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2015 HSR&D/QUERI National Conference Abstract

3077 — Care Coordination Telehealth 'In-Home-Messaging Devices' Lower Alcohol Use in Dually Diagnosed Veterans

Santa Ana EJ, Ralph H. Johnson VAMC and Medical University of South Carolina; Martino S, West Haven VAMC and Yale University School of Medicine; Gebregziabher M, Ralph H. Johnson VAMC and Medical University of South Carolina;

The Care Coordination telehealth In-Home-Messaging Device (IHMD) is an electronic message-delivering and monitoring device that provides assessment and self-management education to patients in their home. We conducted an RCT that investigated the efficacy of IHMD's programmed with a substance abuse intervention (IHMD-SUD) compared to Treatment-As-Usual (TCC).

Veterans (n = 62) with an alcohol use disorder and other co-existing psychiatric disorders were randomized to IHMD-SUD or TCC through the Charleston VAMC substance abuse outpatient program. IHMD-SUD consisted of two daily components spanning 27 days: 1) alcohol and drug use risk assessment; and 2) self-management skills development dialogues designed to provide motivational, coping skills, and support-building. TCC consisted of four 1 hr. therapist-led group sessions consisting of standardized educational presentations on addiction. Data analyses utilized zero-hurdle Poisson models with random intercept to account for correlation between repeated measurements of the responses within subjects. Using the Time-Line Follow Back, we assessed number of alcohol consumption and binge drinking days at 1 and 3-month follow-up.

At 1-month follow-up, participants in IHMD-SUD drank alcohol on significantly fewer days (Est = -0.22, t = -2.45; p = .02) and demonstrated fewer binge drinking days (Est = -0.56, t = -4.73; p < .0001) compared to TCC. Differences at 3-month follow-up were N.S. on number of alcohol consumption days, although differences on binge drinking days between groups continued, favoring IHMD (Est = -0.43, t = -3.79; p < .001) compared to TCC.

Participants who received IHMD's delivered through Care Coordination Home Telehealth drank alcohol on fewer days and demonstrated less hazardous binge drinking days compared to their counterparts who received a group-led face-to-face intervention with a therapist.

IHMD's offering substance abuse treatment dialogues may offer practical, accessible, and effective intervention for patients with substance use disorders, particularly for patient facing treatment barriers.