Receipt of Telehealth Services, Receipt and Retention of Medications for Opioid Use Disorder, and Medically Treated Overdose Among Medicare Beneficiaries Before and During the COVID-19 Pandemic

JAMA Psychiatry, Journal Year: 2022, Volume and Issue: 79(10), P. 981 - 981

Published: Aug. 31, 2022

Importance Federal emergency authorities were invoked during the COVID-19 pandemic to expand use of telehealth for new and continued care, including provision medications opioid disorder (MOUD). Objective To examine receipt services, MOUD (methadone, buprenorphine, extended-release [ER] naltrexone) retention, medically treated overdose before pandemic. Design, Setting, Participants This exploratory longitudinal cohort study used data from US Centers Medicare & Medicaid Services September 2018 February 2021. Two cohorts (before 2020 2019 2021) fee-for-service beneficiaries 18 years older with an International Statistical Classification Diseases, Tenth Revision, Clinical Modification OUD diagnosis. Exposures Pre–COVID-19 vs demographic characteristics, medical substance use, psychiatric comorbidities. Main Outcomes Measures Receipt retention MOUD, behavioral health-related experiencing overdose. Results The pre–COVID-19 comprised 105 240 beneficiaries; these, 61 152 (58.1%) female, 71 (67.6%) aged 45 74 years, 82 822 (79.5%) non-Hispanic White. 70 538 40 257 (57.1%) 46 793 (66.3%) 55 510 (79.7%) During period, a larger percentage in compared prepandemic received OUD-related services (13 829 [19.6%] 593 [0.6%]; P < .001), (28 902 [41.0%] 1967 [1.9%]; (8854 [12.6%] 11 360 [10.8%]; .001). period was similar (18.5% [19 491 240] 18.4% [13 004 538] cohort; = .65). associated increased odds (adjusted ratio [aOR], 1.27; 95% CI, 1.14-1.41) lower (aOR, 0.67; 0.63-0.71). Among cohort, those receiving treatment programs only 0.54; 0.47-0.63) buprenorphine pharmacies 0.91; 0.84-0.98) had who did not receive MOUD. Conclusions Relevance Emergency provide flexibilities by initiating episode care improved reduced Strategies increase are urgently needed.

Language: Английский

---

Take-home dosing experiences among persons receiving methadone maintenance treatment during COVID-19

Journal of Substance Abuse Treatment, Journal Year: 2021, Volume and Issue: 123, P. 108276 - 108276

Published: Jan. 8, 2021

Language: Английский

---

COVID-19 and the health of people who use drugs: What is and what could be?

International Journal of Drug Policy, Journal Year: 2020, Volume and Issue: 83, P. 102958 - 102958

Published: Sept. 1, 2020

Language: Английский

---

Comparison of Characteristics of Deaths From Drug Overdose Before vs During the COVID-19 Pandemic in Rhode Island

JAMA Network Open, Journal Year: 2021, Volume and Issue: 4(9), P. e2125538 - e2125538

Published: Sept. 17, 2021

Importance

The rate of deaths from overdose has increased during the COVID-19 pandemic, and recent US mortality rates have been markedly high. However, scant data are available on causes this increase or subpopulations at elevated risk.

Objective

To evaluate characteristics drug before vs pandemic.

Design, Setting, Participants

This retrospective, population-based cohort study used 4 statewide databases linked person level via Rhode Island Data Ecosystem adults with due to in January 1 August 31, 2019, 2020.

Main Outcomes Measures

unintentional drug-related 2019 2020 observation periods overall by sociodemographic characteristics, drugs contributing cause death, location socioeconomic factors were evaluated. In subgroup analyses restricted Medicaid beneficiaries (n = 271), proportions behavioral health treatment diagnosis claims year death also examined.

