Real-Time Expert Support for Addiction Care Across General Medical Settings: Evaluation of a Chat-Based Intervention

Patients with substance use disorders are often seen by primary care and other frontline clinicians, yet gaps in knowledge, skills, and competing demands limit clinicians' ability to provide evidence-based care. A safety-net system developed a message-based intervention ("Chat") within the electronic health record for clinicians to pose addiction-related queries and receive guidance from addiction medicine experts. We describe the characteristics of Chat queries and the early implementation-related outcomes of the Chat.

We conducted a multi-method evaluation describing the characteristics of Chat queries and cross-sectional surveys of clinicians and addiction experts assessing implementation-related outcomes. Chat characteristics included volume, response time, and nature of the queries. Implementation outcomes included reach (proportion using the Chat), implementation (responsiveness and helpfulness of responses), usability (System Usability Scale), and acceptability, appropriateness, and feasibility (Acceptability of Intervention Measure, Intervention Appropriateness Measure, and Feasibility of Intervention Measure).

Over 6 months, 84 queries were placed; 98% were answered, with an average response time of 4 (SD 19) minutes; 90% of responses occurred in <15 minutes. We surveyed 218 clinicians (60 responses, 28% response rate) and 28 addiction medicine experts (21 response, 75% response rate) with access to the Chat. Among clinicians, 68% (n = 41) were aware of the Chat, and 40% (n = 24) used it. Average usability scores were 87 (SD 11) among clinicians and 87 (SD 10) among experts, indicating excellent usability. Clinicians rated acceptability, appropriateness, and feasibility highly (average scores 4.5, 4.4, and 4.4, respectively). Key barriers include clinicians relying on other in-clinic support and addiction experts citing insufficient knowledge.

The Chat is a pragmatic, usable, and near real-time peer-to-peer solution to support primary care clinicians while they provide care to patients who use substances. The Chat may improve the provision of evidence-based care and can be implemented in systems with existing addiction medicine expertise.