Online Services

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For more information contact Alemi at 703-993
4226 falemi_at_gmu.edu
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Coming Up

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

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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
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Component 1 of online treatmentMotivational
Counseling
We have developed and tested detailed protocols
of care

• 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

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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

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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.
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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

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Component 3 of online treatmentElectronic
Support Groups

• Peer to peer
• Confidential
• 8 times more likely to be attended
• Group norm solidarity
• Participation affects behavior

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Component 4 of online treatmentLaboratory 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

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Component 5 of online treatmentOffice Visits

• Available on patient demand
• Initiated by clinician or patient
• Limited in number

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Coming Up

• Patients reactions to online treatment and
  results of clinical studies

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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

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Peer to Peer SupportReduces Utilization

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

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Patients PreferOnline Counseling

• 300 recovering patients
• Central intake, referred to both
• Online counseling included support group, home
  monitoring, average of 3 contacts per week

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Reminders Change Patients Behavior

• 213 mothers of infants
• Urban clinic
• Computer call before each scheduled appointment

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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
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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

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Change from Baseline to Follow-up
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Coming Up

• Management matters how online treatment
  requires new business and clinical processes

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Care and Technology Are Linked

• Technology leads to new care processes.
• Technology changes the objectives of the care

You cant take a care for a walk You have to take
it to new destinations
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Key Practice Differences
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More Key Practice Differences
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More Key Practice Differences
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More Key Practice Differences
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More Key Practice Differences
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More Key Practice Differences
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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