Results

A total 470 who died included analysis (353 men [75%]; mean [SD] age, 43.5 [12.1] years). 28.1%, 29.2 per 100 000 person-years 37.4 (P .009). Compared higher among (43.2 59.2 person-years;P .003), non-Hispanic White individuals (31.0 42.0 .005), single (54.8 70.4 .04), involving synthetic opioids (20.8 28.3 occurring a personal residence (13.2 19.7 .003). decrease proportion heroin (11 206 [5%] <2% [exact value suppressed];P .02) an persons experiencing job loss (16 [8%] 41 264 [16%];P .01) observed. Among beneficiaries, those aged 50 59 years anxiety 121 [9%] 29 150 [19%];P .03), depression (27 [22%] 57 [38%];P .008), (28 [23%] 55 [37%];P compared 2019.

Conclusions Relevance

study, first 8 months 2020, same period several emerging pandemic identified. These findings may inform interventions that address macroenvironmental changes associated

Language: Английский

---

Are we there yet? Unbundling the potential adoption and integration of telemedicine to improve virtual healthcare services in African health systems

Sensors International, Journal Year: 2021, Volume and Issue: 3, P. 100152 - 100152

Published: Dec. 7, 2021

Since the outbreak of COVID-19, attention has now shifted towards universal vaccination to gracefully lift strict COVID-19 restrictions previously imposed contain spread disease. Sub-Saharan Africa is experiencing an exponential increase infections and deaths coupled with vaccines shortages, personal protective equipment, weak health systems emerging variants. Some developed countries integrated telemedicine reduce impacts shortage healthcare professionals potentially risk exposure, ensuring easy delivery quality services while limiting regular physical contact direct hospitalization. However, adoption telehealth still nascent in many sub-Saharan countries. Therefore, this study reflects on progress made use telemedicine, virtual care services, challenges encountered, proffers ways address them. We conducted a systematic literature review synthesise Africa. The revealed that provides unprecedented benefits such as improving efficiency, effective utilization resources, forward triaging, prevention medical personnel infection, aiding students' clinical observation participation, assurance social support for patients. absence policy political will, cost sustenance inadequate funding, technological infrastructural barriers, patient bias cultural barriers are identified factors African systems. To alleviate some these we recommend development robust policies frameworks care, inclusion school curriculum, supporting research development, increasing removing monopolisation telecommunication developing solutions eccentricities

Language: Английский

---

Use of Telehealth Across Pediatric Subspecialties Before and During the COVID-19 Pandemic

JAMA Network Open, Journal Year: 2022, Volume and Issue: 5(3), P. e224759 - e224759

Published: March 31, 2022

Importance

The identification of variation in health care is important for quality improvement. Little known about how different pediatric subspecialties are using telehealth and what driving variation.

Objective

To characterize trends use before during the COVID-19 pandemic across association delivery change with no-show rates access disparities.

Design, Setting, Participants

In this cohort study, 8 large medical groups California collaborated to share aggregate data on 11 from January 1, 2019, December 31, 2021.

Main Outcomes Measures

Monthly in-person visits subspecialties, characteristics patients participating visits, rates. per 1000 unique were calculated. assess changes rates, a series linear regression models that included fixed effects calendar month used. demographic served person prepandemic period compared those who received period.

Results

conducted 1.8 million 549 306 younger than 18 years (228 120 [41.5%] White 277 167 [50.5%] not Hispanic). A total 72 928 (13.3%) preferred language other English, 250 329 (45.6%) had Medicaid. specialties lower (cardiology, orthopedics, urology, nephrology, dermatology), ranged 6% 29% May 2020, April 30, higher (genetics, behavioral health, pulmonology, endocrinology, gastroenterology, neurology), constituted 38.8% 73.0% visits. From periods, slightly increased lower-telehealth-use (9.2% 9.4%) higher-telehealth-use (13.0% 15.3%), but adjusted differences (comparing lower-use higher-use subspecialties) statistically significant (difference, 2.5 percentage points; 95% CI, −1.2 6.3 points;P = .15). Patients English 6140 (22.2%) vs 2707 (11.4%) neurology (P < .001).

Conclusions Relevance

There was high variability adoption patterns over time. documentation can inform evolving policy patients, including appropriateness patient needs areas where additional tools needed promote appropriate use.

