One-year outcomes of telephone case monitoring for patients with substance use disorder.
BACKGROUND
Many patients treated for substance use disorder (SUD) do not achieve lasting recovery from a single episode of treatment and require continuing care. The current randomized clinical trial investigated whether in-person continuing care as usual (CCAU) following intensive outpatient SUD treatment leads to better SUD outcomes when compared with telephone case monitoring (TCM).


METHODS
This study randomized 667 intensive SUD outpatients to telephone case monitoring versus face-to-face continuing care as usual at two sites. Patients completed data at baseline, 3 and 12months with telephone interviews. Data of interest include self-report of substance use, psychiatric symptoms, quality of life, and treatment satisfaction. We also evaluated potential interaction effects for distance to VA provider, SUD severity, and presence of co-morbid psychiatric disorder.


RESULTS
Participants randomized to the telephone case monitoring condition substantially engaged with face-to-face continuing care resulting in cross-over contamination. We addressed this issue by using randomization as an instrumental variable to evaluate the impact of telephone case monitoring (contamination adjusted, intent to treat analysis). Instrumental variable analyses indicated significant benefit of telephone case monitoring for drug and alcohol percent days abstinent and psychiatric symptom outcomes at 3-months follow-up, but not at 12-month follow-up. No interaction analyses were significant.


CONCLUSIONS
Participants receiving telephone case monitoring achieved better short term outcomes in terms of substance use and psychiatric symptoms. The "on treatment" effects suggests the need for future studies to investigate consumer (patient) perspectives on the optimal duration of telephone case monitoring and use of alternative monitoring methods such as text messaging.
Center for Health Care Evaluation, Health Services Research and Development Service, CA, USA. john.mckellar@va.gov
John
J
McKellar
Todd
T
Wagner
Alexander
A
Harris
Mary
M
Oehlert
Sara
S
Buckley
Rudolf
R
Moos
D000553:Ambulatory Care / Q000379:methods*; D003266:Continuity of Patient Care; D003376:Counseling / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications; D008875:Middle Aged; D010045:Outpatients; D017060:Patient Satisfaction; D011788:Quality of Life; D012423:Rural Health; D057566:Self Report; D019966:Substance-Related Disorders / Q000150:complications / Q000628:therapy*; D013689:Telephone; D016896:Treatment Outcome; D014504:Urban Health