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

项目总结 虽然酒精使用障碍(AUD)是导致发病率和死亡率的主要原因，但有效的药物和 行为疗法是存在的，在美国只有一小部分患有AUD的人接受AUD治疗。 此外，在接受AUD治疗方面，几个群体(例如，种族/民族)之间存在很大差异 少数群体、妇女、居住在农村地区的人)。新冠肺炎大流行导致全球疫情恶化 不健康饮酒增加和护理中断的情况。然而，一个潜在的 积极的变化是远程医疗使用的戏剧性增长。远程医疗治疗AUD可以增加获得机会 护理，从而改善治疗结果，但远程医疗如何发展仍是个未知数 将不同模式的AUD患者的特征纳入AUD护理 和他们的澳元供应商，以及随后的结果。目前也不清楚澳大利亚医疗保健中的远程医疗是否 缩小或扩大利用方面的差距。 为了解决这一知识差距，我们将使用一项混合方法研究，结合对联邦医疗保险的分析， 2016-2024年的医疗补助和商业保险索赔，通过定性访谈，以实现 以下研究目标：1)确定远程医疗与面对面AUD护理的初始纵向模式 评估与不同模式相关的患者、提供者和社区特征；2)描述 与这些初始远程AUD模式相关的长期质量结果；3)评估AUD的差异 随时间的利用以及远程使用和这些差异之间的联系；以及，4)探索 有问题饮酒的提供者和个人对不同护理模式的质量的看法 整合远程医疗和其他数字工具。 这项研究将提供重要的新信息，可以为临床实践提供关于 远程医疗在澳大利亚医疗保健领域的未来。它可以帮助回答有关如何最好地使用Tele-AUD来改进的问题 AUD护理的可获得性和质量，减少差距，支持恢复。结果也将通知 国会、州立法机构、医疗补助计划中关于远程医疗监管和补偿政策的持续辩论 计划和私人保险公司。

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.