Dec 27, 2015
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