Problematic substance use among patients in a Swedish outpatient psychiatry setting: staff and manager perceptions of digital options for increased intervention access

• Published in: Addiction science & clinical practice Vol. 18; no. 1; pp. 65 - 12
• Main Authors: Petersén, Elisabeth, Augustsson, Hanna, Berman, Anne H
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 24-10-2023; BioMed Central; BMC
• Subjects: Access; Analysis; Beliefs, opinions and attitudes; Bipolar disorder; Care and treatment; Clinical outcomes; Comorbidity; Digital interventions; Employee attitude; Employees; Exegesis & hermeneutics; Future; Health aspects; Health care access; Health care industry; Humans; Integrated care; Intervention; Medical treatment; Medicin och hälsovetenskap; Mental disorders; Mental health; Mental health care; Mental health services; Outpatients; Patients; Perceptions; Professional attitudes; Psychiatry; Staff perceptions; Substance abuse; Substance use disorder; Substance-Related Disorders - psychology; Substance-Related Disorders - therapy; Sweden; Technical skills; Telemedicine; Treatment outcomes; Sweden; Substance use disorder; Digital interventions; Staff perceptions; Comorbidity
• ISSN: 1940-0640; 1940-0632; 1940-0640
• DOI: 10.1186/s13722-023-00421-x

Approximately 50% of the patients who globally seek help in psychiatry have been assessed with problematic substance use or been diagnosed with substance use disorder (SUD). Given the high treatment gap for mental health care, in particular SUD, these individuals risk poorer treatment outcomes in psychiatry. Integrated treatment for psychiatric and SUD disorders has been proposed to reduce the treatment gap for SUD, but access to integrated treatment is low. Digital interventions addressing SUD in psychiatry could potentially make treatment available to patients who otherwise would not have access. In this study "digital interventions" comprise an umbrella term covering all kinds of interventions from minimal motivational app-based interventions to internet-based interventions with and without human guidance, up to remote sessions in telepsychiatry. This study aims to explore healthcare staff perceptions of referring patients to digital interventions for reducing problematic substance use, whether or not diagnosed as SUD, in the psychiatric outpatient setting.
The study was exploratory with a qualitative design. Data were collected in the Swedish outpatient psychiatry setting, via individual semi-structured interviews with managers, and focus groups with healthcare staff. An adapted form of phenomenological hermeneutical analysis was used to analyze the data.
Three themes emerged from the analysis. The first theme was Encountering obstacles on the path to future implementation of digital interventions, with sub-themes: Lacking resources and Feeling concerned about technical solutions. The second theme was Searching for ways forward to achieve increased access to care, with sub-themes: Blended care could facilitate integrated care and Addressing variations in patients' technical skills. The third theme was Taking steps towards the future, with sub-themes: Wanting to know more about digital interventions and Formulating a vision for the future.
The study reveals a concern that implementing digital interventions in psychiatry will create additional work or be technically challenging. The staff see significant advantages from the patient perspective, but they feel that they themselves need training in implementing digital interventions. In order to establish constructive implementation of digital interventions for SUD in psychiatry, staff attitudes and concerns need to be considered and addressed. This study was conducted within the Swedish healthcare system and the findings may not generalize to other countries with differing healthcare systems.