Eibl Joseph K, Gauthier Graham, Pellegrini David, Daiter Jeffery, Varenbut Michael, Hogenbirk John C, Marsh David C
Northern Ontario School of Medicine, 935 Ramsey Lake Rd., Sudbury, ON, P3E 2C6, Canada.
Canadian Addiction Treatment Centers, 13291 Yonge St., Ste. 403, Richmond Hill, ON L4E 4L6, Canada.
Drug Alcohol Depend. 2017 Jul 1;176:133-138. doi: 10.1016/j.drugalcdep.2017.01.048. Epub 2017 May 17.
Opioid use disorder has been declared a public health crisis across North America and opioid agonist therapy (OAT) is the standard of care for these patients. Despite the increasing adoption of telemedicine as a delivery method for OAT, its effectiveness has not yet been evaluated against traditional in-person treatment. This study compared treatment outcomes for in-person versus telemedicine-delivered OAT.
We conducted a non-randomized cohort comparison study using an administrative database for patients who commenced OAT between 2011 and 2012 across 58 clinic sites in the province of Ontario, Canada. Patients were stratified by primary treatment modality as being: in-person (<25% appointments by telemedicine), mixed (25-75% by telemedicine), or via telemedicine (>75% appointments by telemedicine). The primary outcome was continuous retention in treatment as defined by one year of uninterrupted therapy, based on pharmacy dosing records.
A total of 3733 OAT initiating patients were identified. Patients treated via telemedicine were more likely to be retained in therapy than patients treated in-person (n=1590; aOR=1.27; 95% CI 1.14-1.41; p<0.001). Telemedicine patients demonstrated a retention rate of 50% at one year whereas in-person patients were retained at a rate of 39%. The mixed group also had higher likelihood of retention than the in-person group (n=418; aOR=1.26; 95% CI 1.08-1.47; p=0.001) and had a retention rate of 47% at one year.
Telemedicine may be an effective alternative to delivering in person OAT, and it has the potential to expand access to care in rural, remote, and urban regions.
阿片类药物使用障碍已被宣布为北美地区的公共卫生危机，阿片类激动剂疗法（OAT）是这些患者的标准治疗方法。尽管远程医疗作为OAT的一种提供方式越来越多地被采用，但其有效性尚未与传统的面对面治疗进行评估。本研究比较了面对面与远程医疗提供的OAT的治疗结果。
我们使用一个行政数据库进行了一项非随机队列比较研究，该数据库涵盖了2011年至2012年期间在加拿大安大略省58个诊所开始接受OAT治疗的患者。患者按主要治疗方式分层为：面对面治疗（远程医疗预约少于25%）、混合治疗（远程医疗预约占25%-75%）或通过远程医疗治疗（远程医疗预约超过75%）。主要结局是根据药房配药记录定义的连续治疗保留情况，即一年不间断治疗。
共识别出3733名开始接受OAT治疗的患者。通过远程医疗治疗的患者比面对面治疗的患者更有可能继续接受治疗（n = 1590；调整后比值比 = 1.27；95%置信区间1.14 - 1.41；p < 0.001）。远程医疗患者一年的保留率为50%，而面对面治疗患者的保留率为39%。混合组继续治疗的可能性也高于面对面治疗组（n = 418；调整后比值比 = 1.26；95%置信区间1.08 - 1.47；p = 0.001），一年的保留率为47%。
远程医疗可能是提供面对面OAT的一种有效替代方法，并且有潜力扩大农村、偏远和城市地区的医疗服务可及性。
