Implementation of Digital Tools in MOUD Improves 30-Day Retention: A Stepped-Wedge Cluster Randomized Trial

ObjectivesTo evaluate the impact on patient retention and treatment continuance of Recovery Connect, a digital remote patient monitoring app used as part of a blended treatment model.MethodsA stepped-wedge cluster randomized trial was conducted across nine outpatient OUD clinics organized into eight clusters. Clusters were sequentially graduated from usual care to a digitally-enhanced model incorporating Recovery Connect, which provided real-time monitoring, psychoeducational and skill based learning content, and messaging between patients and clinicians. The primary outcome was 30-day retention in treatment following either exposure (implementation of the app into the clinic), linkage (connecting the patient app with the clinician’s app), or engagement (levels of usage of the app). Secondary outcomes included treatment continuance and # daily doses within the first 3, 7 and 30 days. Cluster-controlled discrete-time survival analyses were used, adjusting for patient- and clinic-level covariates.ResultsPatients admitted to clinics which had implemented the app saw increased retention (74.8%) compared to those that had not (69.5%; p=.047). Patients who linked with a clinician on Recovery Connect had a 81.3% likelihood of retention, compared to 72.0% (p<.001) among those not linked. Linkage also significantly predicted higher continuance and number of daily doses taken in the first 7 and 30 days. Low, moderate and high engagement levels had progressively higher 30–day retention vs no retention (p<.001).ConclusionsRecovery Connect significantly enhanced patient retention and treatment continuance in OUD treatment. Implementing digital interventions can effectively complement traditional care methods, substantially improving clinical outcomes.