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Qeadan F, Shimizu S, Tingey B, Kroth PJ, Markossian T. The impact of increased telehealth use on the treatment of substance use disorder during the COVID-19 pandemic. SSM Popul Health 2025; 30:101780. [PMID: 40201330 PMCID: PMC11978320 DOI: 10.1016/j.ssmph.2025.101780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2024] [Revised: 02/11/2025] [Accepted: 03/14/2025] [Indexed: 04/10/2025] Open
Abstract
Background The COVID-19 pandemic necessitated a shift from in-person substance use disorder (SUD) treatment to virtual telehealth (TH) visits, creating opportunities to assess the impact of virtual visits on SUD treatment. Methods This study utilized retrospective, de-identified, electronic health record (EHR) data from Oracle EHR Real-World Data to examine the impact of TH on SUD treatment. Patients with a qualifying SUD diagnosis from 141 U.S. health systems were included and divided into pre-TH (January 1, 2017 through January 1, 2019) and COVID (January 1, 2020 through January 1, 2022) cohorts. This study analyzed TH utilization, medications for SUD (MSUD) prescribing, drug-related events, and mental health crises, comparing patient outcomes where the treating clinician was a high TH user versus a low TH user in both pre-COVID and COVID periods. Results Patients visiting high TH clinicians had lower MSUD prescribing rates, yet a higher MSUD day's supply, and higher rates of TH outpatient visits than those visiting low TH providers, with both groups having an increase in TH visits during the COVID period. Patients with high TH clinicians had lower rates of SUD-related hospitalizations than those with low TH providers but similar rates of drug overdoses, relapses, injection-related infections, and mental health crises. Conclusions TH modalities showed increased SUD-related outpatient visits without increasing adverse outcomes, indicating its potential as a sustainable alternative to in-person care. This study highlights the need for further research on TH efficacy for SUD-specific populations and supports the continued integration of telehealth in SUD treatment post-pandemic.
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Affiliation(s)
- Fares Qeadan
- Loyola University Chicago, Parkinson School of Health Sciences and Public Health, Maywood, IL, USA
| | - Sydney Shimizu
- Loyola University Chicago, Parkinson School of Health Sciences and Public Health, Maywood, IL, USA
| | - Benjamin Tingey
- Loyola University Chicago, Parkinson School of Health Sciences and Public Health, Maywood, IL, USA
| | - Philip J. Kroth
- Department of Biomedical Informatics, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Talar Markossian
- Loyola University Chicago, Parkinson School of Health Sciences and Public Health, Maywood, IL, USA
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Sloan ME, Ngoy A, Xiao KB, Barker B, Buckley L, Fodor M, Hardy K, Hendershot CS, Kahan M, La Fleur S, Le Foll B, Manicone M, Sanches M, Simpkin E, Quilty LC, Wyman J, Tang VM, Bozinoff N. Symptom-Triggered Alcohol Withdrawal Management Delivered Over Telemedicine. J Addict Med 2025:01271255-990000000-00499. [PMID: 40310714 DOI: 10.1097/adm.0000000000001491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2024] [Accepted: 03/03/2025] [Indexed: 05/03/2025]
Abstract
OBJECTIVES Alcohol use is one of the leading causes of death and disability globally; however, access to evidence-based care for alcohol use disorder (AUD) is limited. Although telemedicine-based interventions promise to expand treatment access, there are no validated telemedicine-based interventions for alcohol withdrawal management. In this single-arm study, we sought to determine the feasibility of delivering symptom-triggered alcohol withdrawal management over telemedicine. METHODS Thirty actively drinking participants with AUD and a history of alcohol withdrawal were recruited to participate. Participants were scheduled for 3 days of symptom-triggered withdrawal management using the Clinical Institute Withdrawal Assessment for Alcohol Scale Revised delivered by a trained clinician over a telemedicine platform. Primary outcomes were retention in treatment and need for transfer to a higher level of care (eg, the emergency room). Satisfaction with the treatment protocol and relapse to any alcohol use 30 days following treatment initiation were also assessed. RESULTS In total, 93.3% of participants completed all 3 days of alcohol withdrawal management. No participants required transfer to a higher level of care. Satisfaction with treatment was high, with an average Client Satisfaction Questionnaire-8 score of 30.9 (SD = 1.5) out of 32. After the follow-up period, 56.7% of participants remained abstinent from alcohol. CONCLUSIONS Our study provides preliminary evidence that symptom-triggered alcohol withdrawal management over telemedicine is feasible and satisfactory for patients. If these findings are replicated, they could have important implications for access to alcohol withdrawal management services, especially in remote, rural, and underserved regions that lack specialized withdrawal management facilities.
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Pham H, Lin C, Zhu Y, Clingan SE, Lin L(A, Mooney LJ, Murphy SM, Campbell CI, Liu Y, Hser YI. Telemedicine-delivered treatment for substance use disorder: A scoping review. J Telemed Telecare 2025; 31:359-375. [PMID: 37537907 PMCID: PMC11444076 DOI: 10.1177/1357633x231190945] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
IntroductionThe COVID pandemic prompted a significant increase in the utilization of telemedicine (TM) for substance use disorder (SUD) treatment. As we transition towards a "new normal" policy, it is crucial to comprehensively understand the evidence of TM in SUD treatment. This scoping review aims to summarize existing evidence regarding TM's acceptability, quality, effectiveness, access/utilization, and cost in the context of SUD treatment in order to identify knowledge gaps and inform policy decisions regarding TM for SUDs.MethodWe searched studies published in 2012-2022 from PubMed, Cochrane Library, Embase, Web of Science, and other sources. Findings were synthesized using thematic analysis.ResultsA total of 856 relevant articles were screened, with a final total of 42 articles included in the review. TM in SUD treatment was perceived to be generally beneficial and acceptable. TM was as effective as in-person SUD care in terms of substance use reduction and treatment retention; however, most studies lacked rigorous designs and follow-up durations were brief (≤3 months). Telephone-based TM platforms (vs video) were positively associated with older age, lower education, and no prior overdose. Providers generally consider TM to be affordable for patients, but no relevant studies were available from patient perspectives.ConclusionsTM in SUD treatment is generally perceived to be beneficial and acceptable and as effective as in-person care, although more rigorously designed studies on effectiveness are still lacking. Access and utilization of TM may vary by platform. TM service quality and costs are the least studied and warrant further investigations.
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Affiliation(s)
- Huyen Pham
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, USA
| | - Chunqing Lin
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, USA
| | - Yuhui Zhu
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, USA
| | - Sarah E Clingan
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, USA
| | - Lewei (Allison) Lin
- Department of Psychiatry, University of Michigan, Ann Arbor, USA
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, USA
| | - Larissa J Mooney
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, USA
- VA Greater Los Angeles Healthcare System, Los Angeles, USA
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, New York, USA
| | - Cynthia I Campbell
- Center for Addiction and Mental Health Research, Division of Research, Kaiser Permanente Northern California, Oakland, USA
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, USA
| | - Yanping Liu
- Center for Clinical Trials Network, National Institute on Drug Abuse, Bethesda, USA
| | - Yih-Ing Hser
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, USA
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Hendy L, Olguin A, Jimes C, Barrett E, Coffey MJ, Lira MC. Satisfaction with Telehealth Treatment for Opioid Use Disorder Among Individuals Living in Rural and Nonrural Areas. Telemed J E Health 2025. [PMID: 40147471 DOI: 10.1089/tmj.2024.0598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2025] Open
Abstract
Background: Telehealth has grown as a common treatment modality for substance use disorders following expanded telehealth flexibilities during the COVID-19 pandemic. Telehealth can increase access to treatment in rural areas, where there are limited local addiction providers. Methods: We conducted a cross-sectional survey of adults in telehealth treatment for opioid use disorder and compared satisfaction with care and provider-patient relationship quality between participants in rural and nonrural areas. Results: Respondents scored a mean of 4.51 ± 0.694 on the Telemedicine Satisfaction Questionnaire (range: 1-5) and 27.12 ± 5.633 on the Provider-Patient Depth of Relationship Questionnaire (range: 0-32), indicating high overall satisfaction and a deep provider-patient relationship. There were no significant differences based on rural residence. Conclusions: Based on high patient satisfaction, our findings support the future expansion of telemedicine treatment platforms across rural and nonrural areas to address the substantial unmet need for substance use treatment across the United States.
