenorphine patients in their practice. Phase I will beginwith preparatory activities, including streamlining the enrollment system so that any buprenorphineprescriber can use it, adding data collection systems for provider information, and data display systems thatproviders can use to easily access the patient data they wish to see. A Phase I feasibility study (n = 10) willfollow. The milestones require the potential of the incentivized collaborative care model in disseminatingcontingency management to be demonstrated. If successful, the feasibility study will pave the way for arandomized controlled trial (RCT). This RCT will be the primary activity of Phase II of this SBIR award, and isdesigned to evaluate the efficacy of incentivized collaborative care in the dissemination of contingencymanagement. Primary outcome measures will include the engagement in collaborative care in relation to thecontingency management intervention, as well as buprenorphine prescribing trends. Secondary analyses willbe designed to assess the economic effect of DynamiCare on providers. The RCT will also include exploratoryanalyses of patient outcomes. Overall, this project is highly consistent with current ONDCP priorities to,"Identify and address policy barriers related to contingency management interventions (motivationalincentives)," and "Explore reimbursement for motivational incentives and digital treatment for addiction." Ifsuccessful, this project could lead to rapid dissemination of contingency management and improved access tobuprenorphine pharmacotherapy to people with opioid use disorder throughout the United States.
Public Health Relevance Statement: PROJECT NARRATIVE
Contingency management has successfully increased opioid abstinence and medication adherence in many
clinical trials, and buprenorphine is an effective pharmacotherapy in the treatment of opioid use disorder, yet
both remain underused as methods to address the opioid epidemic. The purpose of this SBIR fast-track project
is to enhance the dissemination of contingency management and increase prescribers' willingness to serve
buprenorphine patients by implementing an incentivized collaborative care model that links their practice to a
digital health program that features contingency management at its core. If successful, this project will lead to
substantially enhanced access to contingency management services and buprenorphine treatment on a
national scale.
Project Terms: Adoption ; Alcohol consumption ; Alcohol Drinking ; EtOH drinking ; EtOH use ; alcohol ingestion ; alcohol intake ; alcohol product use ; alcohol use ; alcoholic beverage consumption ; alcoholic drink intake ; ethanol consumption ; ethanol drinking ; ethanol ingestion ; ethanol intake ; ethanol product use ; ethanol use ; Award ; Buprenorphine ; Clinical Trials ; Costs and Benefits ; Counseling ; Data Collection ; Data Display ; Pharmacotherapy ; Drug Therapy ; drug treatment ; Pharmaceutical Preparations ; Drugs ; Medication ; Pharmaceutic Preparations ; drug/agent ; Economics ; Feasibility Studies ; Feedback ; Fees ; Health ; Incentives ; Insurance Carriers ; Insurers ; Lead ; Pb element ; heavy metal Pb ; heavy metal lead ; Manuals ; Marketing ; Medicaid ; Methods ; Motivation ; Outpatients ; Out-patients ; Patient Monitoring ; Client satisfaction ; Patient Satisfaction ; Patients ; Peer Review ; Physicians ; Research ; Substance Use Disorder ; Technology ; Testing ; Time ; Training Support ; United States ; Urine ; Urine Urinary System ; Measures ; Ethical Review ; Outcome Measure ; Caring ; base ; Procedures ; Clinical ; Phase ; Link ; Training ; drug abstinence ; Opioid ; Opiates ; Logistics ; satisfaction ; Policies ; Randomized Controlled Trials ; Nicotine Use Disorder ; programs ; Clinic ; Techniques ; System ; psychosocial ; Services ; Performance ; success ; treatment planning ; novel ; Participant ; Agreement ; payment ; contingency management ; Modeling ; Sampling ; Intervention Strategies ; interventional strategy ; Intervention ; Meta-Analysis ; Provider ; Legal ; Address ; Data ; Improve Access ; Enrollment ; enroll ; Patient-Focused Outcomes ; Patient outcome ; Patient-Centered Outcomes ; Small Business Innovation Research Grant ; SBIR ; Small Business Innovation Research ; Monitor ; trend ; Development ; developmental ; Behavioral ; medication compliance ; drug adherence ; drug compliance ; medication adherence ; health economics ; digital ; information display ; design ; designing ; efficacy evaluation ; efficacy analysis ; efficacy assessment ; efficacy examination ; evaluate efficacy ; examine efficacy ; willingness ; Clinical effectiveness ; Outcome ; Abstinence ; economic outcome ; collaborative care ; addiction ; addictive disorder ; evidence base ; primary outcome ; treatment adherence ; product development ; arm ; opioid use disorder ; opiate use disorder ; opioid use ; opiate consumption ; opiate drug use ; opiate intake ; opiate use ; opioid consumption ; opioid drug use ; opioid intake ; secondary analysis ; opioid epidemic ; opiate crisis ; opioid crisis ; recruit ; Service delivery model ; Service model ; care delivery model ; health care delivery model ; healthcare delivery model ; incentive-based intervention ; service delivery ; buprenorphine treatment ; digital treatment ; digital therapeutics ; digital therapy ; digital health ; provider behavior ; clinician behavior ; physician behavior ;
