An examination of telehealth policy impacts on initial rural opioid use disorder treatment patterns during the COVID-19 pandemic
An examination of telehealth policy impacts on initial rural opioid use disorder treatment patterns during the COVID-19 pandemic
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DOI：
10.1111/jrh.12570
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发表时间：
2021-03-15
影响因子：
4.9
通讯作者：
Ostrach, Bayla
中科院分区：
文献类型：
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作者：
Hughes, Phillip M.;Verrastro, Genevieve;Ostrach, Bayla
目的跟踪农村和小都市混合环境中与COVID-19相关的政策和服务提供变化之前、期间和之后阿片类药物使用障碍（MOUD）服务的护理利用变化。方法使用回顾性、开放队列设计，我们检查了家庭医学诊所MOUD患者在三个确定时期的就诊数据：新冠肺炎疫情前、新冠肺炎疫情过渡期和新冠肺炎疫情。结果指标包括访问的数量和类型（亲自或远程医疗），进入治疗的新患者数量以及进行尿液药物筛查的数量。计算了从患者住所到诊所的距离，以评估农村地区获得医疗服务的情况。结果在COVID期间，MOUD总访问量增加（436前vs. 581后，p <0. 001），而总的新患者访问量保持不变（33前vs. 29后，p = 0. 755）。诊所的总体服务范围扩大，新病人主要来自农村地区。尿液药物筛查之间的时间长度增加（21.1天前与43.5天后，p < 0.001）。结论在此期间，MOUD护理利用的模式证明了远程医疗在这一领域的有效性。允许通过远程医疗提供MOUD的政策变化，放弃亲自启动MOUD的需要，以及增加MOUD的医疗补助补偿，可能在COVID-19大流行期间及以后改善MOUD的可及性方面发挥重要作用。
Purpose Tracking changes in care utilization of medication for opioid use disorder (MOUD) services before, during, and after COVID-19-associated changes in policy and service delivery in a mixed rural and micropolitan setting.Methods Using a retrospective, open-cohort design, we examined visit data of MOUD patients at a family medicine clinic across three identified periods: pre-COVID, COVID transition, and COVID. Outcome measures include the number and type of visits (in-person or telehealth), the number of new patients entering treatment, and the number of urine drug screens performed. Distance from patient residence to clinic was calculated to assess access to care in rural areas. Goodness-of-Fit Chi-Square tests and ANOVAs were used to identify differences between time periods.Findings Total MOUD visits increased during COVID (436 pre vs. 581 post, p < 0.001), while overall new patient visits remained constant (33 pre vs. 29 post, p = 0.755). The clinic's overall catchment area increased in size, with new patients coming primarily from rural areas. Length of time between urine drug screens increased (21.1 days pre vs. 43.5 days post, p < 0.001).Conclusions The patterns of MOUD care utilization during this period demonstrate the effectiveness of telehealth in this area. Policy changes allowing for MOUD to be delivered via telehealth, waiving the need for in-person initiation of MOUD, and increased Medicaid compensation for MOUD may play a valuable role in improving access to MOUD during the COVID-19 pandemic and beyond.