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Affiliation(s)
| | | | | | | | - M Justin Coffey
- Workit Health, Ann Arbor, Michigan, USA
- Department of Psychiatry, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - Marlene C Lira
- Workit Health, Ann Arbor, Michigan, USA
- DrPH Program, Health Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Choi S, Hussain S, Wang Y, D’Aunno T, Mijanovich T, Neighbors CJ. Telehealth Disparities in Outpatient Substance Use Disorder (SUD) Treatment among Medicaid Beneficiaries during COVID-19. Subst Use Misuse 2025; 60:1007-1015. [PMID: 40089385 PMCID: PMC11999779 DOI: 10.1080/10826084.2025.2478603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2025]
Abstract
BACKGROUND We investigated racial and ethnic disparities in telehealth counseling among Medicaid-insured patients in outpatient substance use disorder (SUD) treatment clinics and assessed whether the clinic-level proportion of Medicaid-insured patients moderated these disparities. METHODS Using New York State (NYS) Medicaid and statewide treatment registry data, we analyzed 24,814 admission episodes across 399 outpatient SUD clinics during the first 6 months of COVID-19 (April-September 2020). Our outcome measure was the number of tele-counseling sessions within the first 90 days of treatment. Key independent variables included beneficiary race/ethnicity and the clinic-level proportion of Medicaid-insured patients, divided into four quartiles: lowest, second, third, and highest. Mixed effects negative binomial models assessed the associations between race/ethnicity, Medicaid proportions, and telehealth use, with interaction terms evaluating the moderating role of Medicaid proportions. RESULTS Black and Latinx patients received fewer telehealth sessions than non-Latinx White patients, with adjusted incidence rate ratios (aIRRs) of 0.86 (95% CI: 0.82, 0.91) for Black patients and 0.93 (95% CI: 0.88, 0.98) for Latinx patients. Black patients at clinics with the highest Medicaid proportions had higher telehealth usage rates compared to those at clinics with the lowest Medicaid proportions (aIRR, 1.20; 95% CI, 1.03-1.41). Patients in clinics with the highest Medicaid proportions were more likely to use individual telehealth counseling (aIRR, 1.02-1.88; 95% CI, 1.01-3.04). CONCLUSIONS Significant racial disparities in telehealth use exist, with variations persisting across clinics with different Medicaid proportions. Targeted interventions are needed to address these access gaps.
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Affiliation(s)
- Sugy Choi
- Department of Population Health, New York University Grossman School of Medicine
| | - Shazia Hussain
- New York State Office of Addiction Services and Supports (OASAS)
| | - Yichuan Wang
- New York State Office of Addiction Services and Supports (OASAS)
| | | | - Tod Mijanovich
- New York University Steinhardt School of Culture, Education, and Human Development
| | - Charles J. Neighbors
- Department of Population Health, New York University Grossman School of Medicine
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Nelson LA, Collins SE, Shinagawa E, Park S, Rajeev V, McPhail G, Saplan S, Taylor EM, Aguilar-Bonnette AT, Mednansky S, Douthitt J, King RJ, Taylor MA, Kominsky TK, Green C, Saxon AJ, Clifasefi SL. Content analysis of perceptions of combined pharmacobehavioral treatment for American Indian people with opioid use disorder. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2025; 39:1-13. [PMID: 39786831 PMCID: PMC11836604 DOI: 10.1037/adb0001037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2025]
Abstract
OBJECTIVE Both opioid misuse and overdose mortality have disproportionately impacted the American Indian population. Although medications for opioid use disorder, such as buprenorphine (BUP-NX), are highly effective in reducing overdose mortality, questions have been raised about the cultural acceptability of Western medical approaches in this population. Understanding patients' desired recovery pathways can lead to more culturally appropriate, patient-centered, and effective approaches to opioid use disorder (OUD) treatment. In this qualitative study, we document experiences with combined pharmacobehavioral treatment for OUD and suggestions for enhancing it. METHOD Participants (N = 45) were American Indian patients and community members impacted by OUD. They participated in one-time, 45- to 60-min, semistructured interviews. RESULTS Findings from conventional content analysis indicated participants were grateful for a Tribally run combined pharmacobehavioral OUD treatment program, which made treatment more financially and geographically accessible over a large, rural area. Participants expressed satisfaction with BUP-NX and the accompanying behavioral health programming but were interested in making it more accessible through telemedicine appointments and mailed prescriptions. Participants noted the importance of clear communication about this kind of programming, which tends to be less structured than other substance-use treatment programs, but also appreciated its tailored, compassionate, and holistic approach. Participants were interested in robust counseling options; a low-barrier, acceptance-based, and harm-reduction orientation; as well as more culturally aligned programming that honored their Native heritage and traditional medicine. CONCLUSIONS Treatment providers, researchers, and policymakers should consider integration of more patient-driven, compassionate, and culturally aligned means of intervention for American Indian patients with OUD. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
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Affiliation(s)
| | | | | | - Sooyoun Park
- Elson S. Floyd College of Medicine, Washington State University
| | - Vaishali Rajeev
- Elson S. Floyd College of Medicine, Washington State University
| | - Grace McPhail
- Elson S. Floyd College of Medicine, Washington State University
| | - Sage Saplan
- Elson S. Floyd College of Medicine, Washington State University
| | - Emily M Taylor
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | | | - Sage Mednansky
- Elson S. Floyd College of Medicine, Washington State University
| | | | - Roxanna J King
- Elson S. Floyd College of Medicine, Washington State University
| | | | | | | | - Andrew J Saxon
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Seema L Clifasefi
- Department of Psychiatry and Behavioral Sciences, University of Washington
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7
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Sousa JL, Raja P, Rabinowitz M, Richard J, Smith A, Huskamp HA, Mehrotra A, Busch AB, Uscher-Pines L. Patient Experiences With Group Teletherapy for the Treatment of Mental Illness: A Qualitative Study. Psychiatr Serv 2025; 76:157-162. [PMID: 39468845 PMCID: PMC11786984 DOI: 10.1176/appi.ps.20240058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/30/2024]
Abstract
OBJECTIVE The authors sought to understand patient experiences with group teletherapy to inform improvements in service delivery. METHODS From December 2022 to October 2023, semistructured interviews were conducted with 20 adults with depression or bipolar disorder who had received outpatient group teletherapy in the past 2 years. A rapid thematic analysis was conducted by using a matrix to identify patterns and synthesize data. A logic model from the patients' perspective was developed by extracting common themes related to elements of effective group teletherapy. RESULTS Telehealth allowed for more empowered engagement in group teletherapy and enabled better access and longitudinal attendance for many patients, compared with in-person group therapy. However, many patients reported a reduced sense of emotional intimacy and connectedness with telehealth, and some reported that technology challenges and distractions contributed to feelings of disconnection. Patients were divided in their modality preferences, but many expressed an interest in receiving at least some of their group therapy sessions by telehealth. CONCLUSIONS Although group teletherapy has the potential to meet patients' needs and preferences, more work is needed to improve the quality of the experience for patients.
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Affiliation(s)
- Jessica L Sousa
- RAND, Boston (Sousa, Rabinowitz); Greater Los Angeles U.S. Department of Veterans Affairs Medical Center, Los Angeles (Raja); RAND, Arlington, Virginia (Richard, Uscher-Pines); Depression and Bipolar Support Alliance, Chicago (Smith); Harvard Medical School, Boston (Huskamp, Mehrotra, Busch); Beth Israel Deaconess Medical Center, Boston (Mehrotra); McLean Hospital, Belmont, Massachusetts (Busch)
| | - Pushpa Raja
- RAND, Boston (Sousa, Rabinowitz); Greater Los Angeles U.S. Department of Veterans Affairs Medical Center, Los Angeles (Raja); RAND, Arlington, Virginia (Richard, Uscher-Pines); Depression and Bipolar Support Alliance, Chicago (Smith); Harvard Medical School, Boston (Huskamp, Mehrotra, Busch); Beth Israel Deaconess Medical Center, Boston (Mehrotra); McLean Hospital, Belmont, Massachusetts (Busch)
| | - Maya Rabinowitz
- RAND, Boston (Sousa, Rabinowitz); Greater Los Angeles U.S. Department of Veterans Affairs Medical Center, Los Angeles (Raja); RAND, Arlington, Virginia (Richard, Uscher-Pines); Depression and Bipolar Support Alliance, Chicago (Smith); Harvard Medical School, Boston (Huskamp, Mehrotra, Busch); Beth Israel Deaconess Medical Center, Boston (Mehrotra); McLean Hospital, Belmont, Massachusetts (Busch)
| | - Jessica Richard
- RAND, Boston (Sousa, Rabinowitz); Greater Los Angeles U.S. Department of Veterans Affairs Medical Center, Los Angeles (Raja); RAND, Arlington, Virginia (Richard, Uscher-Pines); Depression and Bipolar Support Alliance, Chicago (Smith); Harvard Medical School, Boston (Huskamp, Mehrotra, Busch); Beth Israel Deaconess Medical Center, Boston (Mehrotra); McLean Hospital, Belmont, Massachusetts (Busch)
| | - Andrew Smith
- RAND, Boston (Sousa, Rabinowitz); Greater Los Angeles U.S. Department of Veterans Affairs Medical Center, Los Angeles (Raja); RAND, Arlington, Virginia (Richard, Uscher-Pines); Depression and Bipolar Support Alliance, Chicago (Smith); Harvard Medical School, Boston (Huskamp, Mehrotra, Busch); Beth Israel Deaconess Medical Center, Boston (Mehrotra); McLean Hospital, Belmont, Massachusetts (Busch)
| | - Haiden A Huskamp
- RAND, Boston (Sousa, Rabinowitz); Greater Los Angeles U.S. Department of Veterans Affairs Medical Center, Los Angeles (Raja); RAND, Arlington, Virginia (Richard, Uscher-Pines); Depression and Bipolar Support Alliance, Chicago (Smith); Harvard Medical School, Boston (Huskamp, Mehrotra, Busch); Beth Israel Deaconess Medical Center, Boston (Mehrotra); McLean Hospital, Belmont, Massachusetts (Busch)
| | - Ateev Mehrotra
- RAND, Boston (Sousa, Rabinowitz); Greater Los Angeles U.S. Department of Veterans Affairs Medical Center, Los Angeles (Raja); RAND, Arlington, Virginia (Richard, Uscher-Pines); Depression and Bipolar Support Alliance, Chicago (Smith); Harvard Medical School, Boston (Huskamp, Mehrotra, Busch); Beth Israel Deaconess Medical Center, Boston (Mehrotra); McLean Hospital, Belmont, Massachusetts (Busch)
| | - Alisa B Busch
- RAND, Boston (Sousa, Rabinowitz); Greater Los Angeles U.S. Department of Veterans Affairs Medical Center, Los Angeles (Raja); RAND, Arlington, Virginia (Richard, Uscher-Pines); Depression and Bipolar Support Alliance, Chicago (Smith); Harvard Medical School, Boston (Huskamp, Mehrotra, Busch); Beth Israel Deaconess Medical Center, Boston (Mehrotra); McLean Hospital, Belmont, Massachusetts (Busch)
| | - Lori Uscher-Pines
- RAND, Boston (Sousa, Rabinowitz); Greater Los Angeles U.S. Department of Veterans Affairs Medical Center, Los Angeles (Raja); RAND, Arlington, Virginia (Richard, Uscher-Pines); Depression and Bipolar Support Alliance, Chicago (Smith); Harvard Medical School, Boston (Huskamp, Mehrotra, Busch); Beth Israel Deaconess Medical Center, Boston (Mehrotra); McLean Hospital, Belmont, Massachusetts (Busch)
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Mancheño-Velasco C, Narváez-Camargo M, Dacosta-Sánchez D, de la Rosa-Cáceres A, Lozano ÓM. Impact of COVID-19 on Substance Use Disorder Treatment: Examining the Influence of In-Person and Telehealth Intervention on Outcomes Using Real-World Data. Healthcare (Basel) 2025; 13:84. [PMID: 39791691 PMCID: PMC11720626 DOI: 10.3390/healthcare13010084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2024] [Revised: 01/02/2025] [Accepted: 01/04/2025] [Indexed: 01/12/2025] Open
Abstract
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.
