REMOTE: tREatMent for Opioid use via TElemedicine

远程：通过远程医疗治疗阿片类药物使用

基本信息

批准号：
10463834
负责人：
Steffani R Bailey
金额：
$ 23.1万
依托单位：
OREGON HEALTH & SCIENCE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-08-15 至 2024-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10463834
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 post-COVID-19 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

项目摘要

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).

项目概要在 2019 年冠状病毒病 (COVID-19) 大流行期间，阿片类药物的流行正在升级。 2018年期间，药物过量导致 67,367 人死亡，其中近 70% 涉及阿片类药物。 2019年初步数据与 2018 年相比，药物过量增加了 4.8%，并且随着 COVID-19 大流行的加剧，许多人各州报告 2020 年阿片类药物相关死亡率进一步增加。这可能是由于社会和经济压力，以及治疗机会有限，特别是在我们最脆弱的群体中人口。阿片类药物使用障碍 (OUD) 治疗历来都是亲自进行的，因为联邦政府法规禁止通过远程医疗（例如视频或电话）和远程开具丁丙诺啡处方保险公司很少承保探访费用。疫情期间，不少保险公司开始承保远程医疗就诊和联邦政府行使权力，允许对患者进行综合治疗通过远程医疗进行 OUD。远程医疗就诊的选择可以增加 OUD 治疗的可及性参与，特别是生活在农村地区或资源有限的人们的参与；然而，有限目前正在研究远程医疗对初级保健机构 OUD 治疗的影响。我们利用这个研究远程医疗对初级保健机构 OUD 治疗影响的前所未有的机会。研究诊所包括两家已建立 OUD 治疗计划的家庭医学诊所。这些诊所（一农村卫生中心和一个联邦合格的卫生中心）为经常面临障碍的患者提供服务医疗保健服务；因此，这些是需要研究的优先人群。这种顺序解释混合的目的研究方法如下：目标 1：使用电子健康记录数据来检查远程医疗与面部医疗 OUD 相关治疗的面对面就诊（例如诊断、医疗服务提供者就诊、行为健康就诊、实施之前、期间和之后远程医疗；目标 2：进行半结构化定性访谈，以评估患者和临床团队的表现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目标 1 分析中观察到的治疗获取和参与模式。这些发现将为远程 OUD 治疗提供提供最佳实践，无论是为了长期可持续发展流行病或应对未来无法亲自访问的紧急情况。我们的发现还为随机实施和有效性试验奠定了基础，旨在促进获得为最需要帮助的人提供 OUD 治疗。这项研究对国家药物研究所高度响应滥用 (NIDA) 在利用远程医疗来开发和支持方面的特别兴趣通知 (NOSI) 对行动受限或有行动受限风险的患者（例如农村和农村地区）进行物质使用障碍的治疗社会经济地位低的人群）。

项目成果

期刊论文数量（2）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Use of Telehealth for Opioid Use Disorder Treatment in Safety Net Primary Care Settings: A Mixed-Methods Study.

在安全网初级保健环境中使用远程医疗治疗阿片类药物使用障碍：一项混合方法研究。

DOI：
10.1080/10826084.2023.2212378
发表时间：
2023
期刊：
Substance use & misuse
影响因子：
2
作者：
Bailey,SteffaniR;Wyte-Lake,Tamar;Lucas,JenniferA;Williams,Shannon;Cantone,RebeccaE;Garvey,BrianT;Hallock-Koppelman,Laurel;Angier,Heather;Cohen,DeborahJ
通讯作者：
Cohen,DeborahJ