Elevance Health Inc, Wilmington, DE, USA.
J Gen Intern Med. 2024 Jan;39(1):95-102. doi: 10.1007/s11606-023-08383-1. Epub 2023 Sep 5.
The COVID-19 pandemic exacerbated access barriers for patients with opioid use disorder. Telehealth presents an opportunity to improve access, treatment quality, and patient outcomes.
To determine patient characteristics associated with initiating buprenorphine treatment via telehealth and to examine how telehealth initiation is associated with access, treatment quality, and health outcomes.
This cross-sectional study used deidentified insurance claims to identify opioid use disorder adult patients initiating buprenorphine treatment between March 1, 2020, and November 30, 2021. Multivariable logistic regression assessed determinants of telehealth initiation. Propensity score matching addressed observed differences between in-person and telehealth initiators.
Treatment quality outcomes included initiation within 14 days of diagnosis, engagement (at least 2 opioid use disorder-related visits), and any buprenorphine refill during the study period. Health outcomes included opioid overdose and opioid use disorder-related emergency department and inpatient visits.
We identified 23,565 adult buprenorphine initiators, including 3314 (14.1%) patients using telehealth. Younger patients (OR 0.91 to 0.77), females (OR 1.18), South (OR 1.63) and Midwest (OR 1.27) regions, rural area (OR 1.12), and higher-income (OR 1.16) neighborhood residents were more likely to use telehealth. Telehealth patients were more likely than in-person patients (54.5% vs. 48.4%; adjusted odds ratio (AOR), 1.29; 95% CI, 1.19-1.40) to stay engaged with opioid use disorder treatment, and more likely to refill buprenorphine during the study period (83.6% vs. 79.0%, AOR 1.37; 95% CI, 1.23-1.52). Telehealth initiation of buprenorphine was associated with 36% lower overdose rate than in-person initiation (adjusted incidence rate ratio 0.64; 95% CI, 0.45-0.94). The two groups evidenced no significant differences in opioid use disorder-related ED visit and hospitalization.
Our findings suggest that telehealth-initiated buprenorphine treatment is associated with reduced opioid overdose rate and improved patient engagement. Our findings strengthen the case for extending telehealth exemptions and prescribing flexibilities for treatment.
COVID-19 大流行加剧了阿片类药物使用障碍患者的获取障碍。远程医疗提供了改善获取、治疗质量和患者结局的机会。
确定通过远程医疗开始接受丁丙诺啡治疗的患者特征，并研究远程医疗的启动如何与获取、治疗质量和健康结果相关。
这项横断面研究使用去标识的保险索赔来确定 2020 年 3 月 1 日至 2021 年 11 月 30 日期间开始丁丙诺啡治疗的阿片类药物使用障碍成年患者。多变量逻辑回归评估了远程医疗启动的决定因素。倾向评分匹配解决了门诊和远程医疗启动者之间观察到的差异。
治疗质量结果包括在诊断后 14 天内开始治疗、参与（至少 2 次阿片类药物使用障碍相关就诊）以及研究期间的任何丁丙诺啡续药。健康结果包括阿片类药物过量和阿片类药物使用障碍相关的急诊和住院就诊。
我们确定了 23565 名成年丁丙诺啡启动者，其中 3314 名（14.1%）患者使用远程医疗。年轻患者（OR 0.91 至 0.77）、女性（OR 1.18）、南部（OR 1.63）和中西部（OR 1.27）地区、农村地区（OR 1.12）和高收入（OR 1.16）社区居民更有可能使用远程医疗。与门诊患者相比，远程医疗患者更有可能保持阿片类药物使用障碍治疗的参与度（54.5% 比 48.4%；调整后的优势比（AOR），1.29；95%置信区间（CI），1.19-1.40），并且更有可能在研究期间续药（83.6% 比 79.0%，AOR 1.37；95%CI，1.23-1.52）。与门诊启动相比，远程医疗启动丁丙诺啡治疗与阿片类药物过量率降低 36%相关（调整后的发病率比 0.64；95%CI，0.45-0.94）。两组在阿片类药物使用障碍相关的急诊就诊和住院治疗方面没有显著差异。
我们的研究结果表明，远程医疗启动的丁丙诺啡治疗与降低阿片类药物过量率和改善患者参与度相关。我们的研究结果为扩大远程医疗豁免和治疗处方灵活性提供了依据。