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Affiliation(s)
- Cinta Mancheño-Velasco
- Department of Clinical and Experimental Psychology, University of Huelva, 21071 Huelva, Spain; (C.M.-V.); (M.N.-C.); (D.D.-S.); (A.d.l.R.-C.)
| | - Marta Narváez-Camargo
- Department of Clinical and Experimental Psychology, University of Huelva, 21071 Huelva, Spain; (C.M.-V.); (M.N.-C.); (D.D.-S.); (A.d.l.R.-C.)
| | - Daniel Dacosta-Sánchez
- Department of Clinical and Experimental Psychology, University of Huelva, 21071 Huelva, Spain; (C.M.-V.); (M.N.-C.); (D.D.-S.); (A.d.l.R.-C.)
| | - Ana de la Rosa-Cáceres
- Department of Clinical and Experimental Psychology, University of Huelva, 21071 Huelva, Spain; (C.M.-V.); (M.N.-C.); (D.D.-S.); (A.d.l.R.-C.)
| | - Óscar M. Lozano
- Department of Clinical and Experimental Psychology, University of Huelva, 21071 Huelva, Spain; (C.M.-V.); (M.N.-C.); (D.D.-S.); (A.d.l.R.-C.)
- Natural Resources, Health and Environment, University of Huelva, 21071 Huelva, Spain
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9
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Vergeer RR, Luk JW, Stangl BL, McCabe EM, Ziausyte U, Schwandt ML, Goldman D, Ramchandani VA, Diazgranados N. Treatment access gap during the COVID-19 Pandemic: impact on problematic alcohol use and the moderating roles of perceived stress and resilience. Front Psychiatry 2024; 15:1487277. [PMID: 39735429 PMCID: PMC11672780 DOI: 10.3389/fpsyt.2024.1487277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2024] [Accepted: 10/29/2024] [Indexed: 12/31/2024] Open
Abstract
Objective The COVID-19 pandemic may have interfered with individuals' access to alcohol use disorder (AUD) treatment, but limited research has documented the impact of treatment interference on drinking behavior. This study's purpose was to examine the associations of AUD treatment interference with problematic alcohol use, and the moderating roles of perceived stress and resilience. Method A cross-sectional survey design was employed. Data were drawn from the baseline assessment of the National Institute on Alcohol Abuse and Alcoholism COVID-19 Pandemic Impact on Alcohol Study. Between June 2020 and March 2021, 288 participants (48.6% female, 51.4% male) responded to key measures of interest by phone and/or through an online survey. Study hypotheses were tested using multiple linear regression models adjusted for demographic characteristics (age, sex, race, ethnicity, years of education, household income, marital status), study enrollment phase, and history of AUD. Results Self-reported AUD treatment interference was positively associated with problematic alcohol use as measured by the Alcohol Use Disorders Identification Test (b = 2.05, p < 0.001). Significant moderation effects indicated the association between AUD treatment interference and problematic alcohol use was stronger at a high level of perceived stress (b = 3.08, p < 0.001) and was attenuated at a high level of resilience (b = -0.13, p = 0.874). Conclusions Self-reported AUD treatment interference may indicate interruption to individuals' support systems and highlight the need for continued access to treatment. Fostering positive coping strategies and resilience may help individuals mitigate risks of problematic drinking amidst a public health crisis.
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Affiliation(s)
- Rhianna R. Vergeer
- Human Psychopharmacology Laboratory, Division of Intramural Clinical and Biological Research (DICBR), National Institute on Alcohol Abuse and Alcoholism (NIAAA), Bethesda, MD, United States
| | - Jeremy W. Luk
- Office of the Clinical Director, DICBR, NIAAA, Bethesda, MD, United States
| | - Bethany L. Stangl
- Human Psychopharmacology Laboratory, Division of Intramural Clinical and Biological Research (DICBR), National Institute on Alcohol Abuse and Alcoholism (NIAAA), Bethesda, MD, United States
| | - Emma M. McCabe
- Human Psychopharmacology Laboratory, Division of Intramural Clinical and Biological Research (DICBR), National Institute on Alcohol Abuse and Alcoholism (NIAAA), Bethesda, MD, United States
| | - Ugne Ziausyte
- Office of the Clinical Director, DICBR, NIAAA, Bethesda, MD, United States
| | | | - David Goldman
- Office of the Clinical Director, DICBR, NIAAA, Bethesda, MD, United States
| | - Vijay A. Ramchandani
- Human Psychopharmacology Laboratory, Division of Intramural Clinical and Biological Research (DICBR), National Institute on Alcohol Abuse and Alcoholism (NIAAA), Bethesda, MD, United States
| | - Nancy Diazgranados
- Office of the Clinical Director, DICBR, NIAAA, Bethesda, MD, United States
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10
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Sims-Rhodes N, Cornwell HE, Barena E, Dubre V, Elliott KS, Nabulsi EH, Yuen N, Sass SM, Miller A, Tiruneh YM, Singh KP. Perceived Barriers and Facilitators of Behavioral-Health Modality Change Adoption During the COVID-19 Pandemic: A Systematic Review. J Multidiscip Healthc 2024; 17:5695-5713. [PMID: 39649371 PMCID: PMC11624676 DOI: 10.2147/jmdh.s472060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 10/07/2024] [Indexed: 12/10/2024] Open
Abstract
Introduction During the Coronavirus Disease 2019 pandemic, there was a surge in demand for mental health services worldwide, presenting challenges for healthcare institutions as they navigated changes in policy and safety regulations. In the United States, this resulted in many behavioral health modality changes to remain in compliance with the Center for Disease Control guidelines. A growing body of literature has documented these, yet few explored barriers and facilitators affecting the adoption of these modality delivery changes. The researchers conducted a systematic review using the PRISMA method, focusing on service delivery changes across healthcare systems in the United States from March 2020 to May 2022. Objective The study objective was to identify barriers and facilitators affecting the adoption of changes to modality delivery of behavioral health services due to pandemic restrictions. Methods This was a systematic review that utilized the PRISMA method. The researchers identified 445 initial articles from eight databases using predetermined keywords and implemented a three-round screening process to select the most pertinent articles for this review. The researchers used a thematic analysis focused on user-related, program-related, technology, and environment-related constructs relevant to engagement with digital mental health interventions, and also addressed provider and administrative-related barriers and facilitators of virtual behavioral health modality changes. Barriers and facilitators were operationalized using the Borghouts Model. Results This systematic review revealed several common barriers and facilitators, including underdeveloped technology infrastructure, privacy and confidentiality concerns, poor technology literacy, availability of diverse technology options, provider technology training, and ease of integration into everyday life. Conclusion This review provides insights into barriers and facilitators of modality change adoption, which could inform the development and implementation of virtual mental healthcare services and may help optimize the application of these services by improving our understanding and ability to overcome barriers influencing their adoption.
