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Clinical Trial Details — Status: Completed

Administrative data

NCT number NCT05252221
Other study ID # 1564446
Secondary ID R01AA028211
Status Completed
Phase N/A
First received
Last updated
Start date September 14, 2021
Est. completion date August 31, 2023

Study information

Verified date April 2024
Source Kaiser Permanente
Contact n/a
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

This pragmatic, cluster-randomized trial in adult primary care clinics in a healthcare system with a diverse membership will examine the effectiveness of an innovative, multi-faceted intervention, the Addiction Telemedicine Consultant (ATC) service using clinical pharmacists to facilitate alcohol use problems and alcohol use disorder (AUD) pharmacotherapy and specialty addiction treatment entry.


Description:

This study will examine the effectiveness of a multi-faceted intervention - the Addiction Telemedicine Consultant service, or "ATC," which consists of: - A 1-hour information session for Primary Care Providers (PCP) about alcohol problems; including alcohol use disorder (AUD) and AUD pharmacotherapy, provided by the research team in collaboration with Kaiser Permanente Northern California (KPNC) addiction medicine and clinical pharmacy leadership. Along with a post session evaluation via survey monkey. - PCP access to expert addiction medicine consultation by KPNC clinical pharmacists, via telephone, videoconference, and secure messaging - during primary care patient visits with the patient present, or asynchronously without the patient present. - Real-time, in-exam-room consultations may include clinical pharmacist assistance with patient assessment, psychoeducation, motivational interventions, and facilitation of patient engagement in addiction treatment. - Asynchronous consultations without the patient present may include clinical pharmacist advice regarding patient-specific treatment options, including pharmacotherapy, psychosocial treatment, and combined treatments, - Ongoing technical assistance for PCPs, including coaching and troubleshooting on alcohol problems assessment and AUD medication prescribing and treatment entry facilitation, from the ATC consultants, as needed. This study will use electronic health record (EHR) data to examine treatment arm effects on implementation outcomes and patient outcomes recorded during the course of regular clinical care, and health services utilization over two years. The study will accomplish this through the following specific aims: Aim 1: To compare the ATC and Usual Care arms on implementation outcomes: AUD medication prescription order rates and specialty addiction treatment referrals over two years. Aim 2: To compare the ATC and UC arms on patient outcomes: AUD medication fills, addiction treatment initiation, alcohol use (quantity/frequency), and services utilization over two years. Aim 3: To understand characteristics associated with ATC implementation, and barriers and facilitators of AUD medication prescription. We will examine provider characteristics (including potential race/ethnic and gender disparities) associated with ATC implementation outcomes using EHR and semi-structured qualitative interviews with PCPs and explore how the different elements of ATC (video consult, telephone, and email) facilitate its implementation. Provider characteristics and EHR portions of this aim involve data only.


Recruitment information / eligibility

Status Completed
Enrollment 41843
Est. completion date August 31, 2023
Est. primary completion date August 31, 2023
Accepts healthy volunteers No
Gender All
Age group 18 Years and older
Eligibility Inclusion Criteria: - Adult KPNC members who had a primary care visit in Oakland or San Francisco Medical Center between 01/01/2020 and 12/31/2021 (~250,000) - PCPs working in Oakland and San Francisco Medical Centers (~300). - Chief physicians, PCPs, and medical assistants working the intervention arm clinics (n~40 Key Informants). Exclusion Criteria:

Study Design


Intervention

Other:
ATC Intervention
The ATC intervention offers convenient access to specialty consultation for PCPs and offers patients direct access to addiction treatment in a non-stigmatized primary care setting

Locations

Country Name City State
United States Kaiser Permanente Oakland California
United States Kaiser Permanente San Francisco California

Sponsors (2)

Lead Sponsor Collaborator
Kaiser Permanente National Institute on Alcohol Abuse and Alcoholism (NIAAA)

Country where clinical trial is conducted

United States, 

Outcome

Type Measure Description Time frame Safety issue
Primary Implementation Outcomes AUD Medication Prescription Rate 2 years
Primary Implementation Outcomes Rates of referrals to specialty addiction treatment 2 years
Primary AUD Medication Fills AUD Medication Fills 2 years
Primary Addiction Treatment Initiation Rate Addiction Treatment Initiation Rate 2 years
Primary Alcohol use (quantity/frequency) Alcohol use (quantity/frequency) 2 years
Primary Rates of referral to specialty Addiction Medicine department Specialty addiction treatment referrals 2 years
Primary Rates of emergency department utilization in the intervention arms Health Service Utilization 2 years
Primary Rates of inpatient services utilization in the intervention arms Health Service Utilization 2 years
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