Use of Telehealth for Opioid Use Disorder Treatment in Safety Net Primary Care Settings: A Mixed-Methods Study.
Use of Telehealth for Opioid Use Disorder Treatment in Safety Net Primary Care Settings: A Mixed-Methods Study.
复制标题
在安全网初级保健环境中使用远程医疗治疗阿片类药物使用障碍：一项混合方法研究。
DOI：
10.1080/10826084.2023.2212378
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发表时间：
2023
影响因子：
2
通讯作者：
Cohen,DeborahJ
中科院分区：
文献类型：
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作者：
Bailey,SteffaniR;Wyte-Lake,Tamar;Lucas,JenniferA;Williams,Shannon;Cantone,RebeccaE;Garvey,BrianT;Hallock-Koppelman,Laurel;Angier,Heather;Cohen,DeborahJ
背景：COVID-19 大流行导致远程医疗显着增加，以提供基于初级保健的阿片类药物使用障碍 (OUD) 治疗。这项混合方法研究检查了大多数 OUD 相关就诊与面对面就诊的相关特征，以及随时间的推移交付方式（面对面、电话、视频）的变化。 方法：使用 ≥1 次就诊且 OUD 诊断就诊至 ≥1 个研究诊所（农村卫生诊所；城市联邦合格健康中心）的患者的电子健康记录数据以及 ≥1 种 OUD 药物从2020 年 3 月 8 日至 2021 年 9 月 1 日，以 > 50% 的 OUD 访问通过远程医疗（相对于 > 50% 面对面）作为因变量，以患者特征作为自变量。还检查了访问类型随时间的变化。归纳编码用于分析来自提供 OUD 护理的临床团队成员 (n= 10) 的访谈数据，以了解围绕就诊类型的决策。结果：新患者（与回访患者相比；OR = 0.47；95%CI:0.27-0.83）、有 ≥1 项精神科诊断的患者（与无精神病诊断患者相比；OR = 0.49,95%CI:0.29-0.82）和农村诊所患者（与城市相比；OR = 0.05；95%CI：0.03-0.08）通过远程医疗就诊的几率低于亲自就诊的几率。不同诊所的就诊类型模式随时间而变化，大多数远程医疗就诊是通过电话进行的。团队成员将患者的灵活性描述为远程医疗的一个关键优势，但认为亲自就诊更有利于与新患者和心理负担增加的患者建立融洽关系。结论：了解远程医疗如何以及为何用于 OUD 治疗对于确保获得护理和为 OUD 相关政策决策提供信息至关重要。
Background: The COVID-19 pandemic resulted in a marked increase in telehealth for the provision of primary care-based opioid use disorder (OUD) treatment. This mixed methods study examines characteristics associated with having the majority of OUD-related visitsviatelehealth versus in-person, and changes in mode of delivery (in-person, telephone, video) over time.Methods:Logistic regression was performed using electronic health record data from patients with ≥1 visit with an OUD diagnosis to ≥1 of the two study clinics (Rural Health Clinic; urban Federally Qualified Health Center) and ≥1 OUD medication ordered from 3/8/2020-9/1/2021, with >50% of OUD visitsviatelehealth (vs. >50% in-person) as the dependent variable and patient characteristics as independent variables. Changes in visit type over time were also examined. Inductive coding was used to analyze data from interviews with clinical team members (n= 10) who provide OUD care to understand decision-making around visit type.Results: New patients (vs. returning; OR = 0.47;95%CI:0.27-0.83), those with ≥1 psychiatric diagnosis (vs. none; OR = 0.49,95%CI:0.29-0.82), and rural clinic patients (vs. urban; OR = 0.05; 95%CI:0.03-0.08) had lower odds of having the majority of visitsviatelehealth than in-person. Patterns of visit type varied over time by clinic, with the majority of telehealth visits deliveredviatelephone. Team members described flexibility for patients as a key telehealth benefit, but described in-person visits as more conducive to building rapport with new patients and those with increased psychological burden.Conclusion: Understanding how and why telehealth is used for OUD treatment is critical for ensuring access to care and informing OUD-related policy decisions.