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Affiliation(s)
- Nicholas Sims-Rhodes
- Department of Epidemiology and Biostatistics, University of Texas at Tyler Health Science Center, Tyler, TX, USA
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Hannah E Cornwell
- Department of Epidemiology and Biostatistics, University of Texas at Tyler Health Science Center, Tyler, TX, USA
| | - Emily Barena
- Department of Psychology and Counseling, The University of Texas at Tyler, Tyler, TX, USA
| | - Vandy Dubre
- Robert R. Muntz Library, The University of Texas at Tyler, Tyler, TX, USA
| | - Kimberly S Elliott
- Department of Healthcare Policy, Economics and Management, University of Texas at Tyler Health Science Center, Tyler, TX, USA
| | - Eman H Nabulsi
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Nelly Yuen
- Department of Psychology and Counseling, The University of Texas at Tyler, Tyler, TX, USA
| | - Sarah M Sass
- Department of Psychology and Counseling, The University of Texas at Tyler, Tyler, TX, USA
| | - Anastasia Miller
- Department of Educational Leadership, Evaluation and Organizational Development, University of Louisville, Louisville, KY, USA
| | - Yordanos M Tiruneh
- Department of Preventive Medicine, University of Texas at Tyler Health Science Center, Tyler, TX, USA
| | - Karan P Singh
- Department of Epidemiology and Biostatistics, University of Texas at Tyler Health Science Center, Tyler, TX, USA
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11
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Narayan S, Gooderham E, Spencer S, McCracken RK, Hedden L. Virtual Primary Care for People With Opioid Use Disorder: Scoping Review of Current Strategies, Benefits, and Challenges. J Med Internet Res 2024; 26:e54015. [PMID: 39622042 PMCID: PMC11650090 DOI: 10.2196/54015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 04/11/2024] [Accepted: 10/06/2024] [Indexed: 12/19/2024] Open
Abstract
BACKGROUND There is a pressing need to understand the implications of the rapid adoption of virtual primary care for people with opioid use disorder. Potential impacts, including disruptions to opiate agonist therapies, and the prospect of improved service accessibility remain underexplored. OBJECTIVE This scoping review synthesized current literature on virtual primary care for people with opioid use disorder with a specific focus on benefits, challenges, and strategies. METHODS We followed the Joanna Briggs Institute methodological approach for scoping reviews and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist for reporting our findings. We conducted searches in MEDLINE, Web of Science, CINAHL Complete, and Embase using our developed search strategy with no date restrictions. We incorporated all study types that included the 3 concepts (ie, virtual care, primary care, and people with opioid use disorder). We excluded research on minors, asynchronous virtual modalities, and care not provided in a primary care setting. We used Covidence to screen and extract data, pulling information on study characteristics, health system features, patient outcomes, and challenges and benefits of virtual primary care. We conducted inductive content analysis and calculated descriptive statistics. We appraised the quality of the studies using the Quality Assessment With Diverse Studies tool and categorized the findings using the Consolidated Framework for Implementation Research. RESULTS Our search identified 1474 studies. We removed 36.36% (536/1474) of these as duplicates, leaving 938 studies for title and abstract screening. After a double review process, we retained 3% (28/938) of the studies for extraction. Only 14% (4/28) of the studies were conducted before the COVID-19 pandemic, and most (15/28, 54%) used quantitative methodologies. We summarized objectives and results, finding that most studies (18/28, 64%) described virtual primary care delivered via phone rather than video and that many studies (16/28, 57%) reported changes in appointment modality. Through content analysis, we identified that policies and regulations could either facilitate (11/28, 39%) or impede (7/28, 25%) the provision of care virtually. In addition, clinicians' perceptions of patient stability (5/28, 18%) and the heightened risks associated with virtual care (10/28, 36%) can serve as a barrier to offering virtual services. For people with opioid use disorder, increased health care accessibility was a noteworthy benefit (13/28, 46%) to the adoption of virtual visits, whereas issues regarding access to technology and digital literacy stood out as the most prominent challenge (12/28, 43%). CONCLUSIONS The available studies highlight the potential for enhancing accessibility and continuous access to care for people with opioid use disorder using virtual modalities. Future research and policies must focus on bridging gaps to ensure that virtual primary care does not exacerbate or entrench health inequities.
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Affiliation(s)
- Shawna Narayan
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ellie Gooderham
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Sarah Spencer
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Rita K McCracken
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Family Medicine, Providence Health Care, Vancouver, BC, Canada
| | - Lindsay Hedden
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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12
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Agbali RA, Balas EA, Beltrame F, Heboyan V, De Leo G. A review of questionnaires used for the assessment of telemedicine. J Telemed Telecare 2024; 30:1636-1666. [PMID: 37032470 DOI: 10.1177/1357633x231166161] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
INTRODUCTION Telemedicine is the exchange of medical information from one site to another via electronic communications with the goal of improving a patient's clinical health status. Prior studies have identified the absence of a standardized assessment tool for evaluating telemedicine encounters. This study aims to collect and to analyze questionnaires used for the assessment of audiovisual telemedicine encounters from a patient perspective and aims to identify reasons driving the use of self-developed questionnaires. METHODS We conducted a systematic search in PubMed for studies that used survey questionnaires to assess synchronous audiovisual telemedicine encounters from 2016 to 2021. We categorized questionnaires used into validated and non-validated types, and for each of them, collected questions, response format, author, year, specialty, and country of publication. RESULTS AND DISCUSSION We analyzed a total of 71 articles. We found that only 16 studies used three validated questionnaires. The remaining 55 studies used non-validated questionnaires. Non-validated questionnaires had a high variability in length and used Likert scales, binary responses, multiple choice, and open-ended answers. We found only eight studies in which the authors gave a reason for resorting to designing their own questionnaires. This review reveals insufficient standardized survey questionnaires to be used for the assessment of audiovisual telemedicine encounters. Future research initiatives should focus on developing a standardized and validated instrument well accepted by researchers.
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Affiliation(s)
- Raphael A Agbali
- College of Allied Health Sciences, Augusta University, Augusta, GA, USA
| | - E Andrew Balas
- College of Allied Health Sciences, Augusta University, Augusta, GA, USA
| | - Francesco Beltrame
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Genova, Italy
| | - Vahe Heboyan
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Gianluca De Leo
- College of Allied Health Sciences, Augusta University, Augusta, GA, USA
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13
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Heijstee N, Black E, Black E, Demirkol A, Mammen K, Mills L, Deacon R, Ezard N, Montebello M, Reid D, Bruno R, Shakeshaft A, Siefried KJ, Farrell M, Lintzeris N. Sociodemographic and Health Factors of the Alcohol Treatment-seeking Population in New South Wales, Australia. J Addict Med 2024; 18:619-627. [PMID: 38828937 DOI: 10.1097/adm.0000000000001311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
OBJECTIVES Although factors associated with alcohol use have been researched at a population level, descriptions of the alcohol and other drug (AOD) treatment-seeking population in New South Wales (NSW), Australia, are limited. This study addresses this gap by analyzing sociodemographic and health characteristics in the NSW AOD treatment-seeking population. METHODS Self-reported Australian Treatment Outcomes Profile data on substance use, health ratings, and sociodemographic factors were acquired from public AOD services (offering services from counseling to ambulatory/inpatient withdrawal management) in 6 administrative health districts from 2016 to 2019 (n = 14,287). Gaussian and multiple logistic regressions were conducted to examine associations between these factors and alcohol consumption quantity. RESULTS Data were analyzed for patients seeking treatment for alcohol consumption specifically (n = 5929; median age, 44 years; 65% male). Valid alcohol consumption data were available for 5460 patients, among whom the mean volume of alcohol consumed was 311 standard drinks (3110 grams of ethanol) over the past 28 days and 15 standard drinks (150 grams of ethanol) per occasion. Higher volumes were consumed by males and those with recent experiences of violence and/or injecting drug use. Caring for children younger than 5 years and having above-median health ratings were associated with lower alcohol consumption. CONCLUSIONS This study contributes to the characterization of the NSW public AOD treatment population and identifies associations between alcohol consumption, sociodemographic factors, and health ratings among people seeking treatment for alcohol consumption. Findings point towards multilevel assessment and comprehensive interventions for people engaging in treatment for alcohol use. Future research should address barriers to treatment.
