This proposal is a collaboration of the University of Wisconsin, Dartmouth College, Forward Health Group, Arapahoe SUD treatment, Access, Salud and Partnership community health centers, and The National Council for Community Behavioral Health and led by multiple PIs David H. Gustafson PhD and Lisa Marsch PhD. Primary care providers are being asked to integrate substance use disorder (SUD) treatment and HIV care into their practices. That means adding a new, complex caseload to an already overburdened system. We propose to test a strategy to implement a wireless smart phone based delivery system, composed of proven treatment and recovery computer programs that will add SUD services and HIV care but relieve the burden. Two information and communication systems have demonstrated ability to improve the effectiveness of SUD treatment and HIV care (TES) and continuing care (ACHESS). While their potential is great, success relies not only on technology, but on a creating a welcoming environment and effective processes to implement and sustain. We propose to overcome key barriers to integrating substance abuse treatment and HIV care into primary care by using a blending of three proven strategies (informed by quality improvement) to implement a seamless combination of evidence-based computer assisted system called Seva (the Sanskrit word for selfless caring). Seva includes: TES addiction treatment, ACHESS relapse prevention, video counseling as well as registry PopulationManager. Seva integrates HIV risk behaviors, status, and services into both the patient interface and provider registry components. Each component of Seva has proven to be effective, but each has its own interface and operates independently making it difficult to easily take advantage of their synergistic potential. We hypothesize that our implementation strategy will create welcoming environment, and enhance implementation success and sustainability by removing barriers and building on facilitators, thus allowing Seva to flourish. We will use quantitative and qualitative methods to determine how much our implementation of SEVA will improve: Reach, Effectiveness, Adoption, Implementation and Maintenance. We will implement Seva in 3 FQHCs. One FQHC (ACCESS community health center in Madison) will be used to test and refine the implementation strategy and adapt SEVA to meet FQHC needs and ensure ease of use. Two other FQHCs will receive SEVA at six-month intervals in a stepped wedge (multiple baseline) design. A coach will be assigned to each FQHC (as is common in quality improvement) to help implement, operate and sustain SEVA. We will measure impact on the FQHC over a three year period.
Smart phones and other wireless technologies have been proven to reduce the burden of treatment and continued care for people with substance use disorders and HIV. Using these technologies may make it practical to treat these illnesses in primary care, a change health policy makers advocate. We propose testing the use of such technology to treat addiction in three federally supported, primary care clinics in Colorado, Montana, and Wisconsin.
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