Shifting Medication Treatment Practices in the COVID-19 Pandemic: A Statewide Survey of Pennsylvania Opioid Treatment Programs.
Shifting Medication Treatment Practices in the COVID-19 Pandemic: A Statewide Survey of Pennsylvania Opioid Treatment Programs.
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DOI：
10.1097/adm.0000000000000981
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发表时间：
2022-11-01
影响因子：
5.5
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中科院分区：
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我们试图了解阿片类药物治疗项目（OTP）如何使OTP运营适应COVID-19大流行以及关于美沙酮和丁丙诺啡的新联邦法规。2020年秋季，我们对宾夕法尼亚州药物和酒精项目部（Pennsylvania Department of Drug and Alcohol Programs）许可的所有103家在线治疗机构（包括临床主任）进行了在线调查。调查领域包括美沙酮带回家和远程保健做法的变化;过量和转移预防策略;对这种变化如何影响患者福祉的看法;以及与新政策和做法有关的财务/业务问题。我们计算了描述性统计量，并进行了卡方检验，以检验非营利与营利以及大型与小型OTP之间的差异。百分之四十七（46%）的OTP对调查做出了回应。分别有10%和25%的人赞成提供电话和视频远程医疗丁丙诺啡诱导。66%的人赞成延长美沙酮的带回家供应，但大多数人表示这些延长适用于少数患者。大多数受访者同意，通过远程医疗提供丁丙诺啡和延长美沙酮带回家的时间，减少了患者在获取药物方面的负担，并防止了暴露于COVID-19，同时没有显著增加过量用药的风险。我们没有发现非营利组织地位或OTP规模在COVID-19实践修改方面存在重大差异。在宾夕法尼亚州，COVID-19疫情导致阿片类药物治疗服务的提供迅速变化。关于较长美沙酮带回家方案和虚拟丁丙诺啡启动的摄取相对较低的调查结果表明，尽管普遍支持这些做法，但需要进一步制定最佳临床实践指南，并了解/解决实施障碍。
We sought to understand how opioid treatment programs (OTPs) adapted OTP operations to the COVID-19 pandemic and new federal regulations around methadone and buprenorphine. In fall 2020, we conducted an online survey of all 103 OTPs licensed by the Pennsylvania Department of Drug and Alcohol Programs, including clinical directors. Survey domains included changes to methadone take-home and telehealth practices; overdose and diversion prevention tactics; perceptions regarding how such changes influence patient well-being; and financial/operational concerns related to the new policies and practices. We calculated descriptive statistics and conducted Chi-square test to test for differences between not-for-profit versus for-profit and large versus small OTPs. Forty-seven percent (46%) OTPs responded to the survey. 10% and 25%, respectively, endorsed offering telephone and video-based telemedicine buprenorphine induction. Sixty-six percent endorsed extending take-home supplies of methadone, but most indicated that these extensions applied to a minority of their patients. Most respondents agreed that provision of buprenorphine via telehealth and extended take-home methadone reduced patient burden in accessing medications and prevented exposure to COVID-19, while not significantly increasing risk of overdose. We did not find major differences in COVID-19 practice modifications by nonprofit status or size of OTP. In Pennsylvania, the COVID-19 pandemic led to rapid changes in provision of opioid treatment services. Findings on relatively low uptake of longer methadone take-home regimens and virtual buprenorphine initiation despite general support for these practices imply a need to further develop guidelines for best clinical practices and understand/address barriers to their implementation.