COVID-19 Pandemic: Natural Experiment in Telehealth on Buprenorphine Treatment in a Large Integrated Healthcare System

COVID-19 大流行：大型综合医疗系统中丁丙诺啡治疗远程医疗的自然实验

• 批准号: 10590255
• 负责人: David Stanley Fink
• 金额: $ 17.43万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-03-01 至 2026-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10590255
• 关键词: Active Learning; Adult; Affect; African American; American; Area; Buprenorphine; COVID-19; COVID-19 pandemic; Caring; Censuses; Characteristics; Clinic; Clinical; Clinical Treatment; Clinical Trials; Communication; Community Pharmacy; Data; Data Set; Databases; Diagnosis; Disease Outbreaks; Dose; Dropout; Educational workshop; Electronic Health Record; Epidemiologist; Evaluation; Exclusion; Funding; Future; Guidelines; Health Insurance; Healthcare; Individual; Inpatients; Institutional Racism; Integrated Health Care Systems; Intervention; Laboratories; Licensing; Life; Location; Long-Term Care; Low income; Maintenance; Medical; Medicare; Methadone; Methods; Modeling; Naltrexone; Natural experiment; Overdose; Patient-Focused Outcomes; Patients; Persons; Pharmaceutical Preparations; Policies; Policy Analysis; Policy Maker; Population; Positioning Attribute; Privatization; Provider; Recording of previous events; Records; Regulation; Relapse; Relaxation; Research; Research Personnel; Role; Rural Community; Series; Substance Use Disorder; System; Telemedicine; Telephone; Testing; Time; Training Programs; Transportation; Treatment outcome; United States Department of Veterans Affairs; Urbanicity; Veterans; Visit; Washington; addiction; buprenorphine treatment; care outcomes; career; coronavirus disease; design; federal policy; flexibility; health care delivery; health care disparity; human old age (65+); insurance claims; medication for opioid use disorder; novel; opioid treatment program; opioid use disorder; opioid withdrawal; post-pandemic; prevent; rate of change; rural area; rural healthcare; skills; sociodemographics; study population; substance use; telehealth; time use; waiver

PROJECT SUMMARY/ABSTRACT Expanded use of telemedicine for buprenorphine prescribing may reduce barriers to buprenorphine prescribers. However, federal regulations that require prescribers to conduct in-person medical evaluations to induct patients on buprenorphine and limit maintenance visits to real-time, two-way, interactive audio-visual communication (i.e., telehealth) has prevented research on the potential role of expanding telehealth for buprenorphine prescribing. The initial surge of COVID-19 cases in the US in March 2020 led federal agencies to ease the in-person evaluation requirement, allowing providers to use telemedicine or telephone-only visits for medical evaluations to start patients on buprenorphine. We propose a study that leverages these COVID-related regulator reforms to answer important clinical and policy questions regarding the regulations governing the use of telehealth for buprenorphine initiation and treatment among Veterans Administration (VA) patients. Serving ~5,000,000 patients each year, we will leverage the VA electronic health record data to answer three important clinical and policy questions. (1) What was the effect of the relaxed buprenorphine prescribing guidelines on buprenorphine treatment rates change during the COVID-19 pandemic overall and by treatment stage (new patients vs. long- standing patients)? (2) What is the effect on treatment outcomes of more flexible telehealth regulations on patients initiating buprenorphine treatment? (3) What is the effect of telehealth use on treatment outcomes on patients in long-standing buprenorphine treatment (in care ≥6 months)? We will answer these questions in three steps: (1) We will use time-series methods to model the monthly counts of VA patients in buprenorphine treatment prior to March 2020, predict the monthly count in treatment from April to December 2020 and compare it to the observe counts to quantify the change in buprenorphine treatment rates associated with more flexible treatment regulations; (2) Test whether: (a) clinical treatment outcomes in patients initiating buprenorphine via telehealth post-Policy changes differ from patients initiating treatment in the year before the outbreak and (b) Investigate individual, facility, and area-level modifiers of the policy effects on clinical treatment outcomes; and (3) Among long-standing patients: (a) Examine the relationship between telehealth use and clinical treatment outcomes and (b) Determine individual, facility, and area-level differences in telehealth buprenorphine treatment. Determining the effects of more flexible telehealth regulations will provide critical information on a potential policy lever to increase access to critical life-saving medications for OUD. The complementary training program comprising of formal courses, workshops, directed readings, and experiential learning will let me develop the skill and expertise to launch my career as a substance use epidemiologist and prepare me to successfully compete for R01 funding as an independent investigator with a focus on understanding the causes of addiction and policy evaluation to inform interventions, prevent, and treat OUD and its related harms.

