Can mHealth improve primary care for alcohol use disorders?

Dr. Joe Glass (center) with Research Support Specialist Eric Goemer and Research Associate Amy Lee, MPH.

Dr. Joe Glass wants to make treatment more comfortable for patients and providers—possibly with digital tools

A career turning point for one of our region's newest health researchers came when he was counseling veterans in Michigan. Joe Glass, PhD, MSW, is now an assistant investigator with Kaiser Permanente Washington Health Research Institute (KPWHRI). In the mid-2000s, though, he was working as a social worker and didn't expect to go into research.

"My supervisor at Ann Arbor Veterans Administration health system was Dr. Stephen Chermack, an addictions researcher," says Dr. Glass. "I had programming skills because I had done IT work, so he pulled me into helping with his projects." Inspired by the challenge, Dr. Glass went on to earn a PhD in social work from Washington University in St. Louis and after a few years on the faculty of the University of Wisconsin-Madison, KPWHRI enticed him to join its behavioral health group.

Dr. Glass has just been awarded a five-year, $960,000 career-development grant from the National Institute of Alcohol Abuse and Alcoholism. He will conduct a pilot study on using mobile health (mHealth) tools such as smartphone apps to help people with alcohol use disorders get accessible, effective treatment in primary care. Dr. Glass and his research team will develop and test a clinical workflow at selected Kaiser Permanente Washington sites as the foundation for a larger study on the impact of mHealth on care and outcomes for people with alcohol use disorders.

The grant also supports Dr. Glass in developing an independent research program. To add to his skills in quantitative data collection and analysis, he will be mentored by senior scientists in gathering and interpreting qualitative data, such as information from patient and provider interviews. He will learn to lead pragmatic trials in close partnership with clinical teams, so the results reflect real-world care for a diverse population. Kaiser Permanente Washington is currently integrating behavioral health, including alcohol and substance use screening, into primary care. Much of Dr. Glass' research takes place in this clinical context.

Dr. Glass' clinical experience gives him a unique perspective for his career development project. "When I was a social worker," he says, "I used technology, like care-management software, to stay aware of patients' status and who I needed to reach out to. But the tools weren't easy to use." This first-hand knowledge about digital clinical tools informed his study strategy. "A focus of my project," he says, "is learning how to create workflows that help primary care teams support patients in using evidence-based mHealth tools in a way that provides more benefit than burden."

On the patient side, Dr. Glass says, "We have evidence that mHealth can work for people with addictions, but we need to learn from primary care patients how mHealth tools might help them address substance use, what motivates them to use these tools or stop, and how they feel about being offered them by their care team." The project will explore how access to technology can address other behavioral health conditions, and will learn from patients of different genders, races, and ethnicities how they may see value in using mHealth tools.

The ultimate goal: Addressing stigma and disparities

Since his work in Ann Arbor, Dr. Glass has stayed connected to veterans’ health. He is affiliated with the VA Puget Sound Health Care System, collaborating with KPWHRI Affiliate Researcher Emily Williams, PhD, MPH, and two other VA researchers, John Blosnich, PhD, MPH, and Keren Lehavot, PhD. The team submitted a grant proposal to study alcohol use in transgender veterans. Exploratory studies suggest high alcohol use in this population but have not used rigorous methods to recruit participants. Two recent studies by the researchers using Centers for Disease Control and Prevention (CDC) data, one of which is published, support the need for larger health system studies to understand how individual, health system, and community factors affect alcohol use in sexual and gender minority populations.

Dr. Glass' overall research plan goes beyond mHealth and specific populations. "My long-term goal," he says, "is making sure all patients get health care in which stigma and socioeconomic factors don't affect the treatment and care they are offered and that they are willing to accept."

by Chris Tachibana

Dr. Glass' KPWHRI mentors for his career development award are Senior Investigator Kathy Bradley, MD, MPH, Senior Investigator and Director of Research, Faculty & Development, Jennifer McClure, PhD, and Senior Investigator Greg Simon, MD, MPH.