3077 — Care Coordination Telehealth 'In-Home-Messaging Devices' Lower Alcohol Use in Dually Diagnosed Veterans

Santa Ana EJ, Ralph H. Johnson VAMC and Medical University of South Carolina; Martino S, West Haven VAMC and Yale University School of Medicine; Gebregziabher M, Ralph H. Johnson VAMC and Medical University of South Carolina;

Objectives:
The Care Coordination telehealth In-Home-Messaging Device (IHMD) is an electronic message-delivering and monitoring device that provides assessment and self-management education to patients in their home. We conducted an RCT that investigated the efficacy of IHMD's programmed with a substance abuse intervention (IHMD-SUD) compared to Treatment-As-Usual (TCC).

Methods:
Veterans (n = 62) with an alcohol use disorder and other co-existing psychiatric disorders were randomized to IHMD-SUD or TCC through the Charleston VAMC substance abuse outpatient program. IHMD-SUD consisted of two daily components spanning 27 days: 1) alcohol and drug use risk assessment; and 2) self-management skills development dialogues designed to provide motivational, coping skills, and support-building. TCC consisted of four 1 hr. therapist-led group sessions consisting of standardized educational presentations on addiction. Data analyses utilized zero-hurdle Poisson models with random intercept to account for correlation between repeated measurements of the responses within subjects. Using the Time-Line Follow Back, we assessed number of alcohol consumption and binge drinking days at 1 and 3-month follow-up.

Results:
At 1-month follow-up, participants in IHMD-SUD drank alcohol on significantly fewer days (Est = -0.22, t = -2.45; p = .02) and demonstrated fewer binge drinking days (Est = -0.56, t = -4.73; p < .0001) compared to TCC. Differences at 3-month follow-up were N.S. on number of alcohol consumption days, although differences on binge drinking days between groups continued, favoring IHMD (Est = -0.43, t = -3.79; p < .001) compared to TCC.

Implications:
Participants who received IHMD's delivered through Care Coordination Home Telehealth drank alcohol on fewer days and demonstrated less hazardous binge drinking days compared to their counterparts who received a group-led face-to-face intervention with a therapist.

Impacts:
IHMD's offering substance abuse treatment dialogues may offer practical, accessible, and effective intervention for patients with substance use disorders, particularly for patient facing treatment barriers.