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Integrated Collaborative Care for Substance Use Disorders (SUMMIT)

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ClinicalTrials.gov Identifier: NCT01810159
Recruitment Status : Completed
First Posted : March 13, 2013
Last Update Posted : April 27, 2017
Sponsor:
Information provided by (Responsible Party):
RAND

Brief Summary:

Primary care settings (PCS) are a missed opportunity for delivering evidence-based treatments for opiate and alcohol-use disorders (OAUD). The investigators propose to evaluate the costs and effectiveness of two strategies to increase the delivery of OAUD treatments in PCS, integrated collaborative care (ICC) and education and resources (E&R). The investigators hypothesize that ICC will be more effective than E&R in promoting A. Implementation outcomes B. Service system outcomes and C. Patient outcomes.

Results from our study will help providers choose between two different strategies and advance the field of implementation research.


Condition or disease Intervention/treatment Phase
Substance Use Disorders Other: Integrated collaborative care Other: Education and Resources Not Applicable

Detailed Description:

Most individuals with opiate and alcohol-use disorders (OAUD) do not receive treatment. Primary care is an ideal setting in which to deliver OAUD treatment, yet evidence-based OAUD treatment is rarely provided.

Barriers to delivery include insufficient organizational support and lack of provider role models and clinical support. The investigators propose to evaluate the effectiveness of two strategies for increasing use of evidence-based treatment for OAUD within primary care: integrated collaborative care (ICC) and education and resources (E&R). While both strategies provide primary care practices with the same clinical information, ICC addresses these barriers by including organizational and technical support for delivering evidence-based care. ICC is grounded in the chronic care model and includes a behavioral health provider working as part of the care team.

Essential elements of ICC strategy include a decision support component to help providers with complex patients, and a restructuring of the delivery and clinical information systems to support the delivery of evidence-based care. Our approach to implementing ICC is based on the organizational transformation model and quality improvement. The investigators define the E&R strategy as providing printed educational materials and access to resources along with provider education. Both strategies are designed to increase the delivery of two evidence-based practices: motivational enhancement therapy and medication assisted therapy.

The investigators propose a 5-year mixed methods study and will conduct a RCT, with randomization occurring at the level of the care team and patient. The investigators partner with 5 Venice Family Clinic (VFC) clinics, two hospitals in LA County, and COPE Health Solutions. VFC is a large federally qualified health center (FQHC) and the largest free clinic in the United States. Our approach includes document review, focus groups, interviews, and surveys for obtaining data on the adoption process and implementation outcomes; analysis of patient records and patient surveys on service system and patient outcomes; and analysis of provider financial records and patient records and surveys for estimating costs. The investigators will enroll 400 patients with an OAUD diagnosis and follow them at 3 and 12 months. Our specific aims are: 1) To measure the process and extent of ICC and E&R implementation; 2) To test the effectiveness of ICC compared to an E&R strategy in promoting A. Implementation outcomes B. Service system outcomes and C. Patient outcomes; and 3) To estimate provider costs for each strategy. The investigators define implementation outcomes as measures of the acceptability, adoption, appropriateness, feasibility, and sustainability of evidence-based OAUD treatment. The investigators define service system outcomes as 1) process measures of treatment quality and 2) treatment co-morbidities. The investigators define patient outcomes as hospital readmissions, OAUD outcomes, patient functioning, negative consequences from substance use, and unmet need. The investigators define cost outcomes as start-up costs, operating costs and medical/psychiatric cost offsets.


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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 397 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Masking Description: We used an R software random number generator to randomly assign eligible participants to either CC or usual care. We used a concealed randomization protocol where neither participant nor researcher (outside of the statistician doing the randomization) was aware of the randomization until after the baseline interview. None of the participants or providers was blinded to treatment allocation after randomization. Interviewers were blinded to treatment allocation
Primary Purpose: Health Services Research
Official Title: Integrated Collaborative Care for Substance Use Disorders
Study Start Date : June 2014
Actual Primary Completion Date : September 2016
Actual Study Completion Date : January 2017

Arm Intervention/treatment
Experimental: ICC
Integrated collaborative care
Other: Integrated collaborative care
Active Comparator: E&R
Education and Resources--enhanced usual care
Other: Education and Resources



Primary Outcome Measures :
  1. unmet need [ Time Frame: past 6 months ]
    Of those identified as screening positive for an opiate or alcohol use disorder, proportion who did not receive treatment for their substance use

  2. abstinent from alcohol and opioid use, past 30 days [ Time Frame: past 30 days ]
    change in abstinence from alcohol and opioid use between baseline and 6 month follow up

  3. negative consequences related to substance use [ Time Frame: past 3 months ]
    SIP-AD frequency questionnaire

  4. Functioning [ Time Frame: past 4 weeks ]
    change in SF-12 between baseline and follow up

  5. Engagement [ Time Frame: 30 days of initiation ]
    Proportion with at least 2 SUD-related visits within 30 days of initiation, Washington Circle

  6. initiation [ Time Frame: Within 14 days of index visit ]
    Washington Circle initiation indicator--at least one SUD-related visit within 14 days of index visit

  7. heavy alcohol use [ Time Frame: 6 months ]
    among people at baseline with heavy alcohol use, proportion with heavy alcohol use in past 30 days


Secondary Outcome Measures :
  1. Proportion initiating Brief therapy [ Time Frame: 6 months ]
    Proportion initiating brief therapy within 6 months

  2. Proportion initiating MAT [ Time Frame: 6 months ]
    Proportion initiating MAT within 6 months, among those eligible for MAT, and if N's are large enough, stratified by type of MAT

  3. abstinence from alcohol, opioids and all other drugs in the previous 30 days [ Time Frame: collected at six months at the past 30 days ]
    abstinence from alcohol, opioids and all other drugs in the past 30 days



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • opiate or alcohol use disorder
  • not currently in substance use disorder treatment
  • past 30 day use of alcohol or opioids
  • English or Spanish speaking

Exclusion Criteria:

  • co-morbid severe mental illness
  • medically unstable

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01810159


Locations
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United States, California
Venice Family Clinic-Simms Mann Health Center
Santa Monica, California, United States, 90405
Venice Family Clinic-Rose lAvenue
Venice, California, United States, 90291
Sponsors and Collaborators
RAND

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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Responsible Party: RAND
ClinicalTrials.gov Identifier: NCT01810159     History of Changes
Other Study ID Numbers: R01DA034266 ( U.S. NIH Grant/Contract )
First Posted: March 13, 2013    Key Record Dates
Last Update Posted: April 27, 2017
Last Verified: April 2017

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by RAND:
substance use disorders
implementation science
collaborative care
opiate disorders
alcohol disorders
Additional relevant MeSH terms:
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Disease
Substance-Related Disorders
Pathologic Processes
Chemically-Induced Disorders
Mental Disorders