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; 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.

项目摘要/摘要 远程医疗对丁丙诺啡处方者的使用扩大可能会减少丁丙诺啡处方者的障碍。 但是，要求开处方人进行面对面医学评估以引入患者的联邦法规 关于丁丙诺啡并将维护访问限制为实时，双向交互式音频通信（即 Telehealth）阻止了研究扩大远程医疗处方处方的潜在作用的研究。 2020年3月，美国Covid-19案件的最初激增导致联邦机构简化了面对面的人 评估要求，允许提供者使用远程医疗或仅电话访问进行医学评估 开始使用丁丙诺啡的患者。我们提出了一项研究，以利用这些相关的监管机构改革 回答有关远程医疗使用的法规的重要临床和政策问题 退伍军人给药（VA）患者的丁丙诺啡倡议​​和治疗。服务约5,000,000 每年患者，我们将利用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）放松的丁丙诺啡处方指南对丁丙诺啡的影响是什么 治疗率在199年大流行期间和按治疗阶段发生变化（新患者与长期患者 站立的患者）？ （2）对更灵活的远程医疗法规对治疗结果的影响是什么 患者启动丁丙诺啡治疗？ （3）远程医疗对治疗结果的影响是什么 长期以来丁丙诺啡治疗的患者（在护理≥6个月内）？我们将在三个中回答这些问题 步骤：（1）我们将使用时间序列方法对丁丙诺啡中VA患者的每月计数进行建模 在2020年3月之前的治疗，预测2020年4月至2020年12月的治疗每月计数并进行比较 它对观察的数量来量化丁丙诺啡治疗率的变化与更灵活相关的 治疗法规； （2）测试是否：（a）患者的临床治疗结果通过 远程医疗后政策变化与爆发前一年的患者启动治疗不同，并且（b） 研究对临床治疗结果的政策影响的个人，设施和面积的修饰符；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 结局和（b）确定远程医疗治疗的个人，设施和面积差异。 确定更灵活的远程医疗法规的影响将提供有关潜在政策的关键信息 杠杆以增加获得关键的救生药物的使用。完整的培训计划 完成正式课程，讲习班，有导阅读和经验丰富的学习将使我开发 技能和专业知识来启动我作为药物使用流行病学家的职业，并为我做好准备 作为独立研究者的R01资金竞争，重点是理解成瘾的原因 和政策评估，以告知干预措施，预防和治疗OUD及其相关危害。