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Affiliation(s)
- Nathan Heijstee
- From the Faculty of Medicine, University of New South Wales, Sydney, Australia (NH, ElB and EmB, NE, MM); Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, Australia (NH, EB, EB, AD, KM, LM, RD, NL); New South Wales (NSW) Drug and Alcohol Clinical Research and Improvement Network, Sydney, Australia (EB, EB, AD, KM, LM, RD, NE, MM, DR, KJS, NL); School of Population Health, University of NSW, Sydney, Australia (EB, AD); Specialty of Addiction Medicine, Sydney University, Sydney, Australia (EB, LM, RD, MM, NL); Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, Australia (NE, KJS); National Centre for Clinical Research on Emerging Drugs, Australia, Sydney, Australia (NE, KJS); Drug and Alcohol Services, Northern Sydney Local Health District, Sydney, Australia (MM); Drug and Alcohol Services, Illawarra Shoalhaven Local Health District, Wollongong, Australia (DR); School of Psychological Sciences, University of Tasmania, Hobart, Australia (RB); National Drug and Alcohol Research Centre, University of NSW, Sydney, Australia (RB, AS, MF); and Poche Centre for Indigenous Health, University of Queensland, Brisbane, Australia (AS)
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Santos JM, Fleck MPA, Teche SP, Passos IC, Costa MH, Rocha NS. Psychometric properties of an online psychotherapy advantages and disadvantages instrument: Preliminary results of a multi-center pilot study. Acta Psychol (Amst) 2024; 251:104566. [PMID: 39488878 DOI: 10.1016/j.actpsy.2024.104566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 10/23/2024] [Accepted: 10/24/2024] [Indexed: 11/05/2024] Open
Abstract
We verified the need for instruments that could assess the perceptions of patients, therapists, and psychotherapy supervisors about online Psychotherapy. OBJECTIVES to Build a scale of advantages and disadvantages of online psychotherapy. METHOD A pilot cross-sectional multicenter sample collected from 2020 to 2021 of 129 patients, 20 therapists, and 35 supervisors. We used several analyses. The final scale contained 22 items divided into two domains: advantages and disadvantages. RESULTS Cronbach's alpha showed good internal consistency (0.88 and 0.85). The scale showed discriminative ability. Convergent validity showed significant correlations between WAI-SR domains (p 〈0,001). The scale showed a good data fit in the confirmatory factor analysis (X2 = 255,859; DF = 197; p = .003; CFI = 0.95; RMSEA = 0.047; GFI = 0.84 TLI = 0.94). CONCLUSION This pilot study showed that the instrument proved preliminary good psychometric properties but needs to be evaluated in a larger sample.
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Affiliation(s)
- J M Santos
- Center of Clinical Research and Center of Experimental Research, Hospital de Clínicas de Porto Alegre (HCPA), Brazil; Graduation Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Medical Faculty, Porto Alegre, Brazil; I-QOL: Innovations and interventions for quality-of-life research group, Brazil
| | - M P A Fleck
- Center of Clinical Research and Center of Experimental Research, Hospital de Clínicas de Porto Alegre (HCPA), Brazil; Graduation Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Medical Faculty, Porto Alegre, Brazil
| | - S P Teche
- Center of Clinical Research and Center of Experimental Research, Hospital de Clínicas de Porto Alegre (HCPA), Brazil; Graduation Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Medical Faculty, Porto Alegre, Brazil.
| | - I C Passos
- Center of Clinical Research and Center of Experimental Research, Hospital de Clínicas de Porto Alegre (HCPA), Brazil; Graduation Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Medical Faculty, Porto Alegre, Brazil.
| | - M H Costa
- Center of Clinical Research and Center of Experimental Research, Hospital de Clínicas de Porto Alegre (HCPA), Brazil; I-QOL: Innovations and interventions for quality-of-life research group, Brazil
| | - N S Rocha
- Center of Clinical Research and Center of Experimental Research, Hospital de Clínicas de Porto Alegre (HCPA), Brazil; Graduation Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Medical Faculty, Porto Alegre, Brazil; I-QOL: Innovations and interventions for quality-of-life research group, Brazil.
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15
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Papalamprakopoulou Z, Ntagianta E, Triantafyllou V, Kalamitsis G, Dharia A, Dickerson SS, Hatzakis A, Talal AH. Telehealth to increase healthcare access; perspectives of people who use drugs. BMC Med Inform Decis Mak 2024; 24:306. [PMID: 39425182 PMCID: PMC11490127 DOI: 10.1186/s12911-024-02718-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Accepted: 10/11/2024] [Indexed: 10/21/2024] Open
Abstract
BACKGROUND People who use drugs (PWUD) often face restricted healthcare access despite their heightened healthcare needs. Factors such as stigma, mistrust of the healthcare system, competing priorities, and geographical barriers pose significant healthcare access challenges. Telehealth offers an innovative solution to expand healthcare access for better inclusion of underserved populations in healthcare. We aimed to explore PWUDs' perceptions of telehealth as a healthcare delivery modality. METHODS We utilized purposive sampling to recruit participants (N = 57) for nine focus group discussions (FGDs) in Athens, Greece. Eligibility criteria required participants to be at least 18 years, with current or prior injection drug use, and current internet access. The FGDs followed a semi-structured interview guide, were audio recorded, transcribed verbatim, translated into English, and de-identified. We applied thematic analysis to analyze FGD transcripts. RESULTS Participants' mean (standard deviation) age was 47.9 (8.9) years, 89.5% (51/57) were male, 91.2% (52/57) were of Greek origin, and 61.4% (35/57) had attended at least 10 years of school. Three main themes emerged from the FGDs: (1) high internet utilization for healthcare-related purposes among PWUD, (2) highlighting telehealth benefits despite access obstacles and PWUDs' concerns about diagnostic accuracy, and (3) approaches to overcome access obstacles and build digital trust. Participants extensively used the internet for healthcare-related processes, such as accessing healthcare information and scheduling provider appointments. Despite being telehealth-inexperienced, most participants expressed a strong willingness to embrace telehealth due to its perceived convenience, time-saving nature, and trusted digital environment. Some participants recognized that the inability to conduct physical examinations through telehealth reduces its diagnostic accuracy, while others expressed concerns about digital literacy and technological infrastructure accessibility. Most participants expressed a preference for video-based telehealth encounters over audio-only encounters. To build trust in telehealth and promote patient-centeredness, participants recommended an initial in-person visit, virtual eye contact during telehealth encounters, patient education, and partnerships with PWUD-supportive community organizations equipped with appropriate infrastructure. CONCLUSIONS PWUD frequently use the internet for health-related purposes and suggested several approaches to enhance virtual trust. Their insights and suggestions are practical guidance for policymakers seeking to enhance healthcare access for underserved populations through telehealth. TRIAL REGISTRATION NCT05794984.
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Affiliation(s)
- Zoi Papalamprakopoulou
- Division of Gastroenterology, Hepatology, and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Hellenic Scientific Society for the Study of AIDS, Sexually Transmitted and Emerging Diseases, Athens, Greece
| | | | | | | | - Arpan Dharia
- Division of Gastroenterology, Hepatology, and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Suzanne S Dickerson
- Faculty Development and PhD Program, School of Nursing, University at Buffalo, Buffalo, NY, USA
| | - Angelos Hatzakis
- Hellenic Scientific Society for the Study of AIDS, Sexually Transmitted and Emerging Diseases, Athens, Greece
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Athens, Greece
| | - Andrew H Talal
- Division of Gastroenterology, Hepatology, and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
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Pacichana-Quinayaz SG, Vélez LMR, Cano DS, Sánchez YML, Orobio OMH, Sánchez MAT, Córdoba GIT, Bonilla-Escobar FJ. Telerehabilitation in Colombia: A Country Report and Qualitative Analysis During the Covid-19 Pandemic - Perceptions of Healthcare Providers and Patients. Int J Telerehabil 2024; 16:e6605. [PMID: 39022433 PMCID: PMC11249649 DOI: 10.5195/ijt.2024.6605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024] Open
Abstract
Given Colombia's status as a middle-income country with healthcare challenges, leveraging telemedicine could significantly benefit hard-to-reach regions, under-resourced and underserved communities. This study provides a comprehensive overview of the country's telerehabilitation landscape, exploring the clinicians' and patients' perspectives during the COVID-19 pandemic through systematic review and qualitative analysis. Sixteen therapists and three patients were identified via snowball sampling. The literature review was scarce and scattered across various topics in the country; some studies delved into specific aspects like legislative frameworks and patient outcomes from different medical specialties. The qualitative analysis demonstrates that despite the learning curve, telerehabilitation strengthens therapeutic support, enhances patient autonomy, fosters a positive patient-provider relationship, achieves treatment goals, promotes family involvement, reduces time and costs, and ensures continuity of therapy services. This study identified research gaps, challenges, and opportunities in telerehabilitation in a Latin American country. Adopting telemedicine technologies in low- and middle-income countries could significantly enhance their healthcare systems.
