COVID-19 Adaptations in the Care of Patients with Opioid Use Disorder: a Survey of California Primary Care Clinics.
COVID-19 Adaptations in the Care of Patients with Opioid Use Disorder: a Survey of California Primary Care Clinics.
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DOI：
10.1007/s11606-020-06436-3
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发表时间：
2021-04
影响因子：
5.7
通讯作者：
McGovern MP
中科院分区：
文献类型：
--
作者：
Caton L;Cheng H;Garneau HC;Fisher T;Harris-Mills B;Hurley B;Newman S;McGovern MP
随着COVID-19危机的爆发，许多联邦机构放松了管制阿片类药物使用障碍治疗的政策。这些变化的影响已被最低限度地记录下来。这些转变的突然性质为检查初级保健中阿片类药物使用障碍治疗的适应性提供了一个自然的机会。研究应对COVID-19的阿片类药物使用障碍患者的医疗和行为健康预约频率、就诊类型和管理的变化。一项包含14个项目的调查询问了参加阿片类药物使用障碍全州扩展项目的初级保健实践。调查内容侧重于COVID-19导致的服务提供变化。调查持续了18天。我们调查了加州57家初级保健诊所的338名临床医生，包括联邦合格的医疗中心和类似的诊所。来自全部57家诊所（100%）和118名工作人员（占所有工作人员临床医生的34.8%）的代表参加了调查。该调查包括七个方面的实践：就诊，行为健康就诊，药物管理，尿药筛查，工作流程，感知患者需求和工作人员的经验。57家初级保健诊所中共有52家（91.2%）报告了为应对COVID-19监管变化而调整的做法。许多诊所表示，医疗（40.4%）和行为健康访问（53.8%）现在完全是虚拟的。三分之二（65.4%）的诊所报告丁丙诺啡处方持续时间增加，尿液药物筛查减少（67.3%）。大多数诊所（56.1%）的患者对行为健康服务的需求有所增加。超过一半（56.2%）的诊所描述了留住病人的更容易或不变的经验。阿片类药物使用障碍患者初级保健方法中的许多调整可能是对COVID-19的暂时反应。需要进一步评估这些适应措施对患者预后的影响，以确定是否应在covid -19后维持这些改变。
With the onset of the COVID-19 crisis, many federal agencies relaxed policies regulating opioid use disorder treatment. The impact of these changes has been minimally documented. The abrupt nature of these shifts provides a naturalistic opportunity to examine adaptations for opioid use disorder treatment in primary care. To examine change in medical and behavioral health appointment frequency, visit type, and management of patients with opioid use disorder in response to COVID-19. A 14-item survey queried primary care practices that were enrolled in a medications for opioid use disorder statewide expansion project. Survey content focused on changes in service delivery because of COVID-19. The survey was open for 18 days. We surveyed 338 clinicians from 57 primary care clinics located in California, including federally qualified health centers and look-alikes. A representative from all 57 clinics (100%) and 118 staff (34.8% of all staff clinicians) participated in the survey. The survey consisted of seven dimensions of practice: medical visits, behavioral health visits, medication management, urine drug screenings, workflow, perceived patient demand, and staff experience. A total of 52 of 57 (91.2%) primary care clinics reported practice adaptations in response to COVID-19 regulatory changes. Many clinics indicated that both medical (40.4%) and behavioral health visits (53.8%) were now exclusively virtual. Two-thirds (65.4%) of clinics reported increased duration of buprenorphine prescriptions and reduced urine drug screenings (67.3%). The majority (56.1%) of clinics experienced an increase in patient demand for behavioral health services. Over half (56.2%) of clinics described having an easier or unchanged experience retaining patients in care. Many adaptations in the primary care approach to patients with opioid use disorder may be temporary reactions to COVID-19. Further evaluation of the impact of these adaptations on patient outcomes is needed to determine whether changes should be maintained post-COVID-19.
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