Treatment retention and reductions in blood alcohol concentration (BAC) during the first 90 days of a telehealth program for alcohol use disorder.

Background: Alcohol use disorder (AUD) treatments, including medications, are increasingly offered via telehealth.Objective: This study characterizes 90-day treatment retention and changes in objectively measured blood alcohol concentration (BAC) in a large cohort receiving AUD telehealth.Methods: Patients received AUD treatment through Ria, a virtual (telehealth) program offering AUD treatment that is tailored to patient goals (e.g. abstinence or controlled drinking). Patients were encouraged to complete breathalyzer readings twice daily for measurement-based care. We characterized rates of 90-day treatment retention (i.e. completing a BAC reading or medical/coaching encounter on the 90th day or later) and used growth curve analyses to model changes in daily estimated peak BAC over 90 days.Results: Of 4121 patients (51.5% women), 50.1% had 90-day treatment retention (n = 2066, 52.2% women). Most patients received prescriptions for AUD medications (84.6%) and completed encounters with medical providers (86.7%) and coaches (86.1%). Patients with 90-day retention provided 184,817 BAC readings in the first 90 days. Growth curve analyses revealed significant reductions in daily estimated peak BAC (p < .001) from a mean of 0.092 (day 1) to 0.038 (day 90). Similar magnitudes of BAC reduction were observed for men and women and for patients with abstinence and controlled drinking goals.Conclusion: Telehealth appears to be a viable approach to delivering AUD treatments in a manner that promotes drinking reductions. Telehealth approaches can yield reductions in objectively measured BAC, including for some patient subgroups that have historically faced greater stigma in AUD treatment settings, such as women and people with non-abstinence drinking goals.

The Psychiatric Assessment and Brief Intervention Program: Partnering With Primary Care Providers.

OBJECTIVE: To present the structure and outcomes to date for the Psychiatric Assessment and Brief Intervention (PABI), a pilot program developed at University of California, San Francisco, to improve access of primary care patients to mental health services. PABI offers diagnostic evaluations and brief (up to 3 months) evidence-based treatment, including pharmacologic management and psychotherapy, to medical patients 18 years of age and older. Core PABI features are ensuring prompt access, actively partnering with patients and referring providers, and coordinating seamless transitions of care. METHODS: Demographic and clinical variables and outcome indicators were collected for all patients seen in PABI from October 2015 to June 2017. Descriptive statistics and mixed-effects linear models were used to analyze the data. RESULTS: During the study period, 139 patients (54% women, mean [SD] age of 48.2 [17.5] years) with a mean of 2 DSM-5 psychiatric diagnoses each (range, 1-5) were seen. Mean time to access was 8 days, with a mean length of stay in the program of 11 weeks. Compared to baseline, final behavioral health measure scores showed significant improvement: the mean Patient Health Questionnaire-9 score decreased by 5.9 points (95% CI, 4.6-7.2), and the mean 7-item Generalized Anxiety Disorder scale score was 4.4 points lower (95% CI, 3.2-5.6; both P values < .0001). CONCLUSIONS: This brief psychiatric treatment program provides prompt access to quality mental health care for patients with medical comorbidities. Results to date suggest that this program leads to significantly improved clinical outcomes. Further research is needed to determine its long-term sustainability and generalizability.