For those who have opioid addiction, many hurdles stand in the form of getting effective treatmentand COVID-19 may have managed to get harder.
But with widespread implementation of telehealth, a fresh study shows, more folks are receiving treatment, even amid the pandemic.
The national study viewed the care received by veterans who received buprenorphine to take care of their opioid use disorder both before and following the pandemic shifted care to telehealth visits in early 2020.
It implies that virtual visits with addiction care providers allowed many patients to remain on the medication to aid their recovery through the entire first year of the pandemic.
In addition, it shows a significant role for telephone-only visits for these patients. Audio visits far outpaced both video visits and in-person visits for several of 2020. And also by early 2021, phone visits still accounted for 1 / 2 of all veterans’ buprenorphine-related visits every month, with video visits at 32% and in-person care at 17%.
Monthly, 14% more veterans were receiving buprenorphine care in February 2021 weighed against March 2019. Throughout that same time, the full total amount of veterans receiving any kind of addiction treatment dropped 6%.
The analysis is published in the American Journal of Psychiatry by way of a team from the University of Michigan and VA Ann Arbor Healthcare System. The lead author is Allison Lin, M.D., M.S., an addiction psychiatrist and researcher in the Addiction Center at Michigan Medicine, U-M’s academic infirmary, and the VA Center for Clinical Management Research.
Informing telehealth policy
The brand new telephone, video and in-person treatment data may help inform major policy questions being debated at this time.
Policymakers will work to potentially replace temporary pandemic-era emergency telehealth policies for patients nationwide, not only in the VA system. Prior to the pandemic, audio-only visits were typically prohibited and video visits to patients in the home were often not reimbursed.
Policymakers should think about evidence carefully prior to making final rules, says Lin.
“Telehealth for patients receiving buprenorphine for opioid use disorder was relatively new in the VA nationwide prior to the pandemic struck, and only video was allowed. The rapid switch to virtual visits for some patients kept folks from dropping out of care, and telephone visits played an integral role,” she says. “Because of the VA’s national patient data system, we’re in a position to provide a few of the first knowledge of phone, video and in-person visits over the pre-pandemic and pandemic era.”
Phone access, she notes, could be especially very important to people who have opioid use disorder who often lack stable housing, high-speed internet or usage of some type of computer.
“Phone visits might provide flexibility to create it better to keep people engaged in care as time passes,” she says. “They are also often a few of the sickest patients we look after, who have a few of the highest risk for overdose. Keeping these patients in care is really a major priority.”
Policies which make it as simple as possible to allow them to stick to addiction care will make a major effect on their overall outcomes, adds Lin, who’s an associate of the U-M Institute for Healthcare Policy and Innovation and the U-M Injury Prevention Center.
“Anecdotally, some clinics have observed no-shows decrease in the last 2 yrs, because we’re able to do phone or video,” she said. “Through the entire pandemic, the assumption has been that people have to go back to pre-COVID-19 status. But this can be an incident where any attempts to push people back again to in-person care should they don’t desire to go, or even to prohibit virtual visits, may have unintended effects. If policies do not let flexibility and offer options, we might lose people, a few of whom have only known care via phone or video.”
Furthermore study, Lin notes, further work is critically had a need to understand patient and clinician experiences and preferences, also to further measure the quality of telehealth-delivered care.
“The target is to know what high-quality care appears like, both via telehealth and in-person, to see standards for the field, but which will devote some time,” she said.
For the time being, efforts to really improve usage of buprenorphine care must continue, she says.
“Addiction may be the one illness we’ve in every of medicine where in fact the condition itself helps it be hard for folks to desire to seek treatment,” she notes. “But because we changed to telehealth doesn’t mean we removed other barriers to care. It will require more to really get effective look after OUD to individuals who require it.”
Lin and her U-M colleague, addiction psychologist and researcher Erin Bonar, Ph.D., will work on exactly that issue within their current research.
Rather than looking forward to patients to get addiction care, their team is exploring methods to outreach to patients and offer treatment via telehealth. This goes beyond past studies which have left it around patients to produce a call to obtain treatment.
Results from their pilot study of the program were very promising and today they’re testing the program in two full-scale randomized controlled trials supported by the National Institutes of Health.
“Addiction care and research have often centered on patients that are treatment-seeking and already in the entranceway. But that is clearly a minority of these with substance use disorders,” says Lin. “Given that we’ve seen the energy of telehealth to aid recovery, we have to reach more of these who could reap the benefits of care. We need to make usage of addiction care easier and meet people wherever they’re.”
Furthermore effort, Lin caused others to build up a free toolkit to greatly help providers make sure that they offer high-quality buprenorphine care along with other treatment for opioid use disorder. It’s available through the Providers Clinical Support System funded by the federal DRUG ABUSE and Mental Health Services Administration. The recent easing of federal rules for providers who want to prescribe buprenorphine could mean more providers will start doing this.
More info: Impact of COVID-19 Telehealth Policy Changes on Buprenorphine Treatment for Opioid Use Disorder, American Journal of Psychiatry (2022). DOI: 10.1176/appi.ajp.21111141
Citation: Telehealth by phone and video proves a lifeline for veterans with opioid addiction (2022, July 28) retrieved 28 July 2022 from https://medicalxpress.com/news/2022-07-telehealth-video-lifeline-veterans-opioid.html
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