For more information contact Alemi at 703 993

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

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

How to Treat Substance Abuse Online n n n Motivational counseling Relapse prevention and monitoring Peer to peer support group Routine urine or hair tests Limited clinic visits Return to Index

We have developed and tested detailed protocols of care Component 1 of online treatment: Motivational Counseling n n 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

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 Feelings Online 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 n Weekly risk assessment Automated analysis Counselor actions: u Face to face visit u Family re-engagement u Increased contact u Change in treatment modality

Component 3 of online treatment: Electronic Support Groups Peer to peer n n n 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 n n 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 n n n 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 n n n 82 pregnant substance abusing patients 1. 5 times more likely to be in treatment 1. 7 times more likely to use self care

Peer to Peer Support Reduces Utilization n 53 recovering parents of infants Randomly assigned Changes in utilization over 4 months

Patients Prefer Online Counseling n n n ~300 recovering patients Central intake, referred to both Online counseling included support group, home monitoring, average of 3 contacts per week

Reminders Change Patients’ Behavior n n n 213 mothers of infants Urban clinic Computer call before each scheduled appointment

Ongoing Study of Impact Patients asked in 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 n No difference in any of the following indices u Alcohol use u Drug use u Family problems u Legal problems u Employment problems u Medical problems u Psychiatric problems

Change from Baseline to Follow-up

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

Care and Technology Are Linked n n 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

More Key Practice Differences

More Key Practice Differences

More Key Practice Differences

More Key Practice Differences

More Key Practice Differences

Summary of Changes n n n n 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