The effectiveness of telemedicine-delivered opioid agonist therapy in a supervised clinical setting
The effectiveness of telemedicine-delivered opioid agonist therapy in a supervised clinical setting
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DOI：
10.1016/j.drugalcdep.2017.01.048
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发表时间：
2017-07-01
影响因子：
4.2
通讯作者：
Marsh, David C.
中科院分区：
文献类型：
--
作者：
Eibl, Joseph K.;Gauthier, Graham;Marsh, David C.
目的：阿片类药物使用障碍已被宣布为北美的公共卫生危机，阿片类药物激动剂治疗（OAT）是这些患者的标准治疗。尽管越来越多地采用远程医疗作为OAT的一种提供方法，但其有效性尚未与传统的面对面治疗进行评估。本研究比较了人与远程医疗提供OAT.Methods的治疗结果：我们进行了一项非随机队列比较研究，使用管理数据库的患者谁开始OAT在2011年和2012年之间在加拿大安大略省的58个诊所网站。患者按主要治疗方式分层为：面对面（远程医疗预约< 25%）、混合（远程医疗预约25-75%）或通过远程医疗（远程医疗预约> 75%）。主要结果是持续保留治疗定义为一年的不间断治疗，根据药房dosing records.Results：共确定了3733 OAT启动患者。通过远程医疗治疗的患者比亲自治疗的患者更有可能保留治疗（n = 1590; aOR = 1.27; 95% CI 1.14-1.41; p < 0.001）。远程医疗患者一年的留存率为50%，而现场患者的留存率为39%。混合组也有更高的可能性保留比在人组（n = 418; aOR = 1.26; 95%CI 1.08-1.47; p = 0.001），1年时的留存率为47%。远程医疗可能是一个有效的替代提供人OAT，它有可能扩大获得保健的农村，偏远，和城市地区。
Objective: Opioid use disorder has been declared a public health crisis across North America and opioid agonist therapy (OAT) is the standard of care for these patients. Despite the increasing adoption of telemedicine as a delivery method for OAT, its effectiveness has not yet been evaluated against traditional in-person treatment. This study compared treatment outcomes for in-person versus telemedicine-delivered OAT.Methods: We conducted a non-randomized cohort comparison study using an administrative database for patients who commenced OAT between 2011 and 2012 across 58 clinic sites in the province of Ontario, Canada. Patients were stratified by primary treatment modality as being: in-person ( < 25% appointments by telemedicine), mixed (25-75% by telemedicine), or via telemedicine ( > 75% appointments by telemedicine). The primary outcome was continuous retention in treatment as defined by one year of uninterrupted therapy, based on pharmacy dosing records.Results: A total of 3733 OAT initiating patients were identified. Patients treated via telemedicine were more likely to be retained in therapy than patients treated in-person (n = 1590; aOR = 1.27; 95% CI 1.14-1.41; p < 0.001). Telemedicine patients demonstrated a retention rate of 50% at one year whereas in-person patients were retained at a rate of 39%. The mixed group also had higher likelihood of retention than the in-person group (n = 418; aOR = 1.26; 95% CI 1.08-1.47; p = 0.001) and had a retention rate of 47% at one year.Conclusion: Telemedicine may be an effective alternative to delivering in person OAT, and it has the potential to expand access to care in rural, remote, and urban regions.