Telemedicine for Treatment of Opioid Use Disorder: NIDA Summer Research Internship Program

项目摘要：对抗阿片类药物流行的一个关键挑战是将个人联系起来 阿片类药物使用障碍的患者进行循证治疗。总统禁毒委员会 成瘾和阿片类药物危机和其他人认为，远程医疗的物质使用障碍（“远程- SUD”）可能是解决方案的一部分。在初步分析中，我们发现远程SUD的使用正在增长 迅速，国会和州立法机构对如何加速这一点有着广泛的政策兴趣 增长2018年10月签署成为法律的“支持患者和社区法”包括几个 旨在减少使用远程SUD的障碍的规定，并可能增加 对远程SUD的补偿。然而，尽管广泛的兴趣和日益增长的使用，从来没有 对南方电信的严格评估例如，不同的远程SUD模型用于治疗 阿片类药物使用障碍，更多地使用tele-SUD存在哪些障碍，以及tele-SUD的使用与 改善（或可能更糟）阿片类药物使用障碍患者的护理质量？为了填补这一知识空白， 我们建议使用以下数据对阿片类药物使用障碍的远程医疗进行全面的国家评估： 2021年从医疗补助，医疗保险和商业保险以及一系列定性访谈。我们 目的是：（1）描述远程SUD如何被纳入阿片类药物使用障碍的不同模型 护理以及随着时间的推移这是如何变化的，（2）确定与更多的远程SUD使用相关的区域因素， 阿片类药物使用障碍，（3）检查远程SUD使用和阿片类药物使用障碍护理质量之间的关联 收到的，这是否因模型而异，以及（4）描述现有的远程SUD计划，并确定障碍 和促进者，以采用和可持续的可持续发展。 拟议的混合方法研究将帮助有兴趣使用远程SUD的供应商，并告知正在进行的 在国会和州立法机构中就tele-SUD的法规和报销进行辩论。我们的目标是 强调推动更多地使用南方城市电信政策和做法，并探讨其在改善 阿片类药物使用障碍患者获得护理的机会和质量。我们的研究将有助于了解如何远程- SUD可用于对抗阿片类药物流行以及其他物质使用障碍，如 酒精和甲基苯丙胺使用障碍。

PROJECT SUMMARY: A key challenge in combating the opioid epidemic has been connecting individuals with opioid use disorder to evidence-based treatments. The President's Commission on Combating Drug Addiction and the Opioid Crisis and others have suggested that telemedicine for substance use disorder (“tele- SUD”) may be part of the solution. In preliminary analyses, we have found that tele-SUD use is growing rapidly, and there is widespread policy interest in Congress and state legislatures in how to accelerate this growth. The SUPPORT for Patients and Communities Act, signed into law in October 2018, includes several provisions intended to reduce barriers to tele-SUD use and will likely increase the availability of and reimbursement for tele-SUD. However, despite the widespread interest and growing use, there has never been a rigorous assessment of tele-SUD. For example, what are the different tele-SUD models being used to treat opioid use disorder, what barriers exist to greater use of tele-SUD, and is tele-SUD use associated with improved (or potentially worse) quality of care for people with opioid use disorder? To fill this knowledge gap, we propose a comprehensive national evaluation of telemedicine for opioid use disorder using data through 2021 from Medicaid, Medicare, and commercial insurance as well as a series of qualitative interviews. Our Aims are to: (1) describe the different models of how tele-SUD is being incorporated into opioid use disorder care and how this is changing over time, (2) identify regional factors associated with greater tele-SUD use for opioid use disorder, (3) examine the association between tele-SUD use and quality of opioid use disorder care received and whether this varies by model, and (4) describe existing tele-SUD programs, and identify barriers and facilitators to tele-SUD adoption and sustainability. The proposed mixed-methods study will help providers interested in using tele-SUD and inform ongoing debates about regulations and reimbursement for tele-SUD in Congress and state legislatures. Our goal is to highlight policies and practices that drive greater use of tele-SUD and explore its potential role in improving access to, and quality of, care for individuals with opioid use disorder. Our research will help inform how tele- SUD may be leveraged to combat the opioid epidemic as well as other substance use disorders, such as alcohol and methamphetamine use disorders.