2012 HSR&D/QUERI National Conference Abstract
3059 — Assessing the Efficacy of Telephone Monitoring among Veterans with Substance Use Disorders
Wagner TH, Sox-Harris A, Moos R, and McKellar J, Palo Alto VA;
The effectiveness of substance use disorder (SUD) treatment depends on keeping patients connected to treatment. A non-VA study found telephone monitoring was easier than and as effective as face-to-face contact at maintaining abstinence at 12 months. We tested whether telephone monitoring improved outcomes for Veterans with a SUD.
We conducted a two-site randomized trial to determine whether adding telephone case monitoring to usual care would improve percent days abstinence relative to usual care. Patients were eligible if they had an ICD-9 diagnosis of alcohol and/or drug dependence, and excluded if they had a condition that precluded involvement in outpatient care (e.g., severe dementia). Outcomes were collected at baseline and 3 months, and 1 year. Primary outcome was self-reported percent days abstinent over the past 30 days. Secondary outcomes included psychiatric symptoms, quality of life, and costs. Costs were obtained from DSS data. As our trial commenced, VA introduced a new performance metric that encouraged more telephone follow-up for SUD care. We conducted intent-to-treat analysis, and also conducted a contamination-adjusted intent-to-treat, which uses randomization as an instrumental variable. Missing data was handled through multiple imputation with 20 datasets.
Of the 667 randomized participants, there were no significant baseline differences between the two groups. The telephone care group averaged 9.1 telephone calls, while the usual care group averaged 1.9 (p < .001). The intent-to-treat analysis found no significant effects among any of the outcomes. The contamination-adjusted intent-to-treat analyses yielded effects that were comparable in size to the intent-to-treat analysis, but with significant positive effects favoring telephone care for percent days abstinent and psychiatric symptoms at 3 months. All of the effects declined over time and were no longer significant at 1 year. The intervention cost approximately $80 more than usual care alone, or $10.53 (2009 dollars) per additional telephone call.
Telephone monitoring was associated with positive, but small effects on percent days abstinent and psychiatric symptoms at 3 months. The intervention had no significant effects at 12 months.
Telephone monitoring was relatively inexpensive, but it may not be sufficient to improve SUD outcomes in the long term.