Pro George, Hayes Corey, Gu Mofan, Bravo Roberto, Baloh Jure
Department of Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR, USA.
College of Pharmacy, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR, USA.
J Behav Health Serv Res. 2025 Sep 9. doi: 10.1007/s11414-025-09966-y.
Telehealth is increasingly a standard and routine clinical option, indicating a changing outlook for SUD treatment from in-person to the more convenient option of telehealth. As populations across geographies increasingly prefer telehealth, more research is warranted that focuses on how where a person lives is associated with telehealth availability. The authors used the Mental Health and Addiction Treatment Tracking Repository (MATTR 2024) to identify telehealth availability among all known licensed SUD treatment facilities in the USA (N = 10,492 facilities). The authors merged external geocoded data to MATTR to characterize the communities and spaces immediately surrounding each facility, including social vulnerability indices (census tract), population demographics (county), and state-level telehealth policies. Multilevel multivariable logistic regression was used to model telehealth availability. Roughly 4 out of 5 treatment facilities (81%) offered telehealth. At the census tract level, for every additional point on the racial/ethnic minority status vulnerability scale, the odds of a facility offering telehealth decreased by 4% (aOR = 0.96, 95% CI = 0.93-0.99, p = 0.02). Compared to states with substantial legal barriers about starting telehealth by any mode, facilities in states with stronger, innovation-ready laws had higher odds of offering telehealth (aOR = 1.47, 95% CI = 1.13-1.92, p < 0.01). Similarly, facilities in states that minimize barriers to allowing nurses to practice and use telehealth independently had higher odds of offering telehealth (aOR = 1.42, 95% CI = 1.09-1.84, p < 0.01). State-level health policies impact access to SUD care in a multitude of ways, and new policies that promote telehealth by minimizing barriers to service delivery will benefit people in need of SUD treatment.
远程医疗日益成为一种标准且常规的临床选择，这表明物质使用障碍（SUD）治疗的前景正在从面对面治疗转变为更便捷的远程医疗选项。随着各地人群越来越倾向于选择远程医疗，有必要开展更多研究，聚焦于一个人的居住地点与远程医疗可及性之间的关联。作者利用心理健康与成瘾治疗跟踪数据库（MATTR 2024），确定了美国所有已知的持牌SUD治疗机构（共10492家机构）中的远程医疗可及性情况。作者将外部地理编码数据与MATTR合并，以描述每个机构周边的社区和区域特征，包括社会脆弱性指数（普查区）、人口统计学特征（县）以及州级远程医疗政策。采用多水平多变量逻辑回归对远程医疗可及性进行建模。大约五分之四的治疗机构（81%）提供远程医疗服务。在普查区层面，种族/族裔少数群体地位脆弱性量表上每增加一分，机构提供远程医疗服务的几率就降低4%（调整后比值比[aOR]=0.96，95%置信区间[CI]=0.93 - 0.99，p = 0.02）。与那些对通过任何方式开展远程医疗设置重大法律障碍的州相比，拥有更完善、支持创新的法律的州的机构提供远程医疗服务的几率更高（aOR = 1.47，95% CI = 1.13 - 1.92，p < 0.01）。同样，那些尽量减少护士独立执业和使用远程医疗障碍的州的机构提供远程医疗服务的几率更高（aOR = 1.42，95% CI = 1.09 - 1.84，p < 0.01）。州级卫生政策会以多种方式影响SUD护理的可及性，通过减少服务提供障碍来促进远程医疗的新政策将使有SUD治疗需求的人受益。
