For more information contact Alemi at 703-993 4226 falemi@gmu.edu.

For more information

contact Alemi at

703-993 4226 falemi@gmu.edu

Coming Up How to care for patients online? Does it work? Why management matters?

How to Treat Substance Abuse Online Motivational counseling Relapse prevention and

monitoring Peer to peer support group Routine urine or hair tests Limited clinic visits

Return to Index

Component 1 of online treatment:

Motivational Counseling Short, 3-4 times a week Message broadcast to patients

in same stage of illness Individualized conversation

aimed at self insight Patients who progress are

moved to new stages

We have developed and tested detailed protocols of care

No Shame

Patients are more likely to report controversial issues such as substance abuse, sexual abuse, suicidal thoughts, sexual dysfunction, etc. to a computer than to a human being

Real FeelingsOnline counselors have more contact and longer lasting relationship with their clients than face to face counselors.

In discussion groups, 56% of messages had

emotional content.

Component 2 of online treatment: Relapse Prevention Weekly risk assessment Automated analysis Counselor actions:

Face to face visit Family re-engagement Increased contact Change in treatment modality

Component 3 of online treatment:

Electronic Support Groups Peer to peer Confidential 8 times more likely to be

attended Group norm & solidarity Participation affects behavior

Component 4 of online treatment:

Laboratory Tests Routine and part of “one day at

a time” philosophy Not punitive Data plotted and provided back

to patients Used in counseling to enhance

motivational interviews

Component 5 of online treatment:

Office Visits Available on patient demand Initiated by clinician or patient Limited in number

Coming Up

Patients’ reactions to online treatment and results of clinical studies

Online Services Improve Compliance

82 pregnant substance abusing patients

1.5 times more likely to be in treatment

1.7 times more likely to use self care

40455055606570758085

Less online More online

% i

n t

rea

tme

nt

Peer to Peer SupportReduces Utilization

53 recovering parents of infants Randomly assigned Changes in utilization over 4 months

-100

-50

0

50

100

Counseling visits MD visits Clinic visits

Online Face to face

Patients PreferOnline Counseling

~300 recovering patients Central intake, referred to both Online counseling included support

group, home monitoring, average of 3 contacts per week

0

20

40

60

80

100

Online Face toface

Reminders Change Patients’ Behavior

303540455055606570

Notreminded

Reminded

On time immunization

213 mothers of infants

Urban clinic Computer call

before each scheduled appointment

Ongoing Study of Impact

Patients askedin 4 States

79 Signed Consent

39 Usual Care + Computer

40 Online Care + Computer

17 Completed Exit Interview

26 Completed Exit Interview

ASI Values at Baseline

No difference in any of the following indices Alcohol use Drug use Family problems Legal problems Employment problems Medical problems Psychiatric problems

Change from Baseline to Follow-up

0

0.2

0.4

0.6

Medicalproblems

Emp.Problems

Alcohol use Drug use FamilyproblemsC

han

ge

in A

SI

sco

re

Usual care Online care

Coming UpManagement matters: how online treatment requires new business and clinical processes

Care and Technology Are Linked Technology leads to new care

processes. Technology changes the

objectives of the care

You can’t take a care for a walk

You have to take it to new destinations

Key Practice Differences

Online Face to face

Frequency Daily & short Less often, 1 hourlong

Focus on Today & tomorrow Past patterns

More Key Practice Differences

Online Face to face

Availability On demand By appointment

Initiated by Mostly clinician Mostly Patient

Counselingmethod

Leading to insight Variable

More Key Practice Differences

Online Face to face

Counselingmethod

Leading to insight Variable

Gatekeeper Informed consumers Clinicians

More Key Practice Differences

Online Face to face

Organizationstructure

Networked anddecentralized

Variable

Participatorymanagement

More Less

Quality control Result and outcomeoriented

Process and effortoriented

More Key Practice Differences

Online Face to face

Informationtechnology

Unifying andstrategic

Often not central toorganization

Privacy Distributed systems Centralized systems

More Key Practice Differences

Online Face to face

One organizationone disease

Specialized No specialization

Service area Across States Local

Summary of Changes

New gatekeepers Focus on one disease Out of sight is not out of mind Subcontractor to existing HMOs Low capital costs Small numbers can be profitable Patient expectations and

behavior will change