CareCreds
Results from using CareCreds

 
 
 
"After just nine months using CareCreds 83.9%  of our Class A addicts were testing street-clean of opiates
and one third of our patients quit all Class A via a CareCreds-assisted Home Detox"

"After just three months in our outcome study, we saw a doubling of the number of our patients earning more than 50% of the credit available to them for taking better care of themselves and others.  After just nine months 83.9 % were street-clean and one third of all our patients had come off  Class A drugs completely i.e.  including Methadone and Subutex." 


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"The result of giving patients stress-reducing personal care with earnings related rewards and praise for taking better care of themselves and others is exceeding our highest expectations. Our CareCred assisted detox and rehab is now getting the majority of sufferers off street drugs and seems to be two hundred percent more effective than usual care and achieves its results for less than a hundredth of the average cost."  See our NICE Report

 SYNOPSIS

41  patients were entered into our outcome study aged between 23 and 62yrs old. They represented over 10% of all the Class A patients being treated in Kingston Upon Thames. 31  completed nine months in the study at the end of April 2010.

  • 35% were looking for work,  and 10% were actually working.
  • There was only one unplanned discharge in over three years and he quickly requested to return (The National Treatment Agency  is pleased if patients can be retained in treatment for even three months)
  • 97% stopped injecting
  • 33 % stopped ALL opiates (including Methadone /Subutex)
  • 94% made Excellent to Good overall progress

Anecdotally nearly all of these patients caused practice staff much less nuisance.

  • Police reported that Kingston was the safest London Borough in 2008; with a large drop in the Crime rate;
  • Burglary  by 3% Criminal damage by 6% Theft & Violence by 10%.
  • In the town centre near where our practice is situated, Criminal damage dropped by 17% Violence against person by 22% and Theft by 24%
 
          Two moved out of our area, one left then requested to return. One tragically died while self-injecting another died of a heart attack unrelated to drugs another patient tragically died of heart failure having completely conquered a thirty year opiate problem with carecreds. At the start most were on Methadone but 34% were using street drugs on top with 17% injecting. 34% had additional alcohol problems, 45% used Cannabis and 86% smoked tobacco. 70% were depressed and only 10% did any exercise. 55% had housing problems and 72% were stressed by shortage of money. Many had serious difficulties reading and writing.
          Analysis of the results of those who have spent at least three months in the study revealed a large (30%) increase in overall CareCred earnings after just this brief time. The Carecred score is, in itself, a measure of healthcare improvement. At the start 13/31 (41.9%) were earning 14 or more CareCreds i.e. half of those available to them. After three months 26/31 (83.9%) had reached this target. This is statistically highly significant p=0.00075.
          Results indicated that giving earnings-related vouchers is the most effective strategy; 82% of this group show improvement in their Carecred scores  as opposed to only 54% in Flat rate earners. The latter  were no better than the Control (no voucher) group.
Looking at the reduction of drug addiction. After nine months using ECBC 83.9% (26/31) were testing free of all Street Class A drugs on random urine testing. Furthermore  33.3% (10/31) had come off all opiates i.e. including Methadone and Subutex. This is a highly significant result as all patients were opiate users before. Neverthe less we feel it is important to maintain surveillance for as long as possible after patients become street clean as a 25% relapse rate has been reported in other studies and believe that he long-term retention of patients using ECBC will enable us to assess relapse rates better.
 
COMMENT
 
         Recent government figures claim that £1 Billion a year is spent on treating Class A addiction (and a further £13.9 Billion on imprisonment for drug-linked crime!). Overall 165,000 patients (?episodes) were treated annually but only 15000 were free of dependency on discharge. i.e. a success rate of 9% at a cost of £66,700 per success. ECBC by contrast has got 33.3% of its patients drug-free after only nine months for less than £778 per success i.e. a hundredth of the cost.
         Despite this, unfortunately Kingston SPAD (Strategic Partnership for Drugs & Alcohol), who had already extended our funding till Easter 2010, were not be able to continue after this date because of Credit Crunch cuts to their budget.  Since stopping three patients who were doing well continued to complete home detox. Two others who were not benefitting so much  become more unstable and perhaps not coincidentally the local figures for theft have begun to rise.
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SARAH & SUMMER June 2012

