Scott-Richardson Maya, Johnson Guinevere, Burnett Sianna, Giordano Nicholas A, Highland Krista B
Department of Anesthesiology, Defense and Veterans Center for Integrative Pain Management, Uniformed Services University, Bethesda, Maryland, USA.
Henry M. Jackson Foundation, Inc., Rockville, Maryland, USA.
Telemed J E Health. 2022 May;28(5):728-735. doi: 10.1089/tmj.2021.0167. Epub 2021 Sep 14.
Introduction:Complementary and integrative therapies such as physical therapy (PT) and occupational therapy (OT) have been shown to improve functional outcomes and reduce opioid use. Due to the COVID-19 (or SARS-CoV-2 [severe acute respiratory syndrome coronavirus 2]) pandemic, these therapies are switching to telehealth and telemedicine practices, but access and utilization may be limited due to state policies and social vulnerability.
Objective:The objective of this cross-sectional analysis was to evaluate the policy changes to telehealth provisions during the pandemic and the degree to which structural barriers could stymie the intended impact of these policies (e.g., PT/OT accessibility).
Materials and Methods:Our analysis examined each states' telehealth policies in relation to PT/OT, ranked their telehealth readiness, identified relationships between existing policies and opioid prescription rates, and discussed how social determinants of health may be associated with telehealth availability and accessibility.
Results:Approximately two of five states have both telehealth and telemedicine policies, whereas the majority of states had either a PT- or OT-specific policy in place. In addition, almost all states and the District of Columbia (90%) had general telehealth/medicine policy changes as a result of the pandemic.
Discussion:Although such policy changes could reduce COVID-19-related barriers, the degree to which these policies can have a large and long-lasting impact may be contingent on structural barriers. Many states that lack broadband access and have high social vulnerability need more improvements to ensure the utilization of telehealth care, including PT and OT.
Conclusion:Despite the policies expanding PT/OT telehealth capabilities, structural barriers may further exacerbate inequities in care accessibility.
诸如物理治疗（PT）和职业治疗（OT）等补充和综合疗法已被证明可改善功能结局并减少阿片类药物的使用。由于2019冠状病毒病（COVID-19，即严重急性呼吸综合征冠状病毒2 [SARS-CoV-2]）大流行，这些疗法正在转向远程医疗和远程医学实践，但由于州政策和社会脆弱性，其可及性和利用率可能受到限制。
本横断面分析的目的是评估大流行期间远程医疗规定的政策变化，以及结构性障碍可能阻碍这些政策预期影响（如PT/OT可及性）的程度。
我们的分析考察了各州与PT/OT相关的远程医疗政策，对其远程医疗准备情况进行排名，确定现有政策与阿片类药物处方率之间的关系，并讨论健康的社会决定因素可能如何与远程医疗的可获得性和可及性相关联。
约五分之二的州同时拥有远程医疗和远程医学政策，而大多数州制定了针对PT或OT的特定政策。此外，几乎所有州和哥伦比亚特区（90%）因大流行而对远程医疗/远程医学政策进行了一般性调整。
尽管此类政策变化可减少与COVID-19相关的障碍，但这些政策能产生重大且持久影响的程度可能取决于结构性障碍。许多缺乏宽带接入且社会脆弱性高的州需要更多改进，以确保远程医疗服务（包括PT和OT）的利用。
尽管政策扩大了PT/OT远程医疗能力，但结构性障碍可能会进一步加剧医疗可及性方面的不平等。
