REMOTE: tREatMent for Opioid use via TElemedicine

远程：通过远程医疗治疗阿片类药物使用

• 批准号: 10283155
• 负责人: Steffani R Bailey
• 金额: $ 19.25万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-15 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10283155
• 关键词: Address; Appointment; Back; Buprenorphine; COVID-19; COVID-19 pandemic; Caring; Cessation of life; Characteristics; Clinic; Clinical; Dangerousness; Data; Diagnosis; Drug Screening; Economics; Effectiveness; Electronic Health Record; Emergency Situation; Ensure; Epidemic; Exercise; Face; Family Practice; Federal Government; Federally Qualified Health Center; Foundations; Future; Health Services; Health Services Accessibility; Healthcare; Insurance; Insurance Carriers; Intervention; Interview; Medical; Methods; Modality; National Institute of Drug Abuse; Opioid; Overdose; Patient Monitoring; Patients; Pattern; Persons; Pharmaceutical Preparations; Population; Primary Health Care; Professional Role; Provider; RQ2; Randomized; Regulation; Reporting; Research; Resources; Risk; Rural; Rural Health Centers; Safety; Structure; Substance Use Disorder; Telemedicine; Telephone; Underserved Population; Urine; Visit; Vulnerable Populations; Work; authority; barrier to care; base; behavioral health; care delivery; effectiveness trial; experience; health care availability; implementation trial; innovation; interest; low socioeconomic status; member; mortality; opioid epidemic; opioid policy; opioid use; opioid use disorder; pandemic disease; primary care setting; randomized trial; remote delivery; remote therapy; remote visit; response; rural area; safety and feasibility; social; stressor; substance use treatment; treatment program; treatment services; trial design; video visit

PROJECT SUMMARY The opioid epidemic is escalating during the coronavirus disease 2019 (COVID-19) pandemic. During 2018, drug overdoses resulted in 67,367 deaths, with almost 70% involving an opioid. Preliminary data from 2019 show a rise of 4.8% in overdoses from 2018 and with the exacerbations of the COVID-19 pandemic, many states are reporting further increases in opioid-related mortality in 2020. This is likely due to increased social and economic stressors, as well as to limited treatment access, particularly among our most vulnerable populations. Opioid use disorder (OUD) treatment has historically been delivered in person, as federal regulations prohibited prescribing of buprenorphine via telemedicine (e.g., video or telephone) and remote visits were rarely covered by insurance providers. During the pandemic, many insurers began covering telemedicine visits and the federal government exercised authority to allow for the comprehensive treatment of OUD via telemedicine. The option for telemedicine visits could increase OUD treatment accessibility and engagement, particularly among those living in rural areas or whose resources are limited; however, limited research exists on the impact of telemedicine on OUD treatment in primary care settings. We leverage this unprecedented opportunity to study the impact of telemedicine on OUD treatment in primary care settings. Study clinics include two Family Medicine clinics with established OUD treatment programs. These clinics (one rural health center and one federally-qualified health center) serve patients that often face barriers to healthcare access; thus, these are priority populations to study. The aims of this sequential explanatory mixed methods study are as follows: Aim 1: Use electronic health record data to examine telemedicine versus face- to-face visits for OUD-related treatment (e.g., diagnosis, visits with medical provider, behavioral health visits, medication orders, appointment no shows, urine drug screens) before, during, and after implementation of telemedicine; Aim 2: Conduct semi-structured qualitative interviews to assess how patients and clinical team members experience OUD treatment that is delivered via telemedicine modalities. We use qualitative data to further explain the patterns of treatment access and engagement observed in Aim 1 analyses. These findings will inform best practices for remote OUD treatment delivery, whether for long-term sustainability post- pandemic or in response to future emergency situations when in-person visits are not possible. Our findings also lay the foundation for a randomized implementation and effectiveness trial designed to advance access to treatment of OUD among those most in need. This study is highly responsive to the National Institute on Drug Abuse (NIDA)'s Notice of Special Interest (NOSI) in the utilization of telemedicine to develop and support treatments for substance use disorder among patients with or at risk of limitations of mobility (e.g., rural and low SES populations).

项目摘要 在2019年冠状病毒病（COVID-19）大流行期间，阿片类药物流行正在升级。在2018年期间 药物过量导致67,367例死亡，几乎70％涉及阿片类药物。 2019年的初步数据 从2018年起，过量剂量增长了4.8％，并且随着COVID-19大流行的加剧，许多 各州报告说，2020年与阿片类药物相关的死亡率进一步增加。这可能是由于社会的增加所致 和经济压力源以及有限的治疗访问，尤其是在我们最脆弱的人中 人群。阿片类药物使用障碍（OUD）治疗历史上已经亲自交付 法规禁止通过远程医疗（例如，视频或电话）和遥控器开处方丁丙诺啡 访问很少被保险提供者覆盖。在大流行期间，许多保险公司开始报道 远程医疗访问和联邦政府行使授权，以允许对 通过远程医疗。远程医疗访问的选项可能会增加OUD治疗可访问性和 参与，特别是在农村地区或资源有限的人中；但是，有限 关于远程医疗对初级保健环境中OUD治疗的影响的研究。我们利用这一点 前所未有的机会，研究远程医疗对初级保健环境中OUD治疗的影响。 研究诊所包括两个具有既定OUD治疗计划的家庭医学诊所。这些诊所（一个 农村卫生中心和一个由联邦资格的健康中心）为患者服务，这些患者经常面临障碍 医疗保健访问；因此，这些是要研究的优先人群。这种顺序解释性混合的目的 方法研究如下：目标1：使用电子健康记录数据检查远程医疗与面部 - 访问与OUD相关治疗的访问（例如，诊断，医疗提供者的访问，行为健康访问， 药物命令，预约没有表演，尿液筛查） 远程医疗； AIM 2：进行半结构化定性访谈以评估患者和临床团队如何 会员体验通过远程医疗方式提供的OUD治疗。我们使用定性数据 进一步解释在AIM 1分析中观察到的治疗访问和参与模式。这些发现 无论是在长期可持续性之后， 当不可能进行面对面访问时，大流行或应对未来的紧急情况。我们的发现 还为旨在提高访问权限的随机实施和有效性试验奠定了基础 在大多数有需要的人中对OUD进行处理。这项研究对国家药物研究所的反应很高 滥用（NIDA）在利用远程医疗的特殊利益通知（NOSI）开发和支持方面 有限制的患者或有限制的患者（例如农村和农村和 低SES人群）。