1. 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, 2011Washington, DC

2. Presenter Disclosures November 1, 2011APHA 20112 (1)The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: Dennis McCarty No relationships to disclose

3. Overview and Research Question  CTN tests behavioral and pharmaceutical treatments for drug abuse  Multiple sites in each trial  Treatment programs differ:  Client population  Clinicians  Organizational factors  Do organizational and workforce variables influence intention to adopt treatment innovations? November 1, 20113APHA 2011

4. How we measured site differences  Workforce characteristics  Clinician demographics and attitudes  Training and recovery status  Organizational characteristics  Treatment orientation (e.g. 12-step only vs. methadone)  Caseloads and productivity expectations  Culture November 1, 20114APHA 2011

5. What do we know?  Variation in healthcare outcomes – it’s nothing new!  Variation in drug treatment outcomes  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  Site by treatment interactions  Distance to outpatient predicted treatment entry (Campbell, et al., 2010) November 1, 20115APHA 2011

6. Site Influences on Treatment Effects (SITE): Goals 1. Assess workforce and organizational variables 2. Examine adoption intentions  Behavioral vs pharmaceutical trials? 3. Explore workforce and organizational influences on patient outcomes* * Planned future analyses November 1, 20116APHA 2011

7. SITE: How was it done?  Collected data from 5 CTN trials  Results from two trials testing innovations  Web-based CBT  Smoking Cessation Medications  Workforce survey  Demographics  Attitudes, social norms and intentions (Theory of Reasoned Action – Ajzen & Fishbein, 1980 )  Data collected before beginning each trial November 1, 20117APHA 2011

8. Two CTN Trials Examined  Web Delivery of Psychosocial Interventions  Web delivered CBT  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)  Smoking cessation medication: bupropion XL & nicotine inhaler  Significant site differences  Counselor characteristics  race, age, education, recovery status  Attitudes, social norms, adoption intention,  Smoking cessation treatment efficacy attitudes November 1, 20118APHA 2011

9. WEB: Intentions vary by site November 1, 20119APHA 2011

10. S-CAST: Intentions vary by site November 1, 201110APHA 2011

11. SITE: Intention to adopt treatment  Workforce and organizational variables were not significant predictors of intentions to adopt behavioral or pharmacological therapies  Web Delivery of Psychosocial Interventions  Social norms were the strongest predictor of intention  Smoking Cessation and Stimulant Treatment  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) November 1, 201111APHA 2011

12. Acknowledgements November 1, 2011APHA 201112  An award (U10 DA015815) from the National Institute on Drug Abuse supported the collection and analysis of study data.