Impact of enhancements to smartphone-based continuing care for alcohol dependence

描述（由申请人提供）：持续护理在物质使用障碍患者的管理中非常重要。新的智能电话通信技术提供了一种新的方式，在酒精治疗后提供个性化的持续护理支持。威斯康星州大学的Gustafson博士和同事最近开发了一种成瘾版本的综合健康增强支持系统（CHESS），这是一种智能手机系统，提供一系列直接支持患者的功能。在随机试验中，CHESS显著改善：（a）生活质量和自我效能 （B）艾滋病毒感染者的生活质量和护理费用，（c）幼儿的哮喘控制，（d）肺癌患者的死亡质量和生存时间。 最重要的是，最近完成的一项由NIAAA资助的关于成瘾版CHESS（ACHESS）的研究结果表明，当向离开住院治疗的患者提供时，它比标准的持续护理产生更好的饮酒结果。该系统的特点包括：与家人、朋友和其他处于恢复期的人接触，进入讨论组，获得其他恢复支持，并获得有关应对压力源的定制信息的网络链接。当患者接近危险地理区域时，全球定位系统（GPS）发出警报~警报/预约提醒~正在进行的微型评估和登记（监测）~以及紧急按钮（患者或GPS激活）。麦凯和同事们还开发了一种基于电话的持续护理方法，电话监测和咨询（TMC），该方法已在两项针对酒精依赖患者的随机试验中证明了疗效。虽然非洲儿童健康和营养状况评估和旅行管理中心的干预措施使用电话技术，但它们具有互补的优势。ACHESS提供自动化的24/7康复支持服务和频繁的症状和状态评估，但不涉及与顾问的定期联系。TMC，另一方面，提供定期和持续的联系与同一辅导员，但不提供持续的支持之间的电话。酒精使用障碍的持续护理的未来可能涉及自动化移动的技术和咨询师联系，但很少有人知道如何最好地整合这些服务。为了解决这个问题， 该研究将采用2 × 2设计[12个月的ACHESS（是/否）× 12个月的TMC（是/否）]，其中280名在强化门诊计划（IOP）中的酒精依赖患者将被随机分配到四种情况中的一种，并随访18个月。我们将确定在ACHESS中加入TMC是否比单独使用TMC或ACHESS产生更少的重度饮酒天数，并测试TMC和ACHESS的主效应。我们还将进行经济分析，以确定每种干预措施及其组合的成本和成本效益。其他分析将检查次要结果，包括酒精使用的生物学测量以及假设的适度和调解效应。该研究的结果将产生重要的信息，通过整合移动的自动恢复支持和咨询师联系，改善患者酒精使用的结果。

DESCRIPTION (provided by applicant): Continuing care is important in the management of patients with substance use disorders. New SMART Phone communication technology provides a novel way to provide personalized continuing care support following alcohol treatment. Dr. Gustafson and colleagues at the University of Wisconsin have recently developed an addiction version of the Comprehensive Health Enhancement Support System (CHESS), a smart phone system that provides a range of functions that directly support patients. In randomized trials CHESS significantly improved: (a) quality of life and self-efficacy for women with breast cancer, (b) quality of life and costs of care in people with HIV, (c) asthma control for young children, and (d) quality of dying and survival length for lung cancer patients. Most important, findings from a recently completed NIAAA-funded study of an addiction version of CHESS (ACHESS) indicated that it produces better drinking outcomes than standard continuing care when provided to patients leaving inpatient treatment. The system's features include: Access to family, friends, and others in recovery access to discussion groups, other recovery supports, and web links tailored information on coping with stressors. Global Positioning System (GPS) alerts when patients approach risky geographic areas~ alerts/reminders of appointments~ ongoing mini assessments and check-ins (monitoring)~ and a panic button (patient or GPS activated). McKay and colleagues have also developed a telephone- based approach to continuing care, Telephone Monitoring and Counseling (TMC), which has demonstrated efficacy in two randomized trials with alcohol dependent patients. Although the ACHESS and TMC interventions use telephone technology, they have complementary strengths. ACHESS provides automated 24/7 re- co very support services and frequent assessment of symptoms and status, but does not involve regular con- tact with a counselor. TMC, on the other hand, provides regular and sustained contact with the same counselor, but does not provide ongoing support between calls. The future of continuing care for alcohol use disorders is likely to involve both automated mobile technology and counselor contact, but little is known about how best to integrate these services. To address this question, the study will feature a 2 x 2 design [ACHESS for 12 months (yes/no) x TMC for 12 months (yes/no)], in which 280 alcohol dependent patients in an intensive outpatient program (IOP) will be randomized to one of the four conditions and followed for 18 months. We will determine whether adding TMC to ACHESS produces fewer heavy drinking days than TMC or ACHESS alone, and test for TMC and ACHESS main effects. We will also conduct economic analyses, to determine the cost and cost-effectiveness of each intervention and their combination. Additional analyses will examine secondary outcomes, including a biological measure of alcohol use, and hypothesized moderation and mediation effects. The results of the study will yield important information on improving patient alcohol use outcomes by integrating mobile automated recovery support and counselor contact.