Multisite Mobile Addiction Services: Four-Year Outcomes

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The goal of this manuscript was to describe services provided in a multi-year Massachusetts-based mobile addiction services program, Community Care in Reach. The descriptive narrative of the manuscript details the conceptual rationale for the program, its implementation, the services provided, the evaluation model and performance indicators, and the content of the technical assistance sessions to promote proper implementation and ustainability. The article addresses an important public health issue and an innovative structural intervention to promote access to health care services to a highly vulnerable and stigmatized population. The study is interesting and has several strengths. The manuscript is well written, it highlights the scope and significance of the issues studied and the innovation of the health service delivery program, and both the services delivered and the steps implemented to ensure program implementation and sustainability. However, further attention to several issues may improve the potential contribution of the manuscript to contemporary research literature.

• The introduction could be strengthened by clearly stating the research question guiding the study and any hypotheses being tested. If the study is meant to be primarily descriptive in nature, then that should be stated.
• Figure 2 depicts the services provided over a period of 2.5 years, i.e., service hours, harm reduction encounters and clinical encounters. Provision of harm reduction encounters showed two large spikes. Please provide some additional information regarding these temporal shifts in service provision.
• The manuscript provides information on technical assistance sessions. This information is largely descriptive, providing information on the topics covered in each session. Is there any information regarding the degree to which session content was actually implemented with fidelity? Is there any information about attendees’ responses to the TA sessions or the degree to which learning objectives were met?
• The discussion of the findings could be further improved by focusing on how the findings of the study can be integrated into existing research on community-based interventions or structural innovations designed to reduce barriers to health care services and increase access among vulnerable multi-problem populations of adults. The discussion section could also be strengthened by reducing the amount of repetition with the results section. What are the implications of this preliminary evaluation? How does it make a meaningful contribution to the existing research or practice-related literatures?

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

The article “Multisite Mobile Addiction Services: Four-Year Outcome” analyzes the effectiveness of a “mobile addiction service” model developed in Massachusetts. This is a useful model for reaching people who use substances and who live in severe conditions of social marginalization and far from traditional health services. The authors describe the expansion of the CCiR model from an initial single-site experience to a multi-organizational program and evaluate its initial results using the RE-AIM framework, combining descriptive quantitative data with qualitative analyses of techincal assistance sessions. The results show a significant volume of clinical and harm-reduction contacts, a a demonstrated ability to reach hard-to-reach populations, and preliminary signs of the model's efficacy and adaptability. Overall, the manuscript is interesting, well motivated, and, in my opinion, deserves consideration for publication. Below, I report minor revisions that could improve and clarify parts of the manuscript.    

 

ABSTRACT

 

Lines 67 to 68. The expression “evaluation for this multisite project included quantitative descriptives and inductive and deductive qualitative methods” could be made more fluid and methodologically more precise. It could be clarified what quantitative data were used and what the qualitative methods refer to. 

Lines 70 to 72. It should be explained why we are only talking about treatment with buprenorphine, as the reference to the drug appears in the text is not very contextualized. One could consider rephrasing the sentence, for example: “Buprenorphine-based treatment (a key medication for opioid use disorder) was initiated…..”

The study's objective should be more clearly explained.

INTRODUCTION

Lines 87 to 96. This part of the text could benefit from a slight reorganization. The following should be better described: the program's origin, the model's characteristics, and the preliminary evidence available. 

Lines 104 to 110. The distinction between what has been demonstrated by the single-site study and what this study aims to evaluate should be made even clearer and more explicit. In particular, the sentence “This paper describes the initial implementation…” could be made a little more precise by clarifying that it is both a description of the implementation and a preliminary evaluation of reach/performance. 

MATERIALS AND METHODS

Lines 114 and 125. This section of the text describes four mobile units that continue the CCiR MAS model, followed by the addition of two more teams. The current description does not specify whether the analysis references only the original four units or includes the additional teams. Clarifying the sample composition at each phase of the study would improve transparency and reduce misinterpretation.

Line 189 to 192 (and Section 3.2). The manuscript provides a clear description of the TA sessions and their themes, but the analytic approach is not sufficiently detailed. The phrase “thematic and inductive approach… as well as a deductive approach” is a bit too general. It would help to add more detail on how the qualitative data from the TA sessions were coded, including which data sources were used, how the codebook was developed, and whether any software was used. Also, explaining whether you used methods to strengthen analytic rigor, such as intercoder agreement or triangulation, would make the methodology more transparent.

DISCUSSION
Lines 279 to 284.  The comparison with other studies on the percentage of subjects initiated on buprenorphine is interesting, but it would be beneficial to better explain the differences in context (e.g., target population, settings, access methods). 

CONCLUSION

The conclusions could be even stronger by explicitly emphasizing the added value of the CCiR MAS model. Although the manuscript highlights the importance of the service in the care of people with substance use disorders, greater emphasis could be placed on the model's adaptability to different healthcare organizational contexts.

Author Response

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Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

The presented for the review article is a narrative description of the program for primary care of patients with drug addictions in the USA. The specification of the program is the mobility setting. It is within the scope of the Special issue of the journal.

I have the several proposals for authors:

1. By my opinion, the Title should be corrected: "Mobile Addiction Services" can be understanding as a mobile phone services or services for behavioral addiction for mobile phone etc.. also it's important to underline the targeted group of patient - homeless drug addicts.
2. There is no the aim of the study, but we can come to clear conclusion without the clear definition of the aim.
3. There is no the statistics, anly descriptions. Authors can more describe the trends, differences in the several periods etc.
4. By my opinion, the use of STROBE check-list (https://www.strobe-statement.org/checklists/) can improve the validity of the results.
5. In the introduction and in the discussion, authors can more describe the other programs for homeless addicts. What is the benefits of your program? What data or results can found the benefits of your program, comparing the other non-mobile?
6. Th Table 1 is very long and it's can be print in the Supplement.
7. It's may be interesting to discuss more about the opiods crisis in the USA and the results of the Mobile Add Services. Can it help to change the trends?

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

The goal of this manuscript was to describe services provided in a multi-year Massachusetts-based mobile addiction services program, Community Care in Reach. The descriptive narrative of the manuscript details the conceptual rationale for the program, its implementation, the services provided, the evaluation model and performance indicators, and the content of the technical assistance sessions to promote proper implementation and sustainability. The article addresses an important public health issue and an innovative structural intervention to promote access to health care services to a highly vulnerable and stigmatized population. The study is interesting and has several strengths. The manuscript is well written, it highlights the scope and significance of the issues studied and the innovation of the health service delivery program, and both the services delivered and the steps implemented to ensure program implementation and sustainability.

The authors have submitted a revised manuscript that has thoughtfully addressed the concerns that I described in my previous review of the manuscript. Specifically, these revisions have addressed my concerns regarding the need to: clearly state the research question guiding the study; provide additional information regarding Figure 2; provide additional information regarding the effectiveness of the technical assistance sessions; and revise and strengthen the discussion section. These revisions have resulted in a significantly stronger manuscript and piece of scholarship.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

Authors have made a lot of important changes after the first round of review. But there are a some next suggestions:

1. The numbers of references is changed with a wrong in one-by-one method (for example, [1,16] etc). It's have to be changed.
2. The quaility of pictures is not so good.
3. There are no statistical analysis of the results. Can you please make a some hypotesis and calculate a statistical test for check this hypotesis?

After the answers for these suggestions article can be published in the special issue.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf