BRiTE Center, Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, USA; School of Human Development and Organizational Studies, College of Education, University of Florida, Gainesville, FL, USA.
Department of Human Development, Family Science, and Counseling, University of Nevada- Reno, Reno, NV, USA; School of Human Development and Organizational Studies, College of Education, University of Florida, Gainesville, FL, USA.
J Subst Use Addict Treat. 2023 Mar;146:208938. doi: 10.1016/j.josat.2022.208938. Epub 2023 Jan 7.
Access to substance use disorder (SUD) treatment remains a significant issue in the United States. Telehealth has potential for increasing access to services; however, it is underutilized in SUD treatment compared to mental health treatment. This study uses a discrete choice experiment (DCE) to examine stated preferences for telehealth (videoconferencing, text-based + video, text only) versus in-person SUD treatment (community-based, in-home) and the attributes (location, cost, therapist choice, wait time, evidence-based practices) most important when choosing between modalities. Subgroup analyses are reported about preference differences based on type of substance and substance use severity.
Four hundred participants completed a survey containing a DCE with eighteen choice sets, the alcohol use disorders inventory test, drug abuse screening test, and a brief demographic questionnaire. The study collected data between April 15, 2020, and April 22, 2020. Conditional logit regression provided a measure of strength for participant preferences for technology-assisted treatment compared to in-person care. The study provides willingness to pay estimates as a real-world measure for the importance of each attribute in participants' decision-making.
Telehealth options that include a video conference option were equally preferrable to in-person care modalities. Text-only treatment was significantly less preferable to all other modalities of care. The ability to choose one's own therapist was a significant driver of treatment preference beyond modality, while wait time did not appear significant in making decisions. Participants with the most severe substance use differed in that they were open to text-based care without video conferencing, did not express a preference for evidence-based care, and valued therapist choice significantly more than those with only moderate substance use.
Telehealth for SUD treatment is equally preferable to in-person care offered in the community or at home, signifying preference is not a barrier for utilization. Text-only modalities may be enhanced by offering videoconference options for most individuals. Individuals with the most severe substance use issues may be willing to engage in text-based support without synchronous meetings with a provider. This approach may offer a less intensive method to engage individuals in treatment who may not otherwise access services.
在美国，获得物质使用障碍（SUD）治疗仍然是一个重大问题。远程医疗有可能增加服务的可及性；然而，与精神健康治疗相比，它在 SUD 治疗中的应用还不够广泛。本研究使用离散选择实验（DCE）来研究对远程医疗（视频会议、基于文本的+视频、仅文本）与面对面 SUD 治疗（基于社区的、家庭内）的选择偏好，以及在选择治疗方式时最重要的属性（地点、成本、治疗师选择、等待时间、基于证据的实践）。根据物质类型和物质使用严重程度，报告了偏好差异的亚组分析。
400 名参与者完成了一项包含 18 个选择集的 DCE 调查、酒精使用障碍测试、药物滥用筛选测试和一份简短的人口统计问卷。该研究于 2020 年 4 月 15 日至 22 日期间收集数据。条件逻辑回归为与面对面护理相比，参与者对技术辅助治疗的偏好提供了一个衡量标准。该研究提供了支付意愿估计值，作为参与者决策中每个属性重要性的真实世界衡量标准。
包括视频会议选项的远程医疗选择与面对面护理方式同样受欢迎。仅文本治疗明显不如其他所有护理方式受欢迎。选择自己治疗师的能力是治疗偏好的重要驱动因素，超出了治疗方式，而等待时间在决策中似乎并不重要。物质使用最严重的参与者有所不同，他们愿意接受没有视频会议的基于文本的护理，不表达对基于证据的护理的偏好，并且比仅中度物质使用的参与者更重视治疗师的选择。
SUD 治疗的远程医疗与社区或家庭提供的面对面护理同样受欢迎，表明偏好不是利用的障碍。对于大多数人来说，仅文本模式可以通过提供视频会议选项来增强。物质使用问题最严重的个人可能愿意接受没有与提供者同步会议的基于文本的支持。这种方法可能为那些否则无法获得服务的人提供一种不那么密集的方法来参与治疗。
