Implementing digital interventions in psychiatric outpatient units: a qualitative analysis of staff attitudes

摘要

BackgroundUp to one-third of patients in psychiatry use alcohol ordrugs at a level that is problematic. A national survey ofoutpatient psychiatric clinic directors and staff in Swedenwas carried out on guidelines and practices regardingscreening, brief intervention and referral to treatment(SBIRT) for their patients, showing that national recommendationsto offer SBIRT for problematic substance use(PSU) are not systematically followed[1]. The objective ofthis research is to investigate whether implementation ofdigital interventions for PSU in psychiatry could be a wayof increasing treatment access for patients and supportingstaff in offering treatment.Material and methodsClinic directors at seven psychiatric outpatient clinics inStockholm, Sweden, were interviewed regarding theirviews on SBIRT for patients in psychiatry as well as thepossibilities of implementing a digital stepped care modelfor offering SBIRT at their clinics. Interviews were transcribedverbatim and subjected to qualitative thematiccontent analysis.ResultsPSU complicates correct diagnostic assessment and effectivetreatment intervention in psychiatry, and patients withPSU are generally referred to the addiction treatmentclinic. However, patients neglect to attend the addictionclinic or do not complete treatment, due to the stigmaticnature of problematic substance because attending paralleltreatments at two different clinics is taxing for patients.Interviewees were positive to the digital stepped care conceptfor psychiatry patients. Implementation would becontingent on easy use and minimal expenditure of stafftime and resources. A barrier is that treating PSU is notperceived as part of psychiatry’s mission and discipline.ConclusionsImplementing a digital stepped care concept for PSUwithin psychiatry could improve patient access to SBIRTand positively influence psychiatric treatment outcomes.Facilitating factors for implementation are user-friendlydesign and minimal time and resource requirements. Apotential barrier is that staff do not perceive PSU treatmentas part of their mission and area of competence.