Haiden A. Huskamp (
Alisa B. Busch is an associate professor of psychiatry and health care policy, McLean Hospital and the Department of Health Care Policy, Harvard Medical School.
Health Aff (Millwood). 2018 Dec;37(12):1940-1947. doi: 10.1377/hlthaff.2018.05134.
Only a small proportion of people with a substance use disorder (SUD) receive treatment. The shortage of SUD treatment providers, particularly in rural areas, is an important driver of this treatment gap. Telemedicine could be a means of expanding access to treatment. However, several key regulatory and reimbursement barriers to greater use of telemedicine for SUD (tele-SUD) exist, and both Congress and the states are considering or have recently passed legislation to address them. To inform these efforts, we describe how tele-SUD is being used. Using claims data for 2010-17 from a large commercial insurer, we identified characteristics of tele-SUD users and examined how tele-SUD is being used in conjunction with in-person SUD care. Despite a rapid increase in tele-SUD over the study period, we found low use rates overall, particularly relative to the growth in telemental health. Tele-SUD is primarily used to complement in-person care and is disproportionately used by those with relatively severe SUD. Given the severity of the opioid epidemic, low rates of tele-SUD use represent a missed opportunity. As tele-SUD becomes more available, it will be important to monitor closely which tele-SUD delivery models are being used and their impact on access and outcomes.
只有一小部分物质使用障碍（SUD）患者接受治疗。SUD 治疗提供者的短缺，特别是在农村地区，是造成这种治疗差距的一个重要因素。远程医疗可能是扩大治疗途径的一种手段。然而，在更大程度地利用远程医疗治疗 SUD（远程 SUD）方面存在一些关键的监管和报销障碍，国会和各州都在考虑或最近通过立法来解决这些问题。为了为这些努力提供信息，我们描述了远程 SUD 的使用情况。我们使用来自一家大型商业保险公司的 2010-17 年的索赔数据，确定了远程 SUD 用户的特征，并研究了远程 SUD 与面对面 SUD 护理的结合使用情况。尽管在研究期间远程 SUD 迅速增加，但我们发现总体使用率较低，尤其是相对于精神卫生的增长而言。远程 SUD 主要用于补充面对面的护理，并且在 SUD 相对严重的患者中使用比例过高。鉴于阿片类药物泛滥的严重程度，远程 SUD 使用率低是一个错失的机会。随着远程 SUD 的普及，密切监测正在使用的远程 SUD 交付模式及其对获得治疗和结果的影响将变得非常重要。
