Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Sep 4, 2025
Date Accepted: Nov 18, 2025
Implementation of a Mobile Digital Tool Supporting MOUD Treatment Improves Retention: A Stepped-Wedge Cluster Randomized Controlled Trial
ABSTRACT
Background:
Despite its proven efficacy, Medication for Opioid Use Disorder (MOUD) retention remains low, with structural and systemic barriers such as access to care and treatment setting, together with individual barriers such as personalization and motivation, contributing to high rates of discontinuation. Digital interventions are a promising solution to many of these barriers, however robust evidence for their effectiveness at improving retention and engagement with treatment is scarce.
Objective:
To evaluate the impact on patient retention, treatment continuance and medication adherence of Recovery Connect, a digital remote patient monitoring app used as part of a blended treatment model.
Methods:
A stepped-wedge cluster randomized trial was conducted across nine outpatient MOUD clinics organized into eight clusters. Clusters were sequentially graduated from usual care to a digitally-enhanced model incorporating Recovery Connect, which provided real-time monitoring, psychoeducational and skill based learning content, and messaging between patients and clinicians. The primary outcome was 30-day retention in treatment following either exposure (implementation of the app into the clinic), linkage (connecting the patient app with the clinician’s app), or engagement (levels of usage of the app). Secondary outcomes included treatment continuance and # daily doses within the first 3, 7 and 30 days. Cluster-controlled discrete-time survival analyses were used, adjusting for patient- and clinic-level covariates.
Results:
Patients admitted to clinics which had implemented the app saw increased retention (74.8%) compared to those that had not (69.5%; p=.047). Patients who linked with a clinician on Recovery Connect had a 81.3% likelihood of retention, compared to 72.0% (p<.001) among those not linked. Linkage also significantly predicted higher continuance and number of daily doses taken in the first 7 and 30 days. Low, moderate and high engagement levels had progressively higher 30–day retention vs no retention (p<.001).
Conclusions:
Recovery Connect significantly enhanced patient retention and treatment continuance in MOUD treatment. Implementing digital interventions can effectively complement traditional care methods, substantially improving clinical outcomes. Clinical Trial: ClinicalTrials.gov ID: NCT07140926
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