项目概要/摘要 扩大使用远程医疗进行丁丙诺啡处方可能会减少丁丙诺啡处方者的障碍。 然而，联邦法规要求处方者进行亲自医疗评估以引入患者 丁丙诺啡并将维护访问限制为实时、双向、交互式视听通信（即 远程医疗）阻碍了对扩大远程医疗对丁丙诺啡处方的潜在作用的研究。 2020 年 3 月，美国 COVID-19 病例最初激增，导致联邦机构放松了面对面的隔离措施 评估要求，允许提供者使用远程医疗或仅电话就诊进行医疗评估 让患者开始服用丁丙诺啡。我们提出一项研究，利用这些与新冠病毒相关的监管改革 回答有关远程医疗使用法规的重要临床和政策问题 退伍军人管理局 (VA) 患者中丁丙诺啡的起始和治疗。服务约 5,000,000 每年，我们都会利用 VA 电子健康记录数据来回答三个重要的临床和 政策问题。 (1)放宽的丁丙诺啡处方指南对丁丙诺啡有何影响 在 COVID-19 大流行期间，治疗率总体上以及按治疗阶段（新患者与长期治疗患者）发生变化 站立的病人）？ (2) 更灵活的远程医疗法规对治疗结果有何影响 患者开始丁丙诺啡治疗？ (3) 远程医疗的使用对治疗结果有何影响 长期接受丁丙诺啡治疗的患者（护理时间≥6 个月）？我们将分三步回答这些问题 步骤：(1) 我们将使用时间序列方法对每月使用丁丙诺啡的 VA 患者计数进行建模 2020年3月之前的治疗，预测2020年4月至2020年12月的每月治疗计数并进行比较 它通过观察计数来量化与丁丙诺啡治疗率相关的变化，更灵活 治疗规定； (2) 测试是否：(a) 通过以下途径开始丁丙诺啡的患者的临床治疗结果 政策变化后的远程医疗与疫情爆发前一年开始治疗的患者不同，(b) 调查政策对临床治疗结果影响的个人、设施和地区层面的修正因素；和 (3) 在长期患者中： (a) 检查远程医疗使用与临床治疗之间的关系 (b) 确定远程医疗丁丙诺啡治疗中的个体、设施和地区差异。 确定更灵活的远程医疗法规的影响将为潜在政策提供关键信息 增加获得 OUD 关键救生药物的机会。补充培训计划 包括正式课程、研讨会、定向阅读和体验式学习，将使我能够发展 技能和专业知识，以开启我作为药物滥用流行病学家的职业生涯，并为我成功做好准备 作为独立调查员竞争 R01 资助，重点是了解成瘾的原因 和政策评估，为干预措施、预防和治疗 OUD 及其相关危害提供信息。

项目成果

Changes in Opioid and Benzodiazepine Poisoning Deaths After Cannabis Legalization in the US: A County-level Analysis, 2002-2020.

美国大麻合法化后阿片类药物和苯二氮卓中毒死亡人数的变化：县级分析，2002-2020 年。

• DOI: 10.1097/ede.0000000000001609
• 发表时间: 2023
• 期刊: Epidemiology (Cambridge, Mass.)
• 作者: Castillo-Carniglia,Alvaro;Rivera-Aguirre,Ariadne;Santaella-Tenorio,Julian;Fink,DavidS;Crystal,Stephen;Ponicki,William;Gruenewald,Paul;Martins,SilviaS;Keyes,KatherineM;Cerdá,Magdalena
• 通讯作者: Cerdá,Magdalena