Study: Telehealth just as effective as in-person care for opioid use disorder treatment

Telehealth was a comparable alternative to in-person care for opioid use disorder during the COVID-19 pandemic, indicating that telehealth can safely be used to expand access to this care, according to researchers.

Ruth Hailu, AB, a research assistant in the department of health care policy at Harvard Medical School, and colleagues wrote in JAMA Network Open that not much is known about the implications of the quick shift to telehealth for opioid use disorder (OUD) treatment. So, they conducted a cohort study to evaluate the associations between indicators of OUD treatment quality and the adoption of telehealth at that time.

The researchers evaluated de-identified administrative claims data from 11,801 patients with a mean age of 53.9 years — 50% of whom were men — who had OUD and were enrolled in either commercial insurance or Medicare Advantage plans. They included data for telehealth visits during both the pre-pandemic period — March 14, 2019, to March 13, 2020 — and the pandemic period — March 14, 2020, to March 13, 2021.

Hailu and colleagues found that, despite the significant increase in telehealth use from the pre-pandemic to pandemic periods, total OUD visit volume per patient episode was stable. The results were comparable for both high and low telehealth use groups — 2.6 to 2.7 visits per patient episode vs. 3.1 to 3.3 visits, respectively.

Clinicians with high vs. low telehealth use were defined as those who conducted a mean of 69.5% and 2.1% of virtual appointments during the pandemic. Primary care physicians, the researchers wrote, were more likely to be in the low vs. high telehealth use group — 48.6% vs. 26.5%.

For patients treated by clinicians in both telehealth use groups, Hailu and colleagues found no differential change in OUD-related clinical events, the initiation of medication for OUD and days’ supply.

Compared with the pre-pandemic period, the researchers reported that the proportion of patients with at least one OUD-related clinical event was lower in the pandemic period. This was observed among patients who were treated by clinicians in both the high (14% to 12.1%) and low (14.7% to 14.6%) telehealth use groups. Additionally, there were no differences in high vs. low telehealth use groups when the researchers evaluated individual OUD-related events. The proportion of patients with an overdose decreased from 1.9% to 1.8% in the high telehealth use group and from 2.3% to 2.1% in the low telehealth use group (adjusted OR = 1.14; 95% CI, 0.72-1.83).

“Overall, based on measures observable in claims data, telemedicine was comparable to in-person care, with no evidence of differential harm or benefit to patients who were seen by clinicians with high and medium vs low telemedicine use,” the researchers wrote. “While we were unable to observe visit appropriateness, the results of this study also do not suggest that telemedicine played a role in the increase in unnecessary or inefficient health care visits, an important concern raised by critics of telemedicine expansion.”

Hailu and colleagues also discussed a digital divide, as patients receiving care from clinicians with high telehealth use “were concentrated in metropolitan counties with higher income and lower proportion of white residents.”

“Given that high telemedicine use was not associated with changes in OUD care, it is possible that populations with access to clinicians with high telemedicine use had more resources to begin with,” they wrote. “Therefore, the digital divide may be a factor in the reduced potential of telemedicine to advance treatment access if additional measures are not taken to make telemedicine availability more equitable.”