Blueprint Project Colorado Site

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Blueprint ProjectColorado Site

• Michael H. Gendel M.D.
• Jay Shore M.D.
• Elizabeth Brooks M.S.

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Description

• 78 Colorado cases selected according to Blueprint
  protocol
• Data obtained for Colorado site and national
  sample
• Analysis run after subtracting Colorado data from
  national sample (n826)

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Reason for Study

• Colorado PHP is philosophically and functionally
  differently from most PHPs
• Emphasis on clinical evaluation by the PHP
• Assignment of level of care based on clinical
  evaluation/information
• Less inclination to refer to 90 day residential,
  specialized care
• More open to participant working while in
  treatment
• Clinical evaluation at CPHP of positive tissue
  tests and/or relapse vs re-evaluation at national
  treatment centers
• Monitoring requirements based on individual case
  rather than standard contracts
• Quality assurance

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CPHP Fiscal Year July 2006- June 2007 Primary
Presenting Problems
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Activity and Funding

• For Blueprint data, funding through RWJ
• CPHP data entry for Blueprint funded by funds
  specifically set aside for research by CPHP Board
  of Directors (501c3)
• From contributions from medical community
• No use of peer assistance funds provided by
  surcharge on Colorado medical license (paid by
  licensees)
• Further review of the 78 cases and analysis of
  results comparing Colorado and national samples
  funded similarly

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Sample ComparisonsSimilarities

• Generally very similar populations
• Previous contact with the PHP
• Gender, age, marital status, specialty, source of
  referral (mostly), mandated or not, history of
  previous treatment for SUD, type of drug abused,
  intravenous route of administration
• Use of 12 step oriented and specialized treatments

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Sample ComparisonsDifferences

• Use of other substances CO 73 vs Natl 50
  (plt.000)
• Number of treatment types
• 88 of Colorado sample received more than one vs
  80 of national sample received only one
• 62 CO vs 17 Natl received two types 14 vs 2
  3 types
• Mean length of inpatient/residential/partial
  hospital stay
• 46 days Colorado vs 72 days national

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Sample ComparisonDifferences

• Work
• 87 of CO cohort received at least some treatment
  while working vs 13 of national sample

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Sample ComparisonDifferences

• Monitoring
• Use of health professional aftercare group
  facilitated by paid mental health professional
  CO 90 vs Natl 58
• 12-step alternative group CO 36 vs Natl 5
• Psychiatric care CO 60 vs Natl 28
• Individual therapy CO 60 vs 36 Natl
• PHP follow up visits CO 100 vs Natl 49
• plt.000 for all of the above

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Sample ComparisonsDifferences

• Drug testing
• Total of tests per case CO 146 vs Natl 82
  includes estimates (plt.000)
• of cases with at least one unauthorized
  positive tests CO 41 vs 19 (pgt.000)
• This remains significant when controlled for
  absolute number of tests
• Examples include drug use, failure to notify CPHP
  of prescribed medication, use of food that is
  forbidden by agreement (e.g. poppy seeds),
  unexcused absence from testing, failure to call
  in to see if testing required

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Sample ComparisonsDifferences

• Relapse
• Colorado and national cohorts similar for
  behavioral relapse (absent addictive drug use)
  and chemical relapse that could have involved
  work
• For relapse at some time during monitoring, less
  severe, not involving work 31 CO vs 16 Natl
  (p.000)

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OutcomesWork

• 77 of Colorado cohort and 71 of national sample
  were working full or part-time at end of study
  period (plt.03)

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OutcomesProgram Completion

• Fully successful completion 65 CO vs 65 Natl
  (not corrected for incorrectly coded CO info
  which would have resulted in significantly better
  outcome)
• Benefited without completion
• 17 CO vs 12 Natl
• Failed program 3 CO vs 10 Natl

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Further Review of Colorado DataNot Compared to
National Sample

• Initial treatment
• 49 inpatient or residential
• 40 outpatient treatment while working
• 63 specialized care (inpatient and/or
  outpatient)
• Ultimate success as a function of type of initial
  treatment type
• 90 outpatient vs 62 inpatient (p.033)
• Initial treatment type not correlated with minor
  relapse or positive UDS

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Summary

• Overall outcomes for Colorado and National
  samples are comparable and reveal generally
  positive outcomes for physicians with SUDs
• Both samples relied on specialized treatment
• Colorado cohort utilized outpatient treatment
  more often and for a longer period of care,
  inpatient less often and for a shorter period of
  care
• Colorado sample demonstrated greater frequency of
  positive drug tests and minor relapse

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Discussion

• Better outcomes in Colorado among those that
  initially received outpatient care than inpatient
  suggests less severe illness in those treated in
  outpatient setting
• Greater frequency of minor relapse
• Did not correlate with initial treatment type
• Could reflect More knowledgeable stance of
  Colorado Board of Medical Examiners more
  tolerant attitude of CPHP differences in
  population (other drug and psychiatric
  comorbidity?)
• Greater frequency of minor relapse did not
  predict unsuccessful outcome