Transcript Quarterly Results and FY 2006 Financial Outlook

Community-based Clinical Trials: Site
Variation and Adoption of Innovation
Dennis McCarty, PhD
Allie Buti, MPH
Lynn Kunkel, MS, CCRP
Holly Fussell, PhD
Danielle Eakins, BA
Michele Straus, MS, RPh
American Public Health Association Annual Meeting
November 1, 2011
Washington, DC
Presenter Disclosures
Dennis McCarty
(1)
The following personal financial
relationships with commercial interests relevant to
this presentation existed during the past 12
months:
No relationships to disclose
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Overview and Research Question
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CTN tests behavioral and pharmaceutical
treatments for drug abuse
Multiple sites in each trial
Treatment programs differ:
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Client population
Clinicians
Organizational factors
Do organizational and workforce
variables influence intention to
adopt treatment innovations?
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How we measured site differences
 Workforce characteristics
 Clinician demographics and attitudes
 Training and recovery status
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Organizational characteristics
 Treatment orientation (e.g. 12-step only
vs. methadone)
 Caseloads and productivity expectations
 Culture
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What do we know?
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Variation in healthcare outcomes – it’s nothing new!
Variation in drug treatment outcomes
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Staff attitudes affect treatment (Campbell, et al., 1997)
Site characteristics affect retention (Simpson et al., 1997)
Number of beds affect length of stay (Jonkman et al., 2005)
Variation in CTN Trials
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Site by treatment interactions
Distance to outpatient predicted treatment entry
(Campbell, et al., 2010)
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Site Influences on Treatment Effects
(SITE): Goals
1. Assess workforce and
organizational variables
2. Examine adoption intentions
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Behavioral vs pharmaceutical trials?
3. Explore workforce and
organizational influences on patient
outcomes*
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* Planned future analyses
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SITE: How was it done?
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Collected data from 5 CTN trials
Results from two trials testing innovations
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Workforce survey
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Web-based CBT
Smoking Cessation Medications
Demographics
Attitudes, social norms and intentions
(Theory of Reasoned Action – Ajzen & Fishbein, 1980)
Data collected before beginning each trial
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Two CTN Trials Examined
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Web Delivery of Psychosocial Interventions
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Web delivered CBT
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Significant site differences
 Counselor characteristics
 race, age, education, recovery status
 Perceived social norms, adoption intention
 Web-delivered treatment efficacy attitudes
S-CAST (Smoking Cessation and Stimulant Treatment)
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Smoking cessation medication: bupropion XL & nicotine inhaler
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Significant site differences
 Counselor characteristics
 race, age, education, recovery status
 Attitudes, social norms, adoption intention,
 Smoking cessation treatment efficacy attitudes
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WEB: Intentions vary by site
Intention to Adopt Web-Delivered Psychosocial
Interventions by Site
Mean Intention Score
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Site
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S-CAST: Intentions vary by site
Mean Intention Score
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Intention to Adopt Smoking Cessation Treatment by Site
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Site
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SITE: Intention to adopt treatment
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Workforce and organizational variables were
not significant predictors of intentions to adopt
behavioral or pharmacological therapies
Web Delivery of Psychosocial Interventions
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Smoking Cessation and Stimulant Treatment
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Social norms were the strongest predictor of intention
Social norms were the strongest predictor of intention
Adopt web-based CBT intention (mean = 2.0)
Adopt smoking medications intention (mean =
1.5) (7-point scale scored -3 to +3)
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Acknowledgements
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An award (U10 DA015815) from the National Institute
on Drug Abuse supported the collection and analysis of
study data.
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