Gender differences in receipt of telehealth versus in person behavioral therapy, medication for opioid use disorder (MOUD), and 90-day MOUD retention during the pandemic: A retrospective veteran cohort study

Women and men veterans' initiation, engagement, and retention in treatment for substance use disorders: A cross-sectional investigation using VHA administrative data

INTRODUCTION

More men have substance use disorders (SUD) in the US compared to women; however, the gender gap is closing, including among US veterans. Little information is available about gender differences in patterns of SUD treatment receipt. The current study evaluated gender differences in SUD outpatient, residential, and medication treatment receipt to address critical gaps in the literature.

METHODS

Veterans Health Administration patients with SUD diagnoses between 10/01/2014 and 9/30/2018 were included (women = 40,841, men = 615,002). The study tracks treatment initiation, engagement, retention, and treatment transitions for 12 months following study entry. Unadjusted Chi-square tests and logistic regressions, adjusted for race/ethnicity, age study entry year, and facility complexity test for gender differences.

RESULTS

Women had higher initiation, engagement, and retention than men in outpatient and residential settings in unadjusted comparisons. However, after adjustment, women were less likely to initiate, engage, and retain. Post-hoc analyses indicate findings were driven by age and race/ethnicity; specifically, women under 60 and non-Hispanic White and Black women were less likely to initiate or retain in SUD care than men. Women were also less likely to transition through outpatient treatment and utilize opioid use medication; however, women were more likely to transition through residential treatment and utilize alcohol use medication.

CONCLUSIONS

Women were found to have lower outpatient and residential SUD treatment receipt and opioid medication utilization but greater alcohol use medication utilization compared to men. Future research is needed to better understand factors leading to these gender differences and to develop tailored treatment approaches to address gender disparities.

Impact of COVID-19 on Substance Use Disorder Treatment: Examining the Influence of In-Person and Telehealth Intervention on Outcomes Using Real-World Data

Background: The COVID-19 health crisis challenged healthcare systems around the world, leading to restrictions in access to face-to-face healthcare services, and forcing rapid adaptation to telehealth services. At present, there is a gap in the functioning of this adaptation in drug-dependence centres. The present study analyses, over four years, care indicators on the care modality (face-to-face vs. hybrid), the patient profile and the impact on retention in treatment. Methods: Retrospective observational study with data collected between 14 March 2019 and 21 June 2023. The electronic health records of 44,930 patients were analysed according to different moments and selected based on the different health measures imposed by the COVID-19 pandemic. Patients were classified according to whether they received an in-person or hybrid intervention. Bivariate statistics and logistic regression analysis were applied. Results: The trend over time shows an increase in the number of patients seen in addiction centres. However, no notable changes within the in-person care modality and a modest increase in telehealth services are observed. Telehealth is primarily used among patients with opiate addiction, as well as with those with comorbid mental disorders. Logistic regression analysis shows that patients in a hybrid modality are more likely to remain in treatment. Conclusions: Results show that hybrid care is associated with higher patient retention rates. Despite this, different profiles are mostly treated with in-person interventions rather than hybrid modalities. Future studies should explore how to generalise personalised hybrid care among SUD patients considering factors such as patients' educational level, employment status or accessibility to mental health services.

Access to MAT: Participants' Experiences With Transportation, Non-Emergency Transportation, and Telehealth

INTRODUCTION

Access to medication assisted treatment (MAT) for opioid use disorder (OUD) in the United States is a significant challenge for many individuals attempting to recover and improve their lives. Access to treatment is especially challenging in rural areas characterized by lack of programs, few prescribers, and transportation barriers. This study aims to better understand the roles that transportation, Medicaid-funded non-emergency medical transportation (NEMT), and telehealth play in facilitating access to MAT in West Virginia (WV).

METHODS

We developed this survey using an exploratory sequential mixed methods approach following a review of current peer-reviewed literature plus information gained from 3 semi-structured interviews and follow-up discussions with 5 individuals with lived experience in MAT. Survey results from 225 individuals provided rich context on the influence of transportation in enrolling and remaining in treatment, use of NEMT, and experiences using telehealth. Data were collected from February through August 2021.

RESULTS

We found that transportation is a significant factor in entering into and remaining in treatment, with 170 (75.9%) respondents agreeing or strongly agreeing that having transportation was a factor in deciding to go into a MAT program, and 176 (71.1%) agreeing or strongly agreeing that having transportation helps them stay in treatment. NEMT was used by one-quarter (n = 52, 25.7%) of respondents. Only 13 (27.1%) noted that they were picked up on time and only 14 (29.2%) noted that it got them to their appointment on time. Two thirds of respondents (n = 134, 66.3%) had participated in MAT services via telehealth video or telephone visits. More preferred in-person visits to telehealth visits but a substantial number either preferred telehealth or reported no preference. However, 18 (13.6%) reported various challenges in using telehealth.

CONCLUSIONS

This study confirms that transportation plays a significant role in many people's decisions to enter and remain in treatment for OUD in WV. Additionally, for those who rely on NEMT, services can be unreliable. Finally, findings demonstrate the need for individualized care and options for accessing treatment for OUD in both in-person and telehealth-based modalities. Programs and payers should examine all possible options to ensure access to care and recovery.