宾夕法尼亚州治疗项目在 COVID-19 期间实施远程医疗药物治疗阿片类药物使用障碍。
Implementation of Telemedicine Delivery of Medications for Opioid Use Disorder in Pennsylvania Treatment Programs During COVID-19.
机构信息
From the Department of Population Health Sciences, Geisinger, Danville, PA (MNP); Section of Addiction Medicine, Tower Health System, Reading, PA (WS); Vital Strategies, New York, NY (RS); Pennsylvania Department of Health, Harrisburg, PA (RS); Department of Addiction Services, WellSpan Health, York, PA (CH); The Wright Centers for Community Health and Graduate Medical Education, Scranton, PA (MR); AT Still University School of Osteopathic Medicine in Arizona, Mesa, AZ (MR); Department of Family Medicine, Lehigh Valley Health Network, Allentown, PA (AC); and Morsani College of Medicine, University of South Florida, North Tampa, FL (AC).
出版信息
J Addict Med. 2023;17(2):e110-e118. doi: 10.1097/ADM.0000000000001079. Epub 2022 Sep 19.
INTRODUCTION
Temporary policy changes during the coronavirus disease 2019 pandemic facilitated rapid expansion of medication for opioid use disorder via telemedicine (tele-MOUD). Evidence for tele-MOUD best practices and its impact on treatment engagement and retention remains limited. This quality improvement initiative compared tele-MOUD implementation among Pennsylvania medication for opioid use disorder (MOUD) programs, evaluated sociodemographic characteristics of patients using tele-MOUD, and described trends in tele-MOUD use and patient engagement and retention.
METHODS
Five health systems with MOUD programs completed questionnaires regarding their tele-MOUD models and provided aggregated sociodemographic data for MOUD patients with in-person and telemedicine visits in 2020. Three programs provided aggregated monthly appointment data (scheduled, completed, no-show, tele-MOUD visits) over the period in which tele-MOUD scaled up.
RESULTS
Differences in tele-MOUD protocols related to provision of tele-MOUD inductions, patient eligibility for tele-MOUD, and operationalization of remote drug testing. Across programs, 88% of prescribers conducted tele-MOUD appointments, and 50% of patients used tele-MOUD in 2020. We observed sociodemographic differences, with a greater proportion of female, White, and non-Hispanic patients using tele-MOUD. Across programs with appointment data, overall patient enrollment increased, and new patient enrollment remained relatively constant. Engagement trends suggested a temporary decline in no-show appointments that aligned with the escalation of tele-MOUD in one program.
CONCLUSIONS
Tele-MOUD protocol differences indicate a need for research to inform evidence-based guidance. Findings suggest that patients largely remained engaged and retained in MOUD as tele-MOUD was implemented but reveal inequities in tele-MOUD use, highlighting the need for efforts to overcome technology access barriers and avoid exacerbating disparities in MOUD access.
简介
在 2019 年冠状病毒病大流行期间，临时政策的改变促进了通过远程医疗（远程-MOUD）快速扩大阿片类药物使用障碍的药物治疗。关于远程-MOUD 的最佳实践及其对治疗参与度和保留率的影响的证据仍然有限。这项质量改进计划比较了宾夕法尼亚州阿片类药物使用障碍（MOUD）治疗计划中的远程-MOUD 实施情况，评估了使用远程-MOUD 的患者的社会人口统计学特征，并描述了远程-MOUD 的使用以及患者参与度和保留率的趋势。
方法
五个拥有 MOUD 计划的医疗系统完成了关于其远程-MOUD 模式的调查问卷，并为 2020 年进行门诊和远程医疗就诊的 MOUD 患者提供了汇总的社会人口统计学数据。三个计划提供了在此期间远程-MOUD 扩大规模期间的每月预约数据（预约、完成、未到、远程-MOUD 就诊）的汇总数据。
结果
远程-MOUD 协议的差异与远程-MOUD 诱导的提供、远程-MOUD 的患者资格以及远程药物检测的运作有关。在所有计划中，88%的开处方者进行了远程-MOUD 预约，并且 50%的患者在 2020 年使用了远程-MOUD。我们观察到社会人口统计学差异，使用远程-MOUD 的患者中女性、白人、非西班牙裔的比例更高。在有预约数据的计划中，总体患者入组增加，新患者入组保持相对稳定。参与趋势表明，与一个计划中远程-MOUD 的升级相一致，未到预约的情况暂时减少。
结论
远程-MOUD 协议的差异表明需要进行研究以提供循证指导。研究结果表明，随着远程-MOUD 的实施，患者在 MOUD 中基本保持了参与度和保留率，但也揭示了远程-MOUD 使用的不平等现象，这突出了需要努力克服技术获取障碍，避免扩大 MOUD 获取方面的差距。
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