Study: Telemedicine for opioid use disorders can be compared to personal care

A study published in JAMA open network found no difference in the frequency of visits for treatment of opioid use disorders, medication initiation, or adverse outcomes between patients treated by clinicians with high or low telemedicine use, suggesting that telemedicine may be comparable to personal care.

The study used de-identified claims data from approximately 11,800 patients with commercial insurance or Medicare Advantage coverage between March 2019 and March 2021.

Clinicians who provided care in the office were divided into groups based on how often they used telemedicine. Providers with low telehealth usage made an average of 2.1% of their office visits virtually during the COVID-19 pandemic, while providers with high usage made almost 70% of those visits via telehealth.

Although telemedicine for the treatment of opioid use disorders has increased during the pandemic, overall visits have remained stable for both high and low telemedicine groups. Providers who used telemedicine more often saw an increase from 2.6 to 2.7 visits per patient episode, while clinicians who used telemedicine less saw an increase from 3.1 to 3.3 visits per patient episode.

In the low use group, 15.3% of patients started medication for an opioid use disorder within two weeks of their first visit pre-pandemic compared with 15.2% during the pandemic. In the high usage group, the proportion of patients who started medication within two weeks was 14.7% pre-pandemic and 13.7% during the pandemic.

The study also found that the proportion of patients with at least one clinical case associated with an opioid use disorder was lower during the pandemic among both frequent and infrequent users and found no difference between groups.

“In a national sample of OUD patients with commercial insurance or Medicare Advantage coverage, we found that treatment by physicians with high telehealth use was not associated with a different outpatient treatment regimen or OUD-related events compared with care by physicians with low telehealth use. . use,” the study authors write.

“Total OUD visits per episode was constant in the pre-pandemic and pandemic periods, regardless of the use of telemedicine, suggesting that telemedicine almost completely replaced rather than supplemented care. Overall, based on the performance observed in these claims, telemedicine was comparable. to personal care, with no evidence of different harms or benefits for patients seen by physicians with high and medium versus low levels of telemedicine use.”

WHY IS IT IMPORTANT

The researchers noted that their findings may not be generalizable to all patient groups, such as people covered by Medicaid and traditional Medicare, or those who are uninsured. They also could not measure some clinical outcomes, such as relapse, overall functioning, or the patient’s use of long-acting buprenorphine implants.

However, they argue that their study suggests that telehealth can be safely scaled up to treat opioid use disorders, as it does not appear to increase unnecessary care. However, the researchers noted that patients who saw clinicians in the high telehealth group were more likely to live in higher-income metropolitan areas with lower proportions of white residents. Rural areas have less access to broadband internet, so telemedicine may not be available to these patients.

“There was no evidence that telemedicine was unsafe or overused among clinicians with high or low telemedicine usage. Conversely, there was no evidence that telemedicine was associated with increased access or improved quality of care,” the researchers write. “The results of this study indicate that telemedicine is a comparable alternative for OUD care, but not one that will significantly change the quality or availability of care in the short term.”