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Affiliation(s)
- Sara Gabriela Pacichana-Quinayaz
- Research Group in Physical Medicine and Rehabilitation at Universidad Del Valle (GIRUV), Department of Physical Medicine and Rehabilitation, Cali, Colombia
- Fundación Somos Ciencia al Servicio de la Comunidad, Fundación SCISCO/Science to Serve the Community, SCISCO Foundation, Cali, Colombia
| | - Lina María Rodríguez Vélez
- Research Group Curriculum and Pedagogy in Higher Education (CURPES), Universidad Del Valle, Cali, Colombia
| | - Daniel Sánchez Cano
- Fundación Somos Ciencia al Servicio de la Comunidad, Fundación SCISCO/Science to Serve the Community, SCISCO Foundation, Cali, Colombia
| | - Yisel Mabirlly León Sánchez
- Fundación Somos Ciencia al Servicio de la Comunidad, Fundación SCISCO/Science to Serve the Community, SCISCO Foundation, Cali, Colombia
| | - Olga Marina Hernández Orobio
- Research Group in Physical Medicine and Rehabilitation at Universidad Del Valle (GIRUV), Department of Physical Medicine and Rehabilitation, Cali, Colombia
| | - Maria Ana Tovar Sánchez
- Research Group in Physical Medicine and Rehabilitation at Universidad Del Valle (GIRUV), Department of Physical Medicine and Rehabilitation, Cali, Colombia
| | - Gloria Isabel Toro Córdoba
- Research Group Curriculum and Pedagogy in Higher Education (CURPES), Universidad Del Valle, Cali, Colombia
| | - Francisco Javier Bonilla-Escobar
- Research Group in Physical Medicine and Rehabilitation at Universidad Del Valle (GIRUV), Department of Physical Medicine and Rehabilitation, Cali, Colombia
- Fundación Somos Ciencia al Servicio de la Comunidad, Fundación SCISCO/Science to Serve the Community, SCISCO Foundation, Cali, Colombia
- Institute for Clinical Research Education, School of Medicine, University of Pittsburgh, Pittsburgh, USA
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17
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Siste K, Ophinni Y, Hanafi E, Yamada C, Novalino R, Limawan AP, Beatrice E, Rafelia V, Alison P, Matsumoto T, Sakamoto R. Relapse Prevention Group Therapy in Indonesia Involving Peers via Videoconferencing for Substance Use Disorder: Development and Feasibility Study. JMIR Form Res 2024; 8:e50452. [PMID: 38888959 PMCID: PMC11220436 DOI: 10.2196/50452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 03/30/2024] [Accepted: 04/24/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Substance use disorder (SUD) is a major health issue in Indonesia, where several barriers to treatment exist, including inaccessibility to treatment services, stigma, and criminalization of drug issues. Peer involvement and the use of telemedicine to deliver psychotherapy are promising approaches to overcome these barriers. OBJECTIVE This study aims (1) to describe the development of a new group psychotherapy coprovided by a health care worker and a peer and (2) to evaluate the acceptability, practicality, and preliminary outcomes of the program delivered via videoconferencing in Indonesia. METHODS Building upon an established relapse prevention therapy in Japan, we developed a 3-month weekly group therapy module in the Indonesian language. Adjustments were made via focus group discussions with local stakeholders in terms of substance types, understandability, inclusive language, and cultural relevance. A pilot study was conducted to test the new module provided by a peer and a psychiatrist via videoconferencing, termed tele-Indonesia Drug Addiction Relapse Prevention Program (tele-Indo-DARPP), with a pre- and postcontrolled design. We analyzed data from semistructured feedback interviews and outcome measurements, including the number of days using substances and quality of life, and compared the intervention (tele-Indo-DARPP added to treatment as usual [TAU]) and control (TAU only) arms. RESULTS In total, 8 people diagnosed with SUD participated in the pilot study with a mean age of 37 (SD 12.8) years. All were men, and 7 (88%) used sedatives as the primary substance. Collectively, they attended 44 of the 48 tele-Indo-DARPP sessions. A total of 3 out of 4 (75%) preferred telemedicine rather than in-person therapy. Positive acceptability and practicality were shown from qualitative feedback, in which the participants who joined the tele-Indo-DARPP reported that they liked the convenience of joining from home and that they were able to open up about personal matters, received helpful advice from peers, and received support from other participants. Providers reported that they feel the module was provider-friendly, and the session was convenient to join without diminishing rapport-building. Meanwhile, troubles with the internet connection and difficulty in comprehending some terminology in the workbook were reported. The intervention arm showed better improvements in psychological health and anxiety symptoms. CONCLUSIONS Group psychotherapy via videoconferencing coprovided by health care workers and peers was acceptable and practical for participants with SUD and service providers in this study. A large-scale study is warranted to examine the effectiveness of the newly developed module in Indonesia.
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Affiliation(s)
- Kristiana Siste
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Youdiil Ophinni
- The Hakubi Center for Advanced Research, Kyoto University, Kyoto, Japan
- Department of Environmental Coexistence, Center for Southeast Asian Studies, Kyoto University, Kyoto, Japan
- Ragon Institute of Mass General, MIT, and Harvard, Cambridge, MA, United States
| | - Enjeline Hanafi
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Chika Yamada
- Department of Environmental Coexistence, Center for Southeast Asian Studies, Kyoto University, Kyoto, Japan
- Department of Drug Dependence Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | | | - Albert P Limawan
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Evania Beatrice
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Vania Rafelia
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Peter Alison
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Toshihiko Matsumoto
- Department of Drug Dependence Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Ryota Sakamoto
- Department of Environmental Coexistence, Center for Southeast Asian Studies, Kyoto University, Kyoto, Japan
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Perumalswami PV, Adams MA, Frost MC, Holleman R, Kim HM, Zhang L, Lin LA. Telehealth and delivery of alcohol use disorder treatment in the Veterans Health Administration. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:944-954. [PMID: 38529689 DOI: 10.1111/acer.15305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 02/09/2024] [Accepted: 03/06/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND The use of telehealth treatment of alcohol use disorder (AUD) has increased since the start of the COVID-19 pandemic. However, it is unclear which patients are using telehealth and how telehealth visits are associated with treatment duration. This study examined characteristics associated with telehealth use among Veterans Health Administration patients receiving AUD treatment. METHODS Using a national retrospective cohort study, we examined data from March 01, 2020 to February 28, 2021 to: First, identify patient characteristics associated with (a) any telehealth versus only in-person care for AUD treatment, and (b) video (≥1 video visit) versus only telephone visits for AUD treatment (≥1 telephone visit, no video) among any telehealth users. This analysis used mixed-effects logistic regression models to adjust for potential correlation across patients treated at the same facility. Second, we assessed whether visit modality was associated with the amount of AUD treatment received (number of AUD psychotherapy visits or medication coverage days). This analysis used mixed-effects negative binomial regression models. RESULTS Among 138,619 patients who received AUD treatment, 52.8% had ≥1 video visit, 38.1% had ≥1 telephone but no video visits, and 9.1% had only in-person visits. In the regression analyses, patients who were male or had an opioid or stimulant use disorder (compared to having no non-AUD substance use disorder) were less likely to receive any telehealth-delivered AUD treatment compared to only in-person AUD treatment. Among patients who received any telehealth-delivered AUD treatment, those who were ≥45 years old (compared to 18-29 years old), Black (compared to White), diagnosed with a cannabis or stimulant use disorder, or diagnosed with a serious mental illness were less likely to receive a video visit than only telephone visits. Receiving any AUD telehealth was associated with receiving more psychotherapy visits and medication coverage days than only in-person care. CONCLUSIONS Telehealth, a common modality for AUD treatment, supported a greater number of psychotherapy visits and a longer duration of medication treatment for AUD. However, some groups were less likely to receive any video telehealth than telephone visits, suggesting that multiple treatment modalities should remain available to ensure treatment access.
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Affiliation(s)
- Ponni V Perumalswami
- Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Gastroenterology Section, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan, USA
| | - Megan A Adams
- Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Gastroenterology Section, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan, USA
| | - Madeline C Frost
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Washington, USA
- Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Rob Holleman
- Health Services Research & Development, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Hyungjin Myra Kim
- Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Consulting for Statistics, Computing & Analytics Research (CSCAR), University of Michigan, Ann Arbor, Michigan, USA
| | - Lan Zhang
- Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Psychiatry, Addiction Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Lewei Allison Lin
- Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan, USA
- Department of Psychiatry, Addiction Center, University of Michigan, Ann Arbor, Michigan, USA
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19
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Oesterle TS, Bormann NL, Ochal DA, Arndt S, Breitinger SA. Transitioning Virtual-Only Group Therapy for Substance Use Disorder Patients to a Hybrid Model. Subst Abuse Rehabil 2024; 15:73-78. [PMID: 38681859 PMCID: PMC11055515 DOI: 10.2147/sar.s460024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/20/2024] [Indexed: 05/01/2024] Open
Abstract
Purpose Telehealth is associated with a myriad of benefits; however, little is known regarding substance use disorder (SUD) treatment outcomes when participants join group therapy sessions in a combination in-person and virtual setting (hybrid model). We sought to determine if treatment completion rates differed. Patients and Methods Policy changes caused by the COVID-19 pandemic created a naturalistic, observational cohort study at seven intensive outpatient (IOP) programs in rural Minnesota. Virtual-only delivery occurred 6/1/2020-6/30/2021, while hybrid groups occurred 7/1/2021-7/31/2022. Data was evaluated retrospectively for participants who initiated and discharged treatment during the study period. Participants were IOP group members 18 years and older who had a SUD diagnosis that both entered and discharged treatment during the 26-month period. A consecutive sample of 1502 participants (181-255 per site) was available, with 644 removed: 576 discharged after the study conclusion, 49 were missing either enrollment or discharge data, 14 transferred sites during treatment, and 5 initiated treatment before the study initiation. Helmert contrasts evaluated the impact of hybrid group exposure. Results A total of 858 individuals were included. Data was not from the medical chart and was deidentified preventing specific demographics; however, the overall IOP sample for 2020-2022, from which the sample was derived, was 29.8% female, and 64.1% were 18-40 years of age. For completed treatment, hybrid group exposure relative to virtual-only had a univariate odds ratio of 1.88 (95% CI: 1.50-2.41, p < 0.001). No significant difference was seen across IOP sites. Conclusion These results describe a novel hybrid group approach to virtual care for SUDs with outcome data not previously documented in the literature. While virtual treatment delivery can increase access, these results suggest a benefit is derived from including an in-person option. Further research is needed to identify how an in-person component may change dynamics and if it can be replicated in virtual-only models.
