Health Services Research & Development

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2007 HSR&D National Meeting Abstract

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National Meeting 2007

3084 — A Brief Care Coordination Intervention for Individuals with a Mental Health and Substance Abuse Problem: Preliminary Outcomes of a Randomized Trial

Smelson DA (VA New Jersey Health Care System and VISN 3 MIRECC) , Kline A (VA New Jersey Health Care System), Sussner B (VA New Jersey Health Care System), Losonczy M (VA New Jersey Health Care System and VISN 3 MIRECC), Lee C (VA New Jersey Health Care System), Owen R (HSR&D Center Arkansas ), Blow F (SMITREC)

Objectives:
Individuals with a serious mental illness have high rates of co-occurring substance abuse that often results in a severe illness course and poor treatment engagement. In an effort to improve outcomes for this population, we previously developed and piloted Time-Limited Case Management TLC, an eight-week integrated care coordination intervention to augment traditional inpatient and outpatient care and to assist with the treatment engagement process. With HSR&D funding, we are testing the efficacy of TLC through a randomized trial targeting 170 acutely hospitalized patients who are randomly assigned to TLC or treatment-as-usual plus attention (TAU+A). Preliminary findings of this trial are reported for the first 55 veterans enrolled in the study.

Methods:
Subjects included 55 seriously mentally ill substance abusing individuals randomized to TLC or TAU+A. Preliminary data include treatment initiation, attendance in treatment, and psychiatric re-hospitalizations.

Results:
Compared to TAU+A, the TLC group had a significantly higher rate of inpatient treatment attendance (4.3 vs. 1.7; p<.01). TLC subjects were more likely than TAU+A subjects to attend their initial outpatient appointment (77.4% vs. 50%, p<.05) and the TLC group had a higher mean attendance rate at outpatient study treatment sessions (6.9 vs. 2.1; p=.01). Although a higher proportion of TLC than TAU+A participants had been hospitalized in the 6 months prior to the intervention (34.4% vs. 26.1%), a substantially smaller (though non-significant) percentage of the TLC group had been hospitalized during the 2 months (12.5% vs. 21.7%) and 6 months (28.1% vs. 39.1%) post-enrollment. The final presentation will also include secondary outcomes related to substance use and mental health symptoms.

Implications:
These preliminary data show trends comparable to our previous non-randomized trial and suggest that TLC assists with treatment engagement and contributes to a reduction in hospitalizations during and after the intervention period.

Impacts:
These preliminary findings have important implications for developing clinical strategies to improve the care of veterans with a serious mental illness and a co-morbid substance abuse disorder. Although preliminary, this data also lends additional support for the efficacy of the TLC intervention.