Assessment of State and Federal Health Policies for Opioid Use Disorder Treatment During the COVID-19 Pandemic and Beyond.
Assessment of State and Federal Health Policies for Opioid Use Disorder Treatment During the COVID-19 Pandemic and Beyond.
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DOI：
10.1001/jamahealthforum.2021.3833
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发表时间：
2021-11
期刊：
影响因子：
--
通讯作者：
Pacula, Rosalie Liccardo
中科院分区：
文献类型：
--
作者：
Pessar, Seema Choksy;Boustead, Anne;Ge, Yimin;Smart, Rosanna;Pacula, Rosalie Liccardo
联邦和州政府在COVID-19大流行期间实施了提供阿片类药物使用障碍（OUD）治疗的临时策略。倡导者希望这些政策中的许多成为永久性的，因为它们有可能扩大获得护理的机会。要考虑多种方式获得和利用治疗的个人与OUD可能已经扩大了州和联邦政策，使研究人员可以做一个更好的工作，评估具体的政策方法的有效性，这将取决于与其他国家的政策的相互作用。我们总结了跟踪医疗保健法规的政府和非营利机构报告的州一级政策数据，特别是凯撒家庭基金会，州医学委员会联合会，美国护士从业者协会，美国医师助理学会和国家安全理事会。数据由该等来源于二零二零年九月至二零二一年一月收集。我们研究了COVID-19大流行期间各州在4个关键领域采取的政策要素的异质性：远程医疗、隐私、许可和阿片类药物使用障碍的药物治疗。分析于二零二零年三月至二零二一年一月期间进行。这项横断面研究发现，联邦和州政府已经采取了重要措施，以确保在COVID-19大流行期间OUD治疗的可用性，但很少有州在其方法上是全面的。尽管所有州和华盛顿特区都采用了至少一项远程医疗政策，但只有17个州采用了改善新患者获得OUD治疗的远程医疗政策。此外，只有9个州放宽了隐私法，这影响了使用特定技术进行远程医疗访问的能力。同样，所有州都通过了至少一项与医疗保健专业许可证有关的政策，但只有35个州扩大了医生助理和护士执业的执业法律范围。44个州扩大了OUD治疗药物的启动和交付。总之，没有一个州在COVID-19大流行期间实施了所有这些政策，以全面扩大OUD治疗的可及性。在大流行期间，相当多的政策变化可能影响到OUD患者获得治疗和保留治疗的机会，因此评估必须考虑到相关政策领域中国家方法的差异，因为政策之间的相互作用可能会限制任何单一政策方法的潜在有效性。
Federal and state governments implemented temporary strategies for providing access to opioid use disorder (OUD) treatment during the COVID-19 pandemic. Advocates hope many of these policies become permanent because of their potential to expand access to care. To consider the multitude of ways access to and utilization of treatment for individuals with OUD might have been expanded by state and federal policy so researchers can do a better job evaluating the effectiveness of specific policy approaches, which will depend on the interaction with other state policies. We summarize state-level policy data reported by government and nonprofit agencies that track health care regulations, specifically the Kaiser Family Foundation, Federation of State Medical Boards, American Association of Nurse Practitioners, American Academy of Physician Assistants, and the National Safety Council. Data were collected by these sources from September 2020 through January 2021. We examine heterogeneity in policy elements adopted across states during the COVID-19 pandemic in 4 key areas: telehealth, privacy, licensing, and medication for opioid use disorder. The analysis was conducted from March 2020 through January 2021. This cross-sectional study found that federal and state governments have taken important steps to ensure OUD treatment availability during the COVID-19 pandemic, but few states are comprehensive in their approach. Although all states and Washington, DC have adopted at least 1 telehealth policy, only 17 states have adopted telehealth policies that improve access to OUD treatment for new patients. Furthermore, only 9 states relaxed privacy laws, which influence the ability to use particular technology for telehealth visits. Similarly, all states have adopted at least 1 policy related to health care professional licensing permissions, but only 35 expanded the scope of practice laws for both physician assistants and nurse practitioners. Forty-four states expanded access to initiation and delivery of medication for OUD treatment. Together, no state has implemented all of these policies to comprehensively expand access to OUD treatment during the COVID-19 pandemic. With considerable policy changes potentially affecting access to treatment and treatment retention for patients with OUD during the pandemic, evaluations must account for the variation in state approaches in related policy areas because the interactions between policies may limit the potential effectiveness of any single policy approach.
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