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Affiliation(s)
- Tyler S Oesterle
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Nicholas L Bormann
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | | | - Stephan Arndt
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
- Department of Biostatistics, University of Iowa, Iowa City, IA, USA
| | - Scott A Breitinger
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
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20
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Elliott KS, Nabulsi EH, Sims-Rhodes N, Dubre V, Barena E, Yuen N, Morris M, Sass SM, Kennedy B, Singh KP. Modality and terminology changes for behavioral health service delivery during the COVID-19 pandemic: a systematic review. Front Psychiatry 2024; 14:1265087. [PMID: 38375514 PMCID: PMC10876001 DOI: 10.3389/fpsyt.2023.1265087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/27/2023] [Indexed: 02/21/2024] Open
Abstract
Introduction The COVID-19 pandemic prompted healthcare professionals to implement service delivery adaptations to remain in compliance with safety regulations. Though many adaptations in service delivery were reported throughout the literature, a wide variety of terminology and definitions were used. Methods To address this, we conducted a PRISMA review to identify service delivery adaptations across behavioral healthcare services in the United States from March 2020 to May 2022 and to identify variations in terminology used to describe these adaptations. We identified 445 initial articles for our review across eight databases using predetermined keywords. Using a two-round screening process, authors used a team approach to identify the most appropriate articles for this review. Results Our results suggested that a total of 14 different terms were used to describe service modality changes, with the most frequent term being telehealth (63%). Each term found in our review and the frequency of use across identified articles is described in detail. Discussion Implications of this review such as understanding modality changes during the COVID-19 pandemic and beyond are discussed. Our findings illustrate the importance of standardizing terminology to enhance communication and understanding among professionals.
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Affiliation(s)
- Kimberly S. Elliott
- Department of Healthcare Policy, Economics and Management, University of Texas at Tyler Health Science Center, Tyler, TX, United States
| | - Eman H. Nabulsi
- Department of Epidemiology and Biostatistics, University of Texas at Tyler, Tyler, TX, United States
| | - Nicholas Sims-Rhodes
- Department of Epidemiology and Biostatistics, University of Texas at Tyler, Tyler, TX, United States
| | - Vandy Dubre
- Robert R. Muntz Library, The University of Texas at Tyler, Tyler, TX, United States
| | - Emily Barena
- Department of Psychology and Counseling, The University of Texas at Tyler, Tyler, TX, United States
| | - Nelly Yuen
- Department of Psychology and Counseling, The University of Texas at Tyler, Tyler, TX, United States
| | - Michael Morris
- Department of Healthcare Policy, Economics and Management, University of Texas at Tyler Health Science Center, Tyler, TX, United States
| | - Sarah M. Sass
- Department of Psychology and Counseling, The University of Texas at Tyler, Tyler, TX, United States
| | - Bridget Kennedy
- Department of Psychology and Counseling, The University of Texas at Tyler, Tyler, TX, United States
| | - Karan P. Singh
- Department of Epidemiology and Biostatistics, University of Texas at Tyler, Tyler, TX, United States
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21
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Austin EJ, O'Brien QE, Ruiz MS, Ratzliff AD, Williams EC, Koch U. Patient and Provider Perspectives on Processes of Engagement in Outpatient Treatment for Opioid Use Disorder: A Scoping Review. Community Ment Health J 2024; 60:330-339. [PMID: 37668745 DOI: 10.1007/s10597-023-01175-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 07/22/2023] [Indexed: 09/06/2023]
Abstract
Effective treatment for opioid use disorder (OUD) is available, but patient engagement is central to achieving care outcomes. We conducted a scoping review to describe patient and provider-reported strategies that may contribute to patient engagement in outpatient OUD care delivery. We searched PubMed and Scopus for articles reporting patient and/or provider experiences with outpatient OUD care delivery. Analysis included: (1) describing specific engagement strategies, (2) mapping strategies to patient-centered care domains, and (3) identifying themes that characterize the relationship between engagement and patient-centered care. Of 3,222 articles screened, 30 articles met inclusion criteria. Analysis identified 14 actionable strategies that facilitate patient engagement and map to all patient-centered care domains. Seven themes emerged that characterize interpersonal approaches to OUD care engagement. Interpersonal interactions between patients and providers play a pivotal role in encouraging engagement throughout OUD treatment. Future research is needed to further evaluate promising engagement strategies.
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Affiliation(s)
- Elizabeth J Austin
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Box 351621, Seattle, WA, 98105, USA.
- Department of Clinical Research and Leadership, School of Medicine and Health Sciences, The George Washington University, Washington, D.C, USA.
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, D.C, USA.
| | - Quentin E O'Brien
- Department of Clinical Research and Leadership, School of Medicine and Health Sciences, The George Washington University, Washington, D.C, USA
| | - Monica S Ruiz
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, D.C, USA
| | - Anna D Ratzliff
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
- Advancing Integrated Mental Health Solutions (AIMS) Center, University of Washington, Seattle, WA, USA
| | - Emily C Williams
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Box 351621, Seattle, WA, 98105, USA
- Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, VA Puget Sound, Seattle, WA, USA
| | - Ulrich Koch
- Department of Clinical Research and Leadership, School of Medicine and Health Sciences, The George Washington University, Washington, D.C, USA
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22
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Bjork JM, Sadicario JS, Jahan NF, Curiel E, Thumma L, Reisweber J. Virtual Hybrid Versus In-Person Administration of Transcending Self Therapy for Veterans with Substance Use Disorders. SUBSTANCE USE : RESEARCH AND TREATMENT 2024; 18:29768357241255437. [PMID: 38803614 PMCID: PMC11129570 DOI: 10.1177/29768357241255437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/30/2024] [Indexed: 05/29/2024]
Abstract
Objectives Veterans with substance use disorder (SUD) can show high severity and are at high risk of relapse due to trauma histories and other comorbid conditions. However, evidence-based SUD therapies may not be available to many veterans due to geographic or transportation constraints. Telehealth approaches have shown promise to improve access to different SUD therapy formats but have not been well-studied in open (rolling-admission) group therapy of in-person patients as administered by a single on-screen therapist. Methods Social distancing required by the COVID-19 pandemic forced the transition of delivery of Transcending Self Therapy (TST) from an in-person therapist to a single remote (on-screen) therapist. In this virtual model, veterans continued to receive TST but the therapist was off site and provided therapy to veterans who were together in the same room during a 28 day residential Veterans Affairs treatment program. In a program evaluation, we compared their changes in quality of life (QoL), treatment satisfaction ratings and group therapy treatment outcomes with those of Veterans who received TST from an in-person therapist. Results In both groups, there was a significant increase in QoL Inventory scores from baseline to post-treatment, with no difference in improvement between treatment modalities (i.e., in-person group vs telehealth-delivered group). Veterans professed knowledge of therapy-driven skills at the end of treatment in both groups and overwhelmingly rated TST as helpful and understandable. Conclusions These data extend previous findings of patient acceptability of remotely-delivered SUD treatment, here with a remote therapist administering open group therapy, as evidenced by improvement in QoL and positive patient feedback about the remote intervention.
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Affiliation(s)
- James M. Bjork
- Richmond Veterans Affairs Medical Center, Richmond, VA, USA
- Insitute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, USA
| | - Jaclyn S. Sadicario
- Richmond Veterans Affairs Medical Center, Richmond, VA, USA
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Nabila F. Jahan
- Richmond Veterans Affairs Medical Center, Richmond, VA, USA
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Espn Curiel
- Richmond Veterans Affairs Medical Center, Richmond, VA, USA
| | - Lillia Thumma
- Richmond Veterans Affairs Medical Center, Richmond, VA, USA
- Insitute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, USA
- Department of Obstetrics & Gynecology, Virginia Commonwealth University, Richmond, VA, USA
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23
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Boyd J, Carter M, Baus A. Access to MAT: Participants' Experiences With Transportation, Non-Emergency Transportation, and Telehealth. J Prim Care Community Health 2024; 15:21501319241233198. [PMID: 38420885 PMCID: PMC10906046 DOI: 10.1177/21501319241233198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/15/2024] [Accepted: 01/25/2024] [Indexed: 03/02/2024] Open
Abstract
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.