Language: Английский

---

Telemedicine Buprenorphine Initiation and Retention in Opioid Use Disorder Treatment for Medicaid Enrollees

JAMA Network Open, Journal Year: 2023, Volume and Issue: 6(10), P. e2336914 - e2336914

Published: Oct. 18, 2023

Importance Early COVID-19 mitigation strategies placed an additional burden on individuals seeking care for opioid use disorder (OUD). Telemedicine provided a way to initiate and maintain transmucosal buprenorphine treatment of OUD. Objective To examine associations between OUD modality (telemedicine vs traditional) during the public health emergency outcomes retention opioid-related nonfatal overdose. Design, Setting, Participants This retrospective cohort study was conducted using Medicaid claims enrollment data from November 1, 2019, December 31, 2020, aged 18 64 years Kentucky Ohio. Data were collected analyzed in June 2022, with updated revision August 2023. Exposures The primary exposure interest initiation. Relevant patient demographic comorbidity characteristics included regression models. Main Outcomes Measures There 2 main interest: after initiation overdose For measured initiation, 90-day follow-up period used. analysis used new-user design; defined as more than 60-day gap treatment. In addition, uptake telemedicine examined, overall within patients initiating treatment, across quarters 2020. Results 41 266 (21 269 women [51.5%]; mean [SD] age, 37.9 [9.0] years) 50 648 Ohio (26 425 [52.2%]; 37.1 [9.3] who received 250 24 741 people Ohio, respectively. initiations increased sharply at beginning Compared nontelemedicine associated better odds both states (Kentucky: adjusted ratio, 1.13 [95% CI, 1.01-1.27]; Ohio: 1.19 1.06-1.32]) adjusting characteristics. not 0.89 0.56-1.40]; 1.08 0.83-1.41]). Conclusions Relevance this enrollees receiving OUD, early pandemic. These findings add literature demonstrating positive

Language: Английский

---

Perspectives of opioid use disorder treatment providers during COVID-19: Adapting to flexibilities and sustaining reforms

Journal of Substance Abuse Treatment, Journal Year: 2021, Volume and Issue: 132, P. 108514 - 108514

Published: May 31, 2021

Language: Английский

---

Telehealth for opioid use disorder treatment in low-barrier clinic settings: an exploration of clinician and staff perspectives

Harm Reduction Journal, Journal Year: 2021, Volume and Issue: 18(1)

Published: Nov. 25, 2021

Abstract Background The majority of individuals with opioid use disorder (OUD) face access barriers to evidence-based treatment, and the COVID-19 pandemic has exacerbated United States (US) overdose crisis. However, also ushered in rapid transitions telehealth USA, including for substance treatment buprenorphine. These changes have potential mitigate care or exacerbate pre-existing inequities. objective this study was qualitatively explore Philadelphia-based low-barrier, harm-reduction oriented, provider perspectives about experiences during pandemic, assess their desire offer patients at programs future. Methods We interviewed 22 OUD prescribers staff working outpatient offering buprenorphine Philadelphia July August 2020. All participants worked low-barrier that provide using a harm reduction-oriented approach without mandating counseling other requirements as condition treatment. analyzed data thematic content analysis. Results Our analysis yielded three themes: 1/ Easier some : facilitates many who difficulty attending in-person appointments due logistical psychological barriers; 2/ A layered digital divide engagement can be seriously limited by patients’ comfort technology; 3/ Clinician control: despite clinic beliefs should freedom choose modality, via may hinge on clinician perceptions patient “stability” rather than preferences. Conclusions Telehealth address issues, however, implementation remain, ability attend healthcare virtually. In addition, models extend currently underserved partially depend treating deemed “unstable” modality. expand previously struggled engage will likely if these are not given opportunity receive telehealth.

Language: Английский

---

“How will I get my next week's script?” Reactions of Reddit opioid forum users to changes in treatment access in the early months of the coronavirus pandemic

International Journal of Drug Policy, Journal Year: 2021, Volume and Issue: 92, P. 103140 - 103140

Published: Feb. 7, 2021

Language: Английский

---