A Randomized Clinical Trial of Alcohol Care Management
|Alcohol Dependence||Behavioral: Alcohol Care Management Behavioral: Usual Care||Phase 4|
|Study Design:||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary Purpose: Treatment
|Official Title:||Primary Care Based Disease Management for Alcohol Dependence|
- Treatment Engagement [ Time Frame: 6 months ]This measured the percentage of subjects who attended at least 2 clinical addiction sessions in a given month. The outcome presented is the percentage during the 6th month of the trial.
- Percent Days of Heavy Alcohol Use [ Time Frame: 6 months ]This is a measure during the 6 month of the percentage of 30 days in which a subject had at least 1 day of heavy drinking as defined by drinking more than 4 standard drinks in a day (3 or more for women).
|Study Start Date:||August 2007|
|Study Completion Date:||July 2011|
|Primary Completion Date:||March 2011 (Final data collection date for primary outcome measure)|
Experimental: Alcohol Care Management
Care management for alcohol dependence delivered in primary care
Behavioral: Alcohol Care Management
Care management for alcohol dependence with a focus on pharmacotherapy
Active Comparator: Usual Care
Usual care included a referral to specialty addiction treatment
Behavioral: Usual Care
Usual care included a referral to a specialty addiction treatment program.
Background: Alcohol dependence is one of the leading causes of disability worldwide. Despite the availability of efficacious treatments less than 20% of individuals with alcohol dependence are actively engaged in treatment. Within the VA system systematic screening was implemented to increase the identification of patients with both abuse and dependence. However, there continues to be a marked discrepancy in the care offered or accessed among those identified with alcohol dependence. Existing treatment guidelines suggest that all persons with dependence receive care in specialty addiction treatment. Data from our center indicate that among those individuals screened in primary care who have AUDIT - C scores of >7, only 30% are formally evaluated with 50% receiving only brief advice and 20% having no evidence of assessment or referral. Of those assessed and referred to specialty care only 60% attend an initial visit and only 33% meet the EPRP performance measure of 2 visits per month for 90 days. This disparity in treatment access exists even though Veterans self report a desire to cut down and readiness to change drinking behaviors. (VA ACQUIP) and a willingness to consider pharmacotherapy.
Aims: Available evidence suggests that primary care may be a key component in the identification of alcohol dependent patients, delivery of initial interventions, and to the success of addiction treatment. Indeed, the vast majority of screening and new case identification occurs within primary care. The primary aims of this proposal are to test the effectiveness of a primary care based Alcohol Care Management (ACM) program and to evaluate the barriers and facilitators to accessing and engaging individuals into treatment. The ACM program uses a Behavioral Health Specialist to deliver care focused on the use of pharmacotherapy in combination with psychosocial support (Medication Management). This model may overcome barriers to care such as frequent intensive visit schedules often required in specialty settings, stigma associated with specialty care or group therapy approaches, access to specialty care in remote areas, and the current focus on a 12 step model of treatment. Secondary aims are to establish the acceptability of primary care based treatments and defining treatment modifiers such as age, barriers, co-occurring depression, and pharmacogenetic response.
Please refer to this study by its ClinicalTrials.gov identifier: NCT00419315
|United States, New York|
|Syracuse VA Medical Center, Syracuse, NY|
|Syracuse, New York, United States, 13210|
|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|