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Affiliation(s)
- Jennifer Boyd
- West Virginia Alliance for Creative Health Solutions, Inc., Culloden, WV, USA
| | - Martha Carter
- West Virginia Alliance for Creative Health Solutions, Inc., Culloden, WV, USA
| | - Adam Baus
- West Virginia Alliance for Creative Health Solutions, Inc., Culloden, WV, USA
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24
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Seidman LC, Handy AB, Temme CR, Greenfield SF, Payne LA. Reflections on the group dynamic in a group cognitive behavioral therapy intervention for young adult women with moderate to severe dysmenorrhea: a qualitative analysis. J Psychosom Obstet Gynaecol 2023; 44:2264486. [PMID: 37800565 PMCID: PMC10640904 DOI: 10.1080/0167482x.2023.2264486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/24/2023] [Indexed: 10/07/2023] Open
Abstract
A recent group cognitive behavioral therapy (gCBT) intervention for dysmenorrhea conducted by our team demonstrated feasibility, acceptability, and preliminary efficacy at reducing menstrual pain. This study aimed to use qualitative analyses to explore participants' reflections about the intervention's group dynamic. Participants included 20 young women ages 18-24 years with average menstrual pain of 8.0 (SD = 1.1) on a 0-10 (0 = none, 10 = worst pain possible) numeric rating scale. Semi-structured individual and group interviews were conducted after the intervention. Researchers then conducted deductive, iterative thematic analysis using a template analysis approach. Two themes were generated: benefit and logistics. The benefit theme included two sub-themes: (1) camaraderie (an emotional, psychological, or social connection between participants); and (2) sharing (information, advice, or experiences). The logistics theme highlighted how the structure of the group influenced the dynamic and was divided into two sub-themes according to the time frame being described: (1) reactions (participants' experiences with how the group dynamic was facilitated); and (2) future (how the group structure could be improved). Results of this study contribute to the growing body of literature related to gCBT for pain conditions. Future research is needed to optimize the group dynamic and evaluate its specific therapeutic role in the treatment.
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Affiliation(s)
| | | | | | | | - Laura A. Payne
- McLean Hospital, Belmont, MA
- Harvard Medical School, Boston, MA
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25
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Beck AK, Waks S, Argent A, Deane FP, Larance B, Manning V, Baker AL, Hides L, Kelly PJ. The benefits and challenges of virtual SMART recovery mutual-help groups: Participant and facilitator perspectives. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 120:104174. [PMID: 37659377 DOI: 10.1016/j.drugpo.2023.104174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 08/20/2023] [Accepted: 08/21/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND COVID-19 prompted widespread transition of face-to-face mutual-help groups to virtual delivery. Current understanding of the experience of virtual mutual-help groups is limited to 12-step approaches or asynchronous groups (e.g., forums). This paper explores participant and facilitator perspectives regarding the benefits and challenges of accessing SMART Recovery mutual-help groups virtually via videoconference. METHODS A self-selected convenience sample of participants (n = 29) and facilitators (n = 15) from SMART Recovery mutual-help groups in Australia were enrolled. Participants and facilitators were sampled to reflect experience of virtual groups delivered via videoconference ('online'), face-to-face groups ('face-to-face') or both types of groups ('both'). Telephone qualitative interviews were conducted using a semi-structured interview guide. Interviews were audio-recorded, transcribed, and analysed using iterative categorisation. RESULTS Participant and facilitators discussed their experience across eight interconnected themes benefits were typically discussed with regard to the (1) availability, (2) ease of access and (3) value add of the chat feature in online groups. Challenges largely pertained to (1) in-group engagement, (2) group size, (3) non-verbal cues, (4) social interaction and (5) technology problems. The impact of these challenges on participant and facilitator experience varied, and neither modality was consistently identified as superior. CONCLUSIONS SMART Recovery mutual-help groups provided participants with another option for accessing mutual-help and appealed to different people under different circumstances. Depending on the needs and preferences of the individual, online SMART Recovery mutual-help groups may help to mitigate a range of barriers to help seeking and may also engage people otherwise unable or reluctant to engage in treatment. To inform training, practice and policy, improved understanding of the individual and contextual factors that enhance participant engagement, experience and outcomes is needed.
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Affiliation(s)
- Alison K Beck
- School of Psychology, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, NSW, Australia.
| | - Shifra Waks
- Discipline of Occupational Therapy, The University of Sydney, NSW, Australia
| | | | - Frank P Deane
- School of Psychology, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, NSW, Australia
| | - Briony Larance
- School of Psychology, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, NSW, Australia
| | - Victoria Manning
- Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Amanda L Baker
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, NSW, Australia
| | - Leanne Hides
- Centre for Youth Substance Abuse Research, Lives Lived Well Group, School of Psychology, University of Queensland, QLD, Australia
| | - Peter J Kelly
- School of Psychology, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, NSW, Australia
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26
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Perumalswami PV, Kilpatrick S, Frost MC, Adams MA, Kim HM, Zhang L, Lin L. The impact of COVID-19 on trends in alcohol use disorder treatment in Veterans Health Administration. Addiction 2023; 118:1062-1071. [PMID: 36738085 DOI: 10.1111/add.16156] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 01/17/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS The COVID-19 pandemic disrupted health-care provision in the United States and prompted increases in telehealth-delivery of care. This study measured alcohol use disorder (AUD) treatment trends across visit modalities before and during COVID-19. DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS We conducted a national, retrospective cohort study with interrupted time-series models to estimate the impact of COVID-19 on AUD treatment in the Veterans Health Administration (VHA) in the United States during pre-COVID-19 (March 2019 to February 2020) and COVID-19 (March 2020 to February 2021) periods. We analyzed monthly trends in telephone, video and in-person visits for AUD treatment and compared patient and treatment characteristics of patients receiving AUD treatment between the pre-COVID-19 and COVID-19 periods. AUD was defined using International Classification of Diseases, 10th revision (ICD-10) codes for alcohol abuse (F10.1) and alcohol dependence (F10.2), which have previously been used to study AUD in VHA. FINDINGS The predicted percentage of VHA patients with an AUD diagnosis receiving any AUD treatment at the beginning of the pre-COVID period was 13.8% (n = 49 494). The predicted percentage decreased by 4.3% (P = 0.001) immediately at the start of the COVID-19 period due to a decline in AUD psychotherapy. Despite an increase of 0.3% per month (P = 0.026) following the start of COVID-19, the predicted percentage of VHA patients with an AUD diagnosis receiving any AUD treatment at the end of the study period remained below the pre-COVID-19 period. In February 2021, AUD psychotherapy visits were primarily delivered by video (50%, 58 748), followed by in-person (36.6%, 43 251) and telephone (13.8%, 16 299), while AUD pharmacotherapy visits were delivered by telephone (38.9%, 3623) followed by in-person (34.3%, 3193) and video (26.8%, 2498) modalities. Characteristics of VHA patients receiving AUD treatment were largely similar between pre-COVID-19 and COVID-19 periods. CONCLUSIONS Despite increased telehealth use, the percentage of United States Veterans Health Administration patients with an alcohol use disorder (AUD) diagnosis receiving AUD treatment declined during COVID-19 (March 2020 to February 2021) mainly due to a decrease in psychotherapy.
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Affiliation(s)
- Ponni V Perumalswami
- Gastroenterology Section, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA
- VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
| | - Sidonie Kilpatrick
- VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Madeline C Frost
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
- Health Services Research and Development Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Megan A Adams
- Gastroenterology Section, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA
- VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Hyungjin Myra Kim
- VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Consulting for Statistics, Computing and Analytics Research (CSCAR), University of Michigan, Ann Arbor, MI, USA
| | - Lan Zhang
- VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Lewei Lin
- VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Consulting for Statistics, Computing and Analytics Research (CSCAR), University of Michigan, Ann Arbor, MI, USA
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27
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Palzes VA, Chi FW, Metz VE, Sterling S, Asyyed A, Ridout KK, Campbell CI. Overall and Telehealth Addiction Treatment Utilization by Age, Race, Ethnicity, and Socioeconomic Status in California After COVID-19 Policy Changes. JAMA HEALTH FORUM 2023; 4:e231018. [PMID: 37204804 PMCID: PMC10199344 DOI: 10.1001/jamahealthforum.2023.1018] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/21/2023] [Indexed: 05/20/2023] Open
Abstract
Importance Addiction treatment rapidly transitioned to a primarily telehealth modality (telephone and video) during the COVID-19 pandemic, raising concerns about disparities in utilization. Objective To examine whether there were differences in overall and telehealth addiction treatment utilization after telehealth policy changes during the COVID-19 pandemic by age, race, ethnicity, and socioeconomic status. Design, Setