REMOTE: tREatMent for Opioid use via TElemedicine

项目总结 在冠状病毒病2019年(新冠肺炎)大流行期间，阿片类药物流行正在升级。2018年， 药物过量导致67,367人死亡，其中近70%涉及阿片类药物。2019年的初步数据 显示自2018年以来过量服用增加了4.8%，随着新冠肺炎大流行的加剧，许多人 各国报告称，2020年与阿片类药物有关的死亡率进一步上升。这很可能是由于社交网络的增加 和经济压力，以及有限的治疗机会，特别是在我们最脆弱的人群中 人口。阿片使用障碍(OUD)治疗历来是亲自进行的，作为联邦政府 条例禁止通过远程医疗(如视频或电话)和远程开丁丙诺啡处方 保险提供商很少承保访问。在大流行期间，许多保险公司开始承保 远程医疗访问和联邦政府行使权力，允许全面治疗 通过远程医疗。选择远程医疗访问可以增加我们治疗可及性和 参与，特别是在那些生活在农村地区或资源有限的人中；然而，有限 已经有关于远程医疗对初级保健环境中的OUD治疗的影响的研究。我们利用这一点 研究远程医疗对初级保健环境中的OUD治疗的影响的前所未有的机会。 研究诊所包括两个家庭医学诊所，它们都有既定的OUD治疗计划。这些诊所(一间 农村卫生中心和一个联邦合格的卫生中心)为经常面临障碍的患者提供服务 获得医疗保健；因此，这些人是优先研究的人群。这一顺序解释的目的好坏参半。 研究方法如下：目的1：利用电子病历数据进行远程医疗与人脸对照检查。 OUD相关治疗的面对面访问(例如，诊断、与医疗提供者的访问、行为健康访问、 用药命令、预约不露面、尿药筛查)实施前、中、后 远程医疗；目标2：进行半结构化定性访谈，以评估患者和临床团队如何 成员体验通过远程医疗方式提供的OUD治疗。我们使用定性数据来 进一步解释在目标1分析中观察到的治疗、获得和参与的模式。这些发现 将提供远程OUD治疗交付的最佳做法，无论是为了实现长期可持续性 在未来不可能进行面对面访问的情况下，应对大流行或应对紧急情况。我们的发现 还为随机实施和有效性试验奠定基础，旨在促进 在最需要帮助的人中间进行治疗。这项研究是对国家药物研究所的高度响应 滥用(NIDA)S特别关注(NOSI)在远程医疗利用中的开发和支持 对行动能力受限或有活动受限风险的患者进行药物使用障碍的治疗(例如，农村和 低SES种群)。

PROJECT SUMMARY The opioid epidemic is escalating during the coronavirus disease 2019 (COVID-19) pandemic. During 2018, drug overdoses resulted in 67,367 deaths, with almost 70% involving an opioid. Preliminary data from 2019 show a rise of 4.8% in overdoses from 2018 and with the exacerbations of the COVID-19 pandemic, many states are reporting further increases in opioid-related mortality in 2020. This is likely due to increased social and economic stressors, as well as to limited treatment access, particularly among our most vulnerable populations. Opioid use disorder (OUD) treatment has historically been delivered in person, as federal regulations prohibited prescribing of buprenorphine via telemedicine (e.g., video or telephone) and remote visits were rarely covered by insurance providers. During the pandemic, many insurers began covering telemedicine visits and the federal government exercised authority to allow for the comprehensive treatment of OUD via telemedicine. The option for telemedicine visits could increase OUD treatment accessibility and engagement, particularly among those living in rural areas or whose resources are limited; however, limited research exists on the impact of telemedicine on OUD treatment in primary care settings. We leverage this unprecedented opportunity to study the impact of telemedicine on OUD treatment in primary care settings. Study clinics include two Family Medicine clinics with established OUD treatment programs. These clinics (one rural health center and one federally-qualified health center) serve patients that often face barriers to healthcare access; thus, these are priority populations to study. The aims of this sequential explanatory mixed methods study are as follows: Aim 1: Use electronic health record data to examine telemedicine versus face- to-face visits for OUD-related treatment (e.g., diagnosis, visits with medical provider, behavioral health visits, medication orders, appointment no shows, urine drug screens) before, during, and after implementation of telemedicine; Aim 2: Conduct semi-structured qualitative interviews to assess how patients and clinical team members experience OUD treatment that is delivered via telemedicine modalities. We use qualitative data to further explain the patterns of treatment access and engagement observed in Aim 1 analyses. These findings will inform best practices for remote OUD treatment delivery, whether for long-term sustainability post- pandemic or in response to future emergency situations when in-person visits are not possible. Our findings also lay the foundation for a randomized implementation and effectiveness trial designed to advance access to treatment of OUD among those most in need. This study is highly responsive to the National Institute on Drug Abuse (NIDA)'s Notice of Special Interest (NOSI) in the utilization of telemedicine to develop and support treatments for substance use disorder among patients with or at risk of limitations of mobility (e.g., rural and low SES populations).