Comparing telemedicine to in-person buprenorphine treatment in U.S. veterans with opioid use disorder.
Comparing telemedicine to in-person buprenorphine treatment in U.S. veterans with opioid use disorder.
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DOI：
10.1016/j.jsat.2021.108492
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发表时间：
2022-03
影响因子：
3.9
通讯作者：
Piette JD
中科院分区：
文献类型：
--
作者：
Lin LA;Fortney JC;Bohnert ASB;Coughlin LN;Zhang L;Piette JD
远程医疗提供的丁丙诺啡（远程丁丙诺啡）可能会增加阿片类药物使用障碍（OUD）患者获得丁丙诺啡的机会，特别是在COVID-19大流行期间，但我们对临床护理中的使用知之甚少。这项研究是一项回顾性国家队列研究，研究对象是2012-2019财政年度接受退伍军人健康管理局（VHA）丁丙诺啡治疗的被诊断患有阿片类药物使用障碍（OUD）的退伍军人。该研究检查了远程丁丙诺啡的使用趋势，并比较了接受远程丁丙诺啡与仅接受面对面治疗的患者的人口统计学和临床特征。在全国VHA退伍军人中，远程丁丙诺啡的使用率从2012财年的2.29%（n=187）增加到2019财年的7.96%（n=1352）。与仅接受面对面护理的患者相比，远程丁丙诺啡患者不太可能是男性（AOR=0.85，95% CI：0.73-0.98）或黑人（AOR=0.54，95% CI：0.45-0.65）。远程丁丙诺啡患者更有可能在社区门诊诊所而不是大型医疗中心接受治疗（AOR=2.91，95% CI：2.67-3.17），并且生活在农村地区（AOR=2.13，95% CI：1.92-2.35）。远程丁丙诺啡治疗患者中提供丁丙诺啡治疗的中位天数为722天（四分位数范围：322-1459），而亲自接受治疗的患者中提供丁丙诺啡治疗的中位天数为295天（四分位数范围：67-854）。在2012年至2019年期间，VHA中使用远程医疗提供丁丙诺啡治疗增加了3.5倍，尽管在COVID-19之前总体使用率仍然很低。远程丁丙诺啡是一种很有前途的方式，特别是在治疗机会有限的情况下;然而，我们必须继续了解从业人员和患者如何使用远程医疗，以及这些患者的结果与使用面对面护理的患者相比如何。
Telemedicine-delivered buprenorphine (tele-buprenorphine) can potentially increase access to buprenorphine for patients with opioid use disorder (OUD), especially during the COVID-19 pandemic, but we know little about use in clinical care. This study was a retrospective national cohort study of veterans diagnosed with opioid use disorder (OUD) receiving buprenorphine treatment from the Veterans Health Administration (VHA) in fiscal years 2012–2019. The study examined trends in use of tele-buprenorphine and compared demographic and clinical characteristics in patients who received tele-buprenorphine versus those who received in-person treatment only. Utilization of tele-buprenorphine increased from 2.29% of buprenorphine patients in FY2012 (n=187) to 7.96% (n=1352) in FY2019 in VHA veterans nationally. Compared to patients receiving only in-person care, tele-buprenorphine patients were less likely to be male (AOR=0.85, 95% CI: 0.73–0.98) or Black (AOR=0.54, 95% CI:0.45–0.65). Tele-buprenorphine patients were more likely to be treated in community-based outpatient clinics rather than large medical centers (AOR=2.91, 95% CI: 2.67–3.17) and to live in rural areas (AOR=2.13, 95% CI:1.92–2.35). The median days supplied of buprenorphine treatment was 722 (interquartile range: 322–1459) among the tele-buprenorphine patients compared to 295 (interquartile range: 67–854) among patients who received treatment in-person. Use of telemedicine to deliver buprenorphine treatment in VHA increased 3.5-fold between 2012 and 2019, though overall use remained low prior to COVID-19. Tele-buprenorphine is a promising modality especially when treatment access is limited; however, we must continue to understand how practitioners and patient are using telemedicine and how these patients’ outcomes compare to those using in-person care.
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