Department of Family Medicine, Boston University Medical Center, Boston, MA, USA.
Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
Subst Use Addctn J. 2024 Jul;45(3):473-485. doi: 10.1177/29767342241236028. Epub 2024 Mar 17.
Patients with substance use disorders (SUDs) exhibit low healthcare utilization despite high medical need. Telehealth could boost utilization, but variation in uptake across SUDs is unknown.
Using Wisconsin Medicaid enrollment and claims data from December 1, 2018, to December 31, 2020, we conducted a cohort study of telemedicine uptake in the all-ambulatory and the primary care setting during telehealth expansion following the COVID-19 public health emergency (PHE) onset (March 14, 2020). The sample included continuously enrolled (19 months), nonpregnant, nondisabled adults aged 19 to 64 years with opioid (OUD), alcohol (AUD), stimulant (StimUD), or cannabis (CannUD) use disorder or polysubstance use (PSU). Outcomes: total and telehealth visits in the week, and fraction of visits in the week completed by telehealth. Linear and fractional regression estimated changes in in-person and telemedicine utilization. We used regression coefficients to calculate the change in telemedicine utilization, the proportion of in-person decline offset by telemedicine uptake ("offset"), and the share of visits completed by telemedicine ("share").
The cohort (n = 16 756) included individuals with OUD (34.8%), AUD (30.1%), StimUD (9.5%), CannUD (9.5%), and PSU (19.7%). Total and telemedicine utilization varied by group post-PHE. All-ambulatory: total visits dropped for all, then rose above baseline for OUD, PSU, and AUD. Telehealth expansion was associated with visit increases: OUD: 0.489, < .001; PSU: 0.341, < .001; StimUD: 0.160, < .001; AUD: 0.132, < .001; CannUD: 0.115, < .001. StimUD exhibited the greatest telemedicine share. Primary care: total visits dropped for all, then recovered for OUD and CannUD. Telemedicine visits rose most for PSU: 0.021, < .001; OUD: 0.019, < .001; CannUD: 0.011, < .001; AUD: 0.010, < .001; StimUD: 0.009, < .001. PSU and OUD exhibited the greatest telemedicine share, while StimUD exhibited the lowest. Telemedicine fully offset declines for OUD only.
Telehealth expansion helped maintain utilization for OUD and PSU; StimUD and CannUD showed less responsiveness. Telehealth expansion could widen gaps in utilization by SUD type.
尽管医疗需求很高，但患有物质使用障碍（SUD）的患者的医疗保健利用率仍然很低。远程医疗可以提高利用率，但 SUD 之间的利用率差异尚不清楚。
使用威斯康星州医疗补助计划的入组和索赔数据，从 2018 年 12 月 1 日至 2020 年 12 月 31 日，我们在 COVID-19 公共卫生紧急事件（PHE）发生后（2020 年 3 月 14 日），对远程医疗扩张期间所有门诊和初级保健环境中的远程医疗使用率进行了队列研究。样本包括连续入组（19 个月）、非怀孕、非残疾的 19 至 64 岁成年人，患有阿片类药物（OUD）、酒精（AUD）、兴奋剂（StimUD）或大麻（CannUD）使用障碍或多种物质使用障碍（PSU）。结局：在一周内的总访问量和远程医疗访问量，以及一周内通过远程医疗完成的访问量的分数。线性和分数回归估计了面对面和远程医疗利用率的变化。我们使用回归系数计算远程医疗利用率的变化、远程医疗使用率上升抵消的面对面下降比例（“抵消”），以及通过远程医疗完成的访问量比例（“份额”）。
队列（n=16756）包括患有 OUD（34.8%）、AUD（30.1%）、StimUD（9.5%）、CannUD（9.5%）和 PSU（19.7%）的个体。PHE 后，所有人群的总访问量和远程医疗访问量均有所变化。所有门诊：所有人群的总访问量下降，然后 OUD、PSU 和 AUD 的总访问量高于基线。远程医疗扩张与访问量增加相关：OUD：0.489，<0.001；PSU：0.341，<0.001；StimUD：0.160，<0.001；AUD：0.132，<0.001；CannUD：0.115，<0.001。StimUD 的远程医疗使用率最高。初级保健：所有人群的总访问量下降，然后 OUD 和 CannUD 的总访问量恢复。PSU 的远程医疗访问量增长最多：0.021，<0.001；OUD：0.019，<0.001；CannUD：0.011，<0.001；AUD：0.010，<0.001；StimUD：0.009，<0.001。PSU 和 OUD 的远程医疗使用率最高，而 StimUD 的远程医疗使用率最低。远程医疗完全抵消了 OUD 的下降。
远程医疗扩张有助于维持 OUD 和 PSU 的利用率；StimUD 和 CannUD 的反应性较低。远程医疗扩张可能会扩大不同 SUD 类型的利用率差距。
