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

BACKGROUND: 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. METHODS: 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). RESULTS: 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