Long-term outcomes of office-based buprenorphine/naloxone maintenance therapy.

BACKGROUND: Buprenorphine/naloxone was approved by the FDA for office-based opioid maintenance therapy (OMT), with little long-term follow-up data from actual office-based practice. 18-Month outcome data on the office-based use of buprenorphine/naloxone (bup/nx) and the impact of socioeconomic status and other patient characteristics on the duration and clinical effects of bup/nx are reported. METHODS: This retrospective chart review and cross-sectional telephone interview provide treatment retention of opioid-dependent patients receiving bup/nx-OMT in an office-based setting. 176 opioid-dependent patients from two different socioeconomic groups (high and low SES) were begun on bup/nx, started intensive outpatient treatment, and followed-up after a minimum of 18 months (18-42 months) by telephone interview to assess treatment outcome. RESULTS: 110 subjects (67%) completed the interview, 77% remained on bup/nx with no difference in retention between high and low SES groups. Those on bup/nx at follow-up were more likely to report abstinence, to be affiliated with 12-step recovery, to be employed and to have improved functional status. CONCLUSIONS: Bup/nx-OMT is a viable treatment option and when coupled with a required abstinence oriented addiction counseling program is effective in promoting abstinence, self-help group attendance, occupational stability, and improved psychosocial outcomes in both low SES and high SES patient populations over an 18-42-month period.

Experiences with ARTEMIS--an Internet-based telemedicine system.

ARTEMIS is one of the first systems to exploit the Internet/Intranet technologies for exchanging patient information among health care providers. The primary project goal was to develop and demonstrate a regional telehealth environment specifically to support real-time consultations among health care providers via a computer network, provide secure access to multi-media patient records and discharge summaries, facilitate authentication/digital sign-off, multi-media mail-based referrals, and network-based dictation/transcription. A prototype is deployed in southern West Virginia in a Community Care Network (CCN). The CCN consists of providers, hospitals, clinics, laboratories, that make up one "Virtual" clinic on the "Intranet". ARTEMIS employs new technologies such as Java and JavaScript for the browser, and CORBA-based "middleware" for interoperability at the server-end. Several experiments were designed for evaluating the impact of ARTEMIS on patient care. In this paper we discuss the challenges we faced and the means by which we plan to meet these challenges. We conclude by outlining new thrust areas in which we are concentrating in our next phase of development of ARTEMIS.

Evaluation of Community Care Network (CCN) system in a rural health care setting.

Concurrent Engineering Research Center (CERC), under the sponsorship of NLM (National Library of Medicine) is in the process of developing a computerized patient record system for a clinical environment distributed in rural West Virginia. This realization of the CCN (Community Care Network), besides providing computer-based patient records accessible from a chain of clinics and one hospital, supports collaborative health care processes like referral and consulting. To evaluate the effectiveness of the system, a study was designed and is in the process of being executed. Three surveys were designed to provide subjective measures, and four experiments for collecting objective data. Data collection is taking place in several phases: baseline data are collected before the system is deployed; the process is repeated with minimal changes three, then six months later or as often as new versions of the system are installed. Results are then to be compared, using whenever possible matching techniques (i.e. the preliminary data collected on a provider will be matched with the data collected later on the same provider). Surveys are conducted through questionnaires distributed to providers and nurses and person-to-person interviews of the patients. The time spent on patient-chart related activities is measured by work-sampling, aided by a computer application running on a laptop PC. Information about missing patient record parts is collected by the providers, the frequency by which new features of the computerized system are used will be logged by the system itself and clinical outcome measures will be studied from the results of the clinics' own patient chart audits. Preliminary results of the surveys and plans for the immediate and distant future are discussed at the end of the paper.