Telehealth in the Treatment of Alcohol Use Disorders: Impact on Access, Disparities, and Quality of Care

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PROJECT SUMMARY While alcohol use disorder (AUD) is a leading cause of morbidity and mortality, and efficacious medication and behavioral treatments exist, only a small minority with AUD in the US receive any AUD treatment. Additionally, there are substantial disparities in receiving AUD care across several groups (e.g., racial/ethnic minorities, women, those who live in rural locations). The COVID-19 pandemic has led to a worsening of the situation with both increases in unhealthy alcohol use and disruptions in care. However, one potentially positive change is the dramatic rise in use of telehealth. Telehealth for treatment of AUD could increase access to care and thereby improve treatment outcomes, but much remains unknown about how telehealth is being incorporated into AUD care, characteristics of the patients who are receiving different patterns of AUD care and their AUD providers, and the subsequent outcomes. It is also unclear whether telehealth in AUD care is reducing or widening disparities in utilization. To address this knowledge gap we will use a mixed methods study that combines analysis of Medicare, Medicaid, and commercial insurance claims from 2016-2024, with qualitative interviews, to achieve the following study aims: 1) identify initial longitudinal patterns of telehealth versus in-person AUD care and assess patient, provider, and community characteristics associated with different patterns; 2) characterize the longer-term quality outcomes associated with these initial tele-AUD patterns; 3) assess disparities in AUD utilization over time and the association between tele-AUD use and these disparities; and, 4) explore the perspective of providers and individuals with problematic drinking on the quality of different care patterns that incorporate telehealth and other digital tools. This study will provide important new information that can inform clinical practice regarding the role of telehealth in AUD care going forward. It can help answer questions about how best to use tele-AUD to improve access to and quality of AUD care, reduce disparities, and support recovery. The results will also inform the ongoing debates on telehealth regulation and reimbursement policy in Congress, state legislatures, Medicaid programs, and private insurers.