Telephone Disease Management At-Risk Drinking (TDM II)
The aim of this study is to test for improvements in treatment outcomes for primary care patients with at-risk drinking when cared for using telephone disease management (TDM) compared to those treated with usual care. Based on our pilot data, TDM for at-risk drinking may be a viable method for reducing alcohol consumption in this population.
Hypotheses: The hypotheses for this research plan are: 1. A significantly greater proportion of patients assigned to TDM will obtain improvement in drinking outcomes compared to usual care. 2. TDM will lead to greater access to behavioral health care and higher intensity of treatment relative to usual care. This effect will be moderated by logistics such as transportation problems, physical functioning, and employment status. 3. More patients assigned to TDM will receive guideline adherent care.
|Alcohol Abuse||Behavioral: Telephone disease management Behavioral: Usual Care|
|Study Design:||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary Purpose: Treatment
|Official Title:||Telephone Disease Management At-Risk Drinking (TDM 11)|
- Reduced Alcohol Use [ Time Frame: 12 months ]Alcohol use as measured by the number of drinking days. Lower is better. There are no upper limits. The lower limit is 0.
- Reduced Problems Related to Alcohol [ Time Frame: 12 months ]The Short Inventory of Problmes was used to measure the number of alcohol related problems encountered in the prior 3 months. The scale has a minimum of 0 with lower as better. The max score is 15 with each problem rated as present or absent.
|Study Start Date:||January 2004|
|Study Completion Date:||February 2009|
|Primary Completion Date:||August 2008 (Final data collection date for primary outcome measure)|
Experimental: Telephone Disease Management
Telephone based disease management or counseling used to promote a reducution in alcohol misuse
Behavioral: Telephone disease management
Telephone based care management
Placebo Comparator: Usual Care
Behavioral: Usual Care
We propose to randomize 200 patients with at-risk drinking from four primary care clinics at the PVAMC and three Community Based Outpatient Clinics (CBOCs). Patients will be identified for participation by 1. referrals from primary care clinicians based on existing screening and clinical exams or 2. from the screening of a random subset of patients with an appointment in the primary care clinic. A baseline assessment will establish eligibility for participation in the study. The baseline assessment will also allow identification of those patients who screen positive but do not have a definable behavioral health problem and those with severe symptoms who may need more intensive help than provided by the study.
Consenting eligible patients will be randomly assigned to TDM or the lower intensity intervention of usual care. For those patients assigned to usual care, the physician will administer further evaluations and treatment as he/she sees fit. For those assigned to TDM, the primary care provider remains the agent of treatment, but a Behavioral Health Specialist (BHS) is made available to: maintain regularly scheduled telephone contact, develop a treatment plan, monitor treatment effectiveness, assess and encourage treatment adherence, and offer support and education. The role of the health specialist is defined by a treatment manual that adheres to the recommendations of VA practice guidelines. TDM is based on a chronic care model of treatment and includes a minimum of three BAI sessions. The health specialist will communicate assessment information with the PCP in order to coordinate treatment decisions.
The principal outcomes of the study relate to reduction in alcohol use within recommended guidelines as well as access and utilization of behavioral health services over the course of 12 months. Results favoring TDM may provide a low-cost, highly efficient mechanism for integrating behavioral health with primary care for these patients. This project thus meets several of the priority areas for HSR&D funding including improving access to care, the implementation of practice guidelines, use of telemedicine, and patient-centered care.
Please refer to this study by its ClinicalTrials.gov identifier: NCT00123409
|United States, Pennsylvania|
|Philadelphia VA Medical Center, Philadelphia, PA|
|Philadelphia, Pennsylvania, United States, 19104|
|Principal Investigator:||David W. Oslin, MD||Philadelphia VA Medical Center, Philadelphia, PA|