What do clinicians want? Understanding frontline addiction treatment clinicians’ preferences and priorities to improve the design of measurement-based care technology

Background Measurement-based care (MBC) is the practice of routinely administering standardized measures to support clinical decision-making and monitor treatment progress. Despite evidence of its effectiveness, MBC is rarely adopted in routine substance use disorder (SUD) treatment settings and little is known about the factors that may improve its adoptability in these settings. The current study gathered qualitative data from SUD treatment clinicians about their perceptions of MBC, the clinical outcomes they would most like to monitor in MBC, and suggestions for the design and implementation of MBC systems in their settings. Methods Fifteen clinicians from one publicly-funded and two privately-funded outpatient SUD treatment clinics participated in one-on-one research interviews. Interviews focused on clinicians’ perceived benefits, drawbacks, and ideas related to implementing MBC technology into their clinical workflows. Interviews were audio recorded, transcribed, and coded to allow for thematic analysis using a mixed deductive and inductive approach. Clinicians also completed a card sorting task to rate the perceived helpfulness of routinely measuring and monitoring different treatment outcomes. Results Clinicians reported several potential benefits of MBC, including improved patient-provider communication, client empowerment, and improved communication between clinicians. Clinicians also expressed potential drawbacks, including concerns about subjectivity in patient self-reports, limits to personalization, increased time burdens, and needing to learn to use new technologies. Clinicians generated several ideas and preferences aimed at minimizing burden of MBC, illustrating clinical changes over time, improving ease of use, and improving personalization. Numerous patient outcomes were identified as “very helpful” to track, including coping skills, social support, and motivation for change. Conclusions MBC may be a beneficial tool for improving clinical care in SUD treatment settings. MBC tools may be particularly adoptable if they are compatible with existing workflows, help illustrate gradual and nonlinear progress in SUD treatment, measure outcomes perceived as clinically useful, accommodate multiple use cases and stakeholder groups, and are framed as an additional source of information meant to augment, rather than replace, existing practices and information sources. Supplementary Information The online version contains supplementary material available at 10.1186/s13722-021-00247-5.


Consent, Confidentiality, Introduction
Introduce myself and project: -I'm a researcher at UW. I'm working with addiction treatment clinicians to make technology to support treatment providers working in addictions that I hope will help with monitoring patients' progress during addiction treatment.
-I'm interviewing people who work in the clinic to better understand your preferences, workflows, and how you do the work that you do. I'm asking for your input to understand how technology could potentially be helpful and where it could potentially cause problems.
-I'm especially interested in knowing how we could design something that (a) requires minimal or no additional work for clinicians, (b) tracks the patient outcomes that you're most interested in, and (c) fits with your existing workflows.
Consent waiver and confidentiality: -The information you share in here is confidential. It won't be shared directly with anyone, including your colleagues and supervisors. It may be shared with other research staff (e.g., research assistants) but will remain de-identified.
-The findings from these interviews may be shared with other researchers and administrators, but your information will remain confidential.
-I'm recording these interviews because I may not always be able to write down everything that you say. However, we do not have to record this if you prefer not to. Is it alright with you if I record this interview?
-Explain waiver of written consent form.

Rapport-Building and Clinical Caseload
Tell me about the kind of work you do in the clinic. What potential problems could you see with this kind of technology?

MBC-Specific Questions: Logistics
Thinking of a few of your typical patients, how do you imagine they would feel about answering a short questionnaire before each of their clinical sessions?
What might be a good way to have these questionnaires fit with the flow of patients in the clinic? When would be best for them to complete them? How frequently? How long should it take?
How might you imagine reviewing the results of these patient questionnaires in your workflow?
When might you review them? How frequently? How long might you spend?

Technology Logistics
[Skip if fewer than 10 minutes remain] Can you tell me about the types of technology (e.g., paper-and-pencil, desktop computer, iPad) that you think would be feasible for patients to use in the clinic? What cognitive and physical limitations might prevent some patients from using iPads or computers? What types of technology patients have access to or are comfortable with?
What worries or concerns do you think clinicians could have about using technology to track patient progress? (e.g., that we would use it to gauge their effectiveness as clinicians? Or that it might not capture the essence of SUD treatment? Or possible retribution in some way?)

MBC-Specific Questions: Content
By now you've mentioned ______ as examples of things you often monitor in your work. What other kinds of things do you monitor in your patients to get a sense of whether they're improving or staying on track during treatment?
Are there different things that you monitor to tell if a patient is failing to improve, or getting worse (as opposed to getting better)?

Demographics and Professional Background Questionnaire
These items ask about your demographic background and professional work: Demographics