1. CALM: Developing Interactive Computerized Brief Interventions
Joseph Conigliaro, MD, MPH
Center for Enterprise Quality and Safety
University of Kentucky

2. Interactive Computer Programs & BIs
Assess drinking status & readiness to change
Initiate provider delivered BIs
Prepare patient & provider for targeted session
Saves time
Facilitate individualized feedback immediately upon submission of data
lower-cost & customized intervention to more drinkers
Provide anonymity, convenience
Patient-centered BI computer programs
Would be useful for initiating and supporting PCP delivered BIs
Can prepare patient & provider for a more targeted, and effective session
And the computer collected data can be used to stimulate counseling sessions that address specific patient needs

3. Internet to Reduce Problem Drinking
Computers, and the internet integral part of life
80% of internet "surfers" in US used it to access health information
Drinkers may prefer this format
way to save face
can begin to look at their drinking in private and nonjudgmental way

4. Current Internet Programs
Accessible only to those with computer/internet
Geared toward younger persons
Not specific to HIV
Not linked to EMR
Not linked to provider
Not linked to clinic visit

5. Specific Aims
Test and adapt an alcohol screening and interactive computer prototype using iterative process of user testing, focus groups and face-to-face interviews with provider & patients
Gather information on effect size of intervention to reduce consumption, and HIV relevant consequences (sexual risk behavior & antiretroviral medication adherence)

6. Computer Assisted Lifestyle Management (CALM)
Identifies hazardous drinkers
Alcohol Use Disorders Identification Test (AUDIT)
Quantity and frequency of consumption
Alcohol related consequences
HIV and alcohol related consequences
Medication adherence
Risky sexual behavior
Readiness to change

7. CALM Delivers Brief Intervention
Patients & providers explore alcohol severity, consequences, goals & Rx barriers
Brief negotiation using FRAMES & Stages of Change
Computer intervention pulls data from electronic medical record and pushes documentation
Specifically the CALM Brief Intervention
Allows Patients & providers to explore alcohol severity, consequences, drinking goals & treatment barriers
Based on form of brief negotiation using FRAMES and the Stages of Change model which I will describe in more detail
Calm is Delivered on a touch screen tablet computer
The Patient print out includes a patient determined treatment plan
Providers receive a print out that includes the patient responses & the patient determined treatment plan

8. FRAMES Feedback Responsibility Advice Menu of options Empathy
Specific and relative to mental, physical & psychosocial health
Responsibility
Stated explicitly by CALM
Advice
Simple and explicit; given as a prescription
Menu of options
Patient chooses goal that matches needs & situation
Increases perceived personal choice and control
Empathy
Acknowledge difficulty of change
By health care provider
Self efficacy
Statements of hope and optimism
Feedback
After thorough assessment on specific behaviors and how they affect mental, physical, and psychosocial health
Enables the patient to view him/herself in terms of drinking and health, and in comparison to population norms
Responsibility
Changing behavior is patient’s responsibility Stated explicitly or implicitly with availability of self-help material

9. CALM

10. Qualitative Evaluation

11. CME Fundamentals of Brief Interventions
NIAAA Guideline and NYSDOH AIDS Institute Guideline
Similar to collaborative effort with NYS HIV providers
Incorporates CALM

12. New study site University of Kentucky Blue Grass Clinic
Rural community (40%)
18% women
800 unique patients

13. CALM SPECS
Java/J2EE application that runs on a Tomcat application server and Appache 2.2 web server
Database is MySql 5.0
Follows MVC (Model-View-Controller) object oriented design pattern
Java servlets used to implement Controller
JSPs used for presentation of data (the View)
Java classes are the Model

14. Methodological Issues
Is the clinic an appropriate venue to administer CALM? Role of Internet?
What is the best way to deliver info to providers?
Timing of intervention with respect to provider visit?

15. Methodological Issues
Minimal set of adherence questions?
Minimal set of risky sexual behavior questions?
Should we adjust the threshold for “hazardous” drinking in the HIV Population?

16. CALM Website Can be used as:
Authoring program of BIs
Management of BIs
Reporting/statistical tool (all data can be exported into Excel, CSV or HTML format)
Provides application level security, where Administrators (aka super-users) can manage access/privileges of other users

17. BI Portal

21. Reports

27. Future enhancements: Question Library
Allow multimedia to be inserted into Brief Intervention text
HTML toolbox to allow formatting of text questions
Definition links

28. CALM
NIAAA
University of Kentucky
Baltimore VA
Pittsburgh VA
VACS