Department of Psychiatry, Tufts University, Boston, MA, USA.
Global Health Institute, American University of Beirut, Beirut, Lebanon.
Curr Psychiatry Rep. 2022 Sep;24(9):375-386. doi: 10.1007/s11920-022-01346-z. Epub 2022 Jul 27.
Telehealth-delivered medication-assisted treatment for opioid use disorder (tele-MOUD) has received increased attention, with the intersection of the opioid epidemic and COVID-19 pandemic, but research on recent developments is scattered. We critically review recent literature on tele-MOUD and synthesize studies reporting primary data under four themes: clinical effectiveness, non-clinical effectiveness, perceptions, and regulatory considerations.
Despite increasing publications, most failed to include long-term comprehensive assessments. Findings indicate favorable outcomes such as improvements in retention and abstinence rates, positive experiences, and improved feasibility with the relaxation of regulatory measures. With increased adoption, clinician and patient perceptions appeared largely positive. Negative findings, albeit minor, were primarily associated with workflow adaptation difficulties and limited access of underserved populations to technology and internet connection. Additional financial, logistical, outreach, and training support for clinicians, patients, and support staff is recommended, in addition to permanent evidence-based regulatory reforms, to scale and optimize tele-MOUD services. Comprehensive recommendations to overcome limitations are expanded therein.
随着阿片类药物流行和 COVID-19 大流行的交叉,远程医疗提供的药物辅助治疗阿片类药物使用障碍(远程-MOUD)受到了越来越多的关注,但关于最新发展的研究较为分散。我们批判性地回顾了最近关于远程-MOUD 的文献,并根据四个主题综合了报告原始数据的研究:临床效果、非临床效果、认知和监管考虑因素。
尽管出版物越来越多,但大多数都没有包括长期的综合评估。研究结果表明,监管措施放宽后,保留率和戒断率提高、体验积极以及可行性提高等结果良好。随着采用率的增加,临床医生和患者的认知似乎大多是积极的。尽管负面发现较小,但主要与工作流程适应困难以及服务不足人群获得技术和互联网连接的机会有限有关。建议为临床医生、患者和支持人员提供额外的财务、后勤、外展和培训支持,以及永久性的基于证据的监管改革,以扩大远程-MOUD 服务的规模并优化其效果。其中还扩展了克服限制的全面建议。