Telehealth allowed patients to stay in treatment for opioid use disorder during pandemic
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The expansion of telehealth services during the COVID-19 pandemic allowed patients to remain in treatment for opioid use disorder, according to findings published in the Journal of Rural Mental Health.
“Opioid use disorder is intertwined with many infectious disease syndromes, including skin and soft tissue infection, osteomyelitis, endocarditis, hepatitis C, hepatitis B and HIV, which occur as collateral damage in these patients, leading to increased costs of care across the spectrum,” Raghavendra Tirupathi, MD, FACP, FIDSA, FRCP, an infectious disease physician at Keystone Health, told Healio. “This is even more true in our rural patients and clinics with minimal resources. Removing barriers for medication-assisted therapy in these settings with the help of telehealth as demonstrated in our study will definitely increase retention and care and in turn decrease the incidence of many of these life-threatening infections, saving health care dollars and improving outcomes.”
‘Effective mode of treatment delivery’
Tirupathi and colleagues conducted a retrospective chart review of patients in Medications for Opioid Use Disorder (MOUD) treatment with buprenorphine at a rural Federally Qualified Health Center in south-central Pennsylvania. The patients’ EHRs were searched from July 1, 2019, to June 30, 2020. Only active patients were included in the study. Clinic visits for MOUD patients on buprenorphine were fully transitioned to telehealth due to COVID-19-related social distancing guidelines by April 1, 2020. Telehealth services were delivered using a HIPAA-compliant software program through audio-video or audio-only appointments.
The researchers divided patients’ EHR data into four groups of 3-month time points to track treatment retention rates before and during the pandemic:
- group one: July 1, 2019, to Sept. 30, 2019 (n = 309);
- group two (baseline): Oct. 1, 2019, to Dec. 31, 2019 (n = 327);
- group three: Jan. 1, 2020, to March 31, 2020 (n = 360); and
- group four: April 1, 2020, to June 30, 2020 (n = 365).
Tirupathi and colleagues reported that the percentage of patients who were retained in treatment — meaning, those who stayed in treatment across two consecutive time points — was 92.55% (95% CI, 0.896-0.956) at baseline, 94.18% (95% CI, 0.916-0.967) before COVID-19 and 90.83% (95% CI, 0.878-0.939) during COVID-19.
Social distancing due to the COVID-19 pandemic challenged patient retention in MOUD programs, according to Tirupathi and colleagues. All MOUD clinic visits were originally in-person. COVID-19-related social distancing measures caused the transition to telehealth with drug screening requirements waived for new and returning patients.
Expanded coverage and access to telehealth in response to the pandemic provided patients with continued access to evidence-based treatment, the researchers said.
Overall, the “results reflect the potential of telemedicine as an effective alternative to in-person treatment visits,” coauthor Jagdeep Kaur, MD, DFAPA, a clinical associate professor in the department of psychiatry and behavioral sciences at the University of California, Davis, told Healio. “Telemedicine should be considered as an effective mode of treatment delivery.”
Avoiding a ‘telehealth cliff’
Congress recently approved a $1.5 trillion spending package with provisions that will extend telehealth services for at least 5 months after the expiration of the COVID-19 public health emergency. The legislation will allow patients to avoid a “telehealth cliff” — as the American Telemedicine Association described it — and enable Federally Qualified Health Centers and rural health clinics to continue to offer telehealth services, such as MOUD treatment.
“Many of our patients in Federally Qualified Health Centers are uninsured, underinsured and lack in many social determinants of health including transportation,” Tirupathi said. “Telehealth provides a convenient and effective way of providing care to these underprivileged patients.”
References:
ATA and ATA action commend congress for extending telehealth flexibilities post public health emergency to temporarily avoid the ‘telehealth cliff’, but will continue to work with congress on permanent solutions. https://www.americantelemed.org/press-releases/ata-and-ata-action-commend-congress-for-extending-telehealth-flexibilities-post-public-health-emergency-to-temporarily-avoid-the-telehealth-cliff-but-will-continue-to-work-with-cong/. Published March 9, 2022. Accessed March 10, 2022.
Kaur J, et al. Rural Ment Health. 2022;doi:10.1037/rmh0000206.