                                              Sarah*and Summer  
                            A CareCreds Case Study                                
Sarah is a clever, pretty young woman who comes from a family in which both her parents had substance abuse and other problems. She was often disruptive or missed school and consequently failed to learn to her potential. At the age of 13 yrs she was raped and afterwards ran away from home. She then spent a long time on the streets. She was introduced to heroin and cocaine by an older "boyfriend"  Sarah's habit got even worse after this and she had to pay for it by theft etc. Eventually she spent some time in custody. Socially she developed a protective skin of violence and lying. She behaved rudely and failed appointments with the local Drug services  and no GPs kept her for long.  Consequently she avoided social services and returned to living on the streets. She was 21 yrs old when a patient introduced her to our practice. She dressed provocatively and was often hypomanic due to the heroin and cocaine. She took some time to settle but after six months stabilised on Methadone. She spent a further two years using street drug top-ups as well as Methadone. Then she accidentally became pregnant. She then volunteered to try our new ECBC scheme. Being under more continuous care incentivised by CareCreds she began dressing more modestly, improved both her learning and social behaviour. Also she managed to taper off her Methadone and completed a Home Detox a month before delivery. She had a risky time in the neonatal period after a brief involvement with a much older addict but again CareCreds sufficiently attached her to our services for her to be helped escape him and again we Detoxed her. She has now managed to complete a Rehab and is caring very well for her baby having been clean of all opiates and cocaine for over two years and has been discharged from the ECBC scheme. Because it is so essential she remains totally free of of drugs, she and her baby will need vigilance and long term support and possibly a further episode of ECBC. But now at last she is leading a much happier, healthier and more meaningful life.
* Case and photo published with Sarah's permission
                                                                                         

CareCreds get GP's £1000 Enterprise Award for innovative clinical care.
 
A panel of judges including Dr Imran Rafi - Medical director of the Royal college of General Practitioners clinical innovation and research centre,  Antony Chuter - Chairman of the RCGP Patient Partnership Group,  Dr Mike Devlin - Head of advisory services at the MDU, Dr Paula Hensler - Medical editor of Haymarket Medical Media and Colin Cooper - Editor-in-chief of Haymarket Medical Media have selected the CareCreds scheme for 2011 GP Enterprise Award for Specific innovative clinical care. See gponline.com/awards.
 
 
More Financial Support for CareCreds
 
To date we have received over £4000 in charitable donations and recently Kingston PCT has given us a further £4000. We have used this money to develop our new Mobile Contingency self-management service. This is designed for use by anyone with any sort of severe addiction. It should be available shortly at minimal cost to users.  

FOLLOW UP RESULTS to 2010  

  • Recent results  (November 2010) show that even six months after our local funding of vouchers ran out because of cutbacks, 75% of our patients remain street clean of Class A and a third are now working - being maintained by just being given praise for earning CareCreds.  Our evidence suggests that a full CareCred service has a valuable role in stabilising chaotic patients and in helping keep them in harm reducing care. It also incentivises their progress towards successful home detox and rehab and is very useful in supporting patients who have undergone much more expensive clinic based detox/rehab to remain drug clean and do paid work. We are therefore providing our own funding to give our patients Boots Card payments over Christmas. Further follow up in April 2012 has shown that a year after stopping CareCreds the percentage of patients being street-clean remained at 75%. Confirming that there are persistent additional benefits from using this scheme. 

 FOLLOW UP RESULTS to 2012
 
As a follow-up to the above we have done a quick analysis in February 2011, just two months after these Boots Card payments had been resumed. (See below) This suggests that CareCreds are conferring extra benefit over our usual clinical care. As can be seen, stopping paid vouchers resulted in a measure of relapse to just 75% street clean before Christmas but since they were restored this proportion has risen back to 87 %. However relatively small numbers are involved and a larger series is needed to confirm the reality of these findings. It is for this reason that our CareCred service is constructed to generate ongoing and potentially very large analyses and any clinicians wishing to use them should easily be able to find out if they are worthwhile within their service. In April 2012 we did a further follow-up to see how well patients have done one year after CareCreds was stopped. Two patients had died. One of a heart problem and the other committed suicide. Two had left the area and could not be traced. Of the remainder the results were gratifying in 75% remained street clean and under regular clinical care. A very recent picture of Sarah and Summer is shown above. Given that all these patients had such severe and disabling addiction we feel that these results were excellent.

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CareCred Scores 2009


 
 These are very encouraging results. The greatest room for improvement in CareCred scores would now come from stopping smoking and increasing exercise.