Table 2 SUD Treatment Clinician Perceptions of Measurement-Based Care (MBC) Benefits and Drawbacks

Domain 1: Perceived Benefits of MBC

 Improved patient-clinician communication

  Additional source of information (beyond patient verbal report)

“…this report would give me more information, so it would make the client contact more…listening, less stressful …sometimes I'm…trying to get information that I need but also listen…it would be helpful to just be able to…not be so stressed about needing this information from them, and just be able to listen. I think we would both benefit from that.”

“…it gave me some extra information that I didn't always glean from day-to-day interactions and things they didn't want to talk about… individuals that felt more comfortable in the writing…because of the privacy or…learning style…”

  Helps guide in-session communication

“If you say, ‘how'd your week go last week?’, ‘Oh, it's okay.’ That's one thing. But if we could…say, ‘Hey, I see Wednesdays, it looks like it's been a pattern of a really hard day for you. What's going on on Wednesdays?’…that could be really valuable”

  Clinician tool to highlight change over time

“I could see over time it being helpful, a method of tracking…two months down the road that we could look back with the patient and say, "Hey, look at the progress that you made. When you first came in you could not manage to make it to an appointment and now for the last month you've made it to every appointment on time. Or last month you told me that you were just using all the time…And now three times this last week, you were able to have a trigger and walk away from it"

“…when I was doing it collaboratively with the client, I'd be like, "When you came in, you said that your depression was a 9 out of 10 and you were close to killing yourself. Today, you're saying it's a five. That's got to feel great"

  Working as a preventative tool to notice patterns and encourage coping skills

“….early on those withdrawal symptoms and cravings, because if we can see a pattern or know really when it's happening for people, then we can better help them determine other things to…avoid those triggers or to handle it when they are having severe cravings or withdrawals”

  Reduces clinician bias in communication and understanding of patient

“What I like about this is… It's just data. There's no…you're putting a positive or negative thing on it…”

“I still don't want it to be like, ‘You did it. You achieved this …’ Nothing that is positive or negative. Nothing where it's like, ‘Our goal is to get to 10.’ Just more of like, ‘Is this enough of visual or a pattern for you to want to move on?’”

Empowering to patient

 Increased patient self-reflection

“…[it] might be helpful to the patient…to be able to reflect on while looking at the last four months, this is what you're reporting…Were you aware of that? Develop more insight…that can be a really valuable thing for patients…”

“It can be normalizing…it can encourage them…to not be dependent on outpatient services, and to realize that a lot of the work happens outside of here, and…it might feel to them like a lifeline…I'm actively doing the work”

 Patient sees progress over time

“Being able to see something…over time. Having the patient have access to that same information…in many ways they're more cut off from their own medical records…so they can see their progress…There's a lot of value potentially in that”

 Patient is agent in their own care

“…we're going to give you access to being able to see and track your own [stuff]. I think that it would be beneficial to train the client to bring awareness to their own stuff…It shows hope. There's hopefulness…that recovery's possible…”

“Anything that you can track, where the person feels like they are being more of an agent in their care…”

Improved communication between clinicians

“There would be this common information…people could share that would…get on the same page faster and not put the patient through so much duplication and asking questions”

“…I think for our providers here too, who may be accustomed to the old style of addictions treatment, that abstinence is the only way, for me being able to go to them and say, ‘I'm asking you to write her another script and they're still using, but look, I can document this, this and this thing where they're making progress.’ It will help”

Domain 2: perceived drawbacks or barriers of MBC

 Patient self-reports are subjective

  Patient self-reports are subjective

“…maybe you could have them doing a weekly…thing. But…they could be filling that out and… [saying that their] recovery is great, and they're taking the survey…sitting there drinking a beer…it's hard to know the validity of it”

  Patient self-report is dependent on their mood and attitude

“Limitations?…What problems are we going to face with [client] attitude…what's their attitude going to be like and how's that going to affect our reports that we're going to now be counting on?”

“If it's completed when they come to clinic, there may be a pattern of coming to clinic that alters sort of mood and perceptions of past mood…People tend to sort of bias feelings that are more recent in their sort of assessment of how they're doing. If coming to clinic to see a provider with whom they may have, let's say, good rapport and actually this is something to look forward to in some way…”

 Lack of personalization

  Patient may answer in a rote manner if there is not enough variation or customization of questions

“…in our one-on-ones…we're just asking them the same questions every week… I don't know if it's a great format in following progress…Because patients tend to just say, "Yeah, yeah, yeah,"…There's no in-depth questions”

“…our weekly worksheets are…the same questions every week…maybe asking those same questions in a different…way every week… so it's not like they know the answers already and…answer it…repetitively”

  Possibility of clinicians not using reports (patient doesn’t feel heard)

“…doing something over and over…you have to be careful it doesn't get too routine you stop thinking, because, "Oh yeah, I know this one, they're going down that road." So making a bunch of assumptions without checking in”

  Technology is “cold” and impersonal

“…maybe a downside could be that…the computer doesn't think like a person, so the information…would be…rigid maybe and not…thoughts or emotion going into it. It would be cold”

 Burden of time

  Too much information for clinicians

“…there would be some way for that information to come in…and have it be something usable…I don't want 40 lines of information every week on every patient…that's going to be real hard to find the wheat from the chaff”

  Increased workload for clinicians

“… [an iPad would be] another device or another thing that I would have to make sure I took care of. Obviously it would be more simple if it was somehow pulled from the stuff on the computer versus adding an iPad or something. If it's like power up this iPad and go to this app and log in … You know what I mean?”

 Clinician anxiety or difficulty with using new technology

“I am not very techy…have mad anxiety with techy stuff…It took me a while to learn this system…”