Digitalapproachesinprimarycare:Earlyfindingsfromtheimplementa7onofthewww.checkupandchoices.com™webapp1

ReidK.Hester,Ph.D.&WilliamCampbell,Ph.D.ResearchDivisionCheckup&Choices,LLCreid@checkupandchoices.comwilliam@checkupandchoices.com

1Ini7aldevelopmentofthewebappwassupportedbygrantR43AA022024-1fromNIAAA.

•  Checkup&Choices,LLCholdstheIPofCheckupandChoices.comandIamtheco-founderofthecompany.

2

Disclosure

Overview

•  Ra7onale•  Theinterven7on•  Implementa7ons•  Implementa7onresearchframework•  Results/Lessonslearned

•  Healthcareorganiza7ons– Digitalinterven7onsforpa7entswhoscreenposi7veforheavydrinking

– Steppedcaremodelofinterven7on(Sobell&Sobell,2000)

– Poten7alforhealthcareimprovedclinicaloutcomesandcostsavings,w/fewaddi7onaldemandsonclinicresources.

4

Ra7onale

CheckupandChoices.com

Screen:Age,Alcohol,Drugs,ReadinesstoChange

Druguseonly

Drinker’sCheck-up(25+) CollegeDrinker’sCheck-up(<25)

ModerateDrinking OvercomingAddicFons

Flowchart

No

ResearchFramework

•  Numerousmodelstoguidedissemina7on&implementa7onresearch(Tabaketal.,2012)

•  ConsolidatedFrameworkforImplementa7onResearch(CFIR,hZp://cfirguide.org,Damshroderetal.,2009)– CFIRadvantagesforourprojects

Results

•  Developingimplementa7onplanstakesmonths–  Involvesnumerousstakeholdersinclientorganiza7onandourcompany

– Tailoringtheinterven7on(sub-domain)contentsalsotakes7me

•  Howtheappwillbeintegratedintotheclinicworkflowisuniquetoeachorganiza7on

Implementa7on

•  CaseStudyinContrasts:TwoverydifferentpathsfordeploymentinlargeHMOs– Feasibility

•  KaiserPermanente(Sacramento,CA)•  AdultPrimaryCareClinic

– Efficacy•  PresbyterianMedicalGroup(Albuquerque,NM)•  Sixseparateembeddedbehavioralhealthcareclinics

•  KaiserFeasibilityStudy:Deployment– SingleclinicinlargeHMO– OneearlyadopterMDinthatclinicandherteam–  Iden7fySxsfromrecordsof100ofherPxs– SendformalleZerwithlinktosite– DevelopC&Csub-domainforKP– Developintroduc7onandcomple7onpageonsite

•  Includepa7entsurvey– Minimizestudydemandsonclinicteam

9

•  PresbyterianEfficacyStudy– SixbehavioralhealthclinicsacrossABQ– PxsreferredtositebyclinicalpsychologistsbasedonresultsofAUDIT-C

– Providewithpamphletdescribingsitethatcontainsaccesscode

– DevelopC&Csub-domainforPMG– Developintroduc7onandcomple7onpageonsite

•  Includepa7entsurvey– Workintensivelywithteamtorefineprotocolforbroaderdissemina7onthroughoutPMG

10

•  Implementa7on:Analysis–  C&CtracksdataPxsinputtosite

•  DrinkingData•  Pxfeedbackaboutsite

–  C&CemploysGoogleAnaly7cstotrackengagementandusagepaZerns

–  KPandPMGF/UwithPxswhentheyreturntoclinic•  Notategenericpossibleoutcomes

–  Collaborateonplanfornextstep•  Presentclinicalandsiteengagementgroupdata•  Expandstudytoen7reclinicorfullyadopt•  Developabilitytocorrelatesiteusewithhealthoutcomes

11

CurrentStatus:12monthsin

•  Progressw/KaiserPermanente– SendingoutfirstbatchofleZerson9/23

•  Progressw/PresbyterianMedicalGroup– S7lldevelopingini7alprotocol– PreparingtopresenttoPMGmanagement

Conclusions

•  Implementa7onofnewtechnologyrequires:– Sensi7vitytoestablishedorganiza7onaldynamics

•  Rollingwithresistance•  Reflec7velistening

– Awarenessof

•  ResearchstaffatBTA(ini7aldevelopmentofCC)– WilliamCampbell,Ph.D.,KathrynLenberg,Ph.D.,TomHaney,M.S.(programmer)

•  StaffatCCLLC•  SherryPruiZ•  PMGPsychologists

– PaulWilson,leadpsychologist

14

Thanks

Thankyou!

References•  Damschroder,L.J.,Aron,D.C.,Keith,R.E.,Kirsch,S.R.,Alexander,J.A.&

Lowery,J.C.(2009).Fosteringimplementa7onofhealthservicesresearchfindingsintoprac7ce:aconsolidatedframeworkforadvancingimplementa7onscience.Implementa)onScience,4:50.

•  Hester,R.K.,Delaney,H.D.,&Campbell,W.(2012).TheCollegeDrinker’sCheck-up:Outcomesoftworandomizedclinicaltrialsofacomputer-basedbriefmo7va7onalinterven7on.PsychologyofAddic)veBehaviors,26,1-12.

•  Hester,R.K.,Delaney,H.D.,&Campbell,W.,(2011).Moderatedrinking.comandModera7onManagement:12-monthoutcomesofarandomizedclinicaltrial.JournalofConsul)ngandClinicalPsychology,79,215-224.AbstractathZp://psycnet.apa.org/psycinfo/2011-03047-001

References•  Hester,R.K.,Lenberg,K.L.,Campbell,W.,&Delaney,H.D.D.(2013b).

OvercomingAddic7ons,aweb-basedapplica7on,andSMARTRecovery,anonlineandin-personmutualhelpgroupforproblemdrinkersPart1:Three-MonthOutcomesofaRandomizedControlledTrial.JournalofMedicalInterneResearch,15(7):e134.

•  Hester,R.K.,Squires,D.D.,&Delaney,H.D.(2005).TheComputer-basedDrinker’sCheck-up:12monthoutcomesofacontrolledclinicaltrialwithproblemdrinkers.JournalofSubstanceAbuseTreatment,28(2),159-169.

•  Tabak,R.G.,Khoong,E.C.,Chambers,D.A.,&Brownson,R.C.(2012).Bridgingresearchandprac7ce:Modelsfordissemina7onandimplementa7onresearch.AmericanJournalofPreven)veMedicine,42(3),337-350.