Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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1055 — Automated, Mobile, Ancillary Care for Substance Abuse Treatment

Lead/Presenter: Brent Moore, COIN - West Haven
All Authors: Moore BA (VA Connecticut Healthcare System) Printz DM (VA Connecticut Healthcare System) Heapy AA (VA Connecticut Healthcare System) Pilkey D (VA Connecticut Healthcare System) Buono FD (VA Connecticut Healthcare System) Rosen MI (VA Connecticut Healthcare System)

Objectives:
Evaluate feasibility and acceptability of the Veterans' Recovery Line among Veteran patients and providers. Evaluate initial efficacy of the Veterans' Recovery Line among patients starting substance abuse treatment.

Methods:
This study was a mixed-methods evaluation of the Veterans' Recovery Line (VRL) as an automated ancillary intervention in substance abuse treatment. Veteran patients (N = 35) in intensive outpatient (IOP) treatment were recruited for a 5-week randomized pilot trial. Patients were randomly assigned to receive treatment-as-usual (TAU-15) or VRL+TAU (20). Primary outcome measures were IOP retention and attendance. Additional feasibility and preliminary efficacy data included participation of eligible patients, number of system calls, days/week of primary substance use, days/week of any substance use, and coping skills efficacy. Patient and staff qualitative data were also collected.

Results:
There were no group differences on baseline characteristics. IOP completion was high (86%, n = 30) and did not differ by condition (p = .40). Findings met the apriori criteria of acceptability and feasibility for a full-scale trial. First, the majority of eligible patients (73%) participated in the study, and none refused their assigned condition. Second, patients assigned to VRL+TAU had marginally more days in treatment after their randomization date (9.2 vs 5.9, p = .055) and attended more IOP sessions than those assigned to TAU (54.7 vs. 46.0, p = .03). VRL use met acceptability criteria ( > 50% calling > 5 days for > 30 minutes total time; M = 13.4 calls, M = 122 minutes). Finally, although self-reported primary and any substance use days/week decreased and did not differ by condition (p's > .27), coping skills efficacy improved significantly (p = .01) for VRL+TAU (19.6 to 30.3, p = .001), but not for TAU (p = .54). In qualitative interviews IOP providers (n = 4) felt the VRL was a useful extension of their program when patients could not access a clinician and reported positive feedback about the VRL.

Implications:
High rates of patient participation and qualitative findings support VRL's feasibility and acceptability. The VRL showed promise in improving treatment retention and acquisition of coping skills among Veterans in IOP treatment.

Impacts:
The findings from this pilot indicate that a full scale efficacy/effectiveness trial is warranted. The supplemental treatment system is low-cost, scalable, and could improve patient outcomes throughout the Veterans Healthcare System.