National Center for PTSD, Behavioral Sciences Division, VA Boston Healthcare System, Boston, MA, United States of America; Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States of America.
Boston VA Research Institute, Boston, MA, United States of America.
J Subst Use Addict Treat. 2024 Jan;156:209188. doi: 10.1016/j.josat.2023.209188. Epub 2023 Oct 20.
COVID-19 significantly negatively impacted access to care among patients with opioid use disorder (OUD). The Veterans Health Administration (VHA) enacted policies to expand telehealth and medication for OUD (MOUD) during the public health emergency, which offset risk of treatment disruption. In this study, we evaluated gender differences in utilization of behavioral therapy in person and via telehealth, MOUD utilization, and achieving 90-day MOUD retention pre-post pandemic onset, given known gender differences in treatment utilization between men and women. Secondarily, we examined MOUD receipt and retention as a function of in-person vs. telehealth behavioral therapy received over time.
Using VHA's nationwide electronic health record data, we compared outcomes between men and women veterans, pre- to post-pandemic onset (January 2019-February 2020 vs. March 2020-April 2021). Primary outcomes included receipt of behavioral therapy (in person or telehealth), number of appointments attended, any MOUD, and whether patients achieved 90-day MOUD retention post-induction.
Veterans with OUD were less likely to receive behavioral therapy post-pandemic onset, which was driven by marked decreases in in-person care; these effects were strongest among women. The odds of receiving MOUD also decreased pre- to post-pandemic onset, particularly among men. Receipt of or achieving 90-day MOUD retention was differentially related to receipt of behavioral therapy via in person vs. telehealth; telehealth was more strongly associated with these utilization indicators post-pandemic onset-an effect that was more pronounced for men.
The likelihood of receiving behavioral therapy and MOUD were lower during COVID-19 and varied by gender, with men being less likely to receive MOUD over time and women being less likely to receive in-person behavioral therapy. Behavioral therapy received via telehealth was generally associated with improved MOUD utilization compared to in-person behavioral therapy, but this was less true for women than for men regarding utilization of or achieving 90-day MOUD retention. In addition to the need for further telehealth expansion for veterans with OUD, more research should explore how to better engage men in MOUD treatment and improve adherence to MOUD among women engaged in behavioral therapy.
COVID-19 显著影响了阿片类药物使用障碍（OUD）患者的医疗服务获取。退伍军人健康管理局（VHA）在公共卫生紧急情况下颁布了扩大 OUD 远程医疗和药物治疗（MOUD）的政策，这降低了治疗中断的风险。在这项研究中，鉴于男女之间在治疗利用方面存在已知的性别差异，我们评估了个人和远程医疗行为治疗、MOUD 利用以及在大流行前后 90 天 MOUD 保留率方面的性别差异。其次，我们研究了随着时间的推移，通过个人或远程医疗接受的行为治疗作为 MOUD 接收和保留的函数。
使用 VHA 的全国性电子健康记录数据，我们比较了大流行前后（2019 年 1 月至 2 月与 2020 年 3 月至 2021 年 4 月）男性和女性退伍军人之间的结果。主要结果包括接受行为治疗（个人或远程医疗）、就诊次数、任何 MOUD 以及患者在诱导后是否达到 90 天 MOUD 保留。
患有 OUD 的退伍军人在大流行后接受行为治疗的可能性降低，这主要是由于个人护理的大幅减少；这些影响在女性中最为明显。MOUD 的接受率也在大流行前后下降，尤其是在男性中。接受 MOUD 或达到 90 天 MOUD 保留率与通过个人或远程医疗接受行为治疗的关系不同；远程医疗在大流行后与这些利用指标的相关性更强，对于男性来说，这种影响更为明显。
在 COVID-19 期间，接受行为治疗和 MOUD 的可能性较低，并且因性别而异，男性随着时间的推移不太可能接受 MOUD，而女性不太可能接受个人行为治疗。与个人行为治疗相比，通过远程医疗接受的行为治疗通常与 MOUD 的利用改善相关，但对于女性而言，与男性相比，接受或达到 90 天 MOUD 保留率的情况并非如此。除了需要为 OUD 退伍军人进一步扩大远程医疗服务外，还应开展更多研究，探讨如何更好地让男性参与 MOUD 治疗，并提高参与行为治疗的女性对 MOUD 的依从性。
