REMOTE: tREatMent for Opioid use via TElemedicine

项目摘要 在2019冠状病毒病（COVID-19）大流行期间，阿片类药物的流行正在升级。2018年期间， 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 自2018年以来，过量用药增加了4.8%，随着COVID-19大流行的加剧，许多 各国报告称，2020年类阿片相关死亡率将进一步上升。这可能是由于社会 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。阿片类药物使用障碍（OUD）治疗历来是亲自提供的，因为联邦 法规禁止通过远程医疗开出丁丙诺啡的处方（例如，视频或电话）和远程 医疗保险公司很少支付探视费用。疫情期间，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。远程医疗访问的选择可以增加OUD治疗的可及性， 参与，特别是生活在农村地区或资源有限的人;然而， 在初级保健环境中，对远程医疗对OUD治疗的影响进行了研究。我们利用这个 这是一个前所未有的机会，可以研究远程医疗对初级保健环境中OUD治疗的影响。 研究诊所包括两个已建立OUD治疗计划的家庭医学诊所。这些诊所（1个 农村卫生中心和一个具有联邦资格的卫生中心）为经常面临障碍的患者提供服务 因此，这些是研究的优先人群。这种顺序解释的目的是混合的 方法研究如下：目的1：使用电子健康记录数据来检查远程医疗与面对面医疗。 OUD相关治疗的面对面访视（例如，诊断，与医疗提供者的访问，行为健康访问， 药物订单，预约没有显示，尿液药物屏幕）之前，期间，和之后的实施 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 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， 进一步解释目标1分析中观察到的治疗获得和参与模式。这些发现 将为远程OUD治疗提供最佳实践，无论是长期可持续性， 在大流行病期间，或在无法亲自访问时应对未来的紧急情况。我们的研究结果 也为随机实施和有效性试验奠定了基础， 在最需要的人群中治疗OUD。这项研究是高度响应国家药物研究所 滥用（NIDA）的特别利益通知（NOSI）在利用远程医疗发展和支持 在具有或处于活动受限风险的患者中治疗物质使用障碍（例如，农村和 低社会经济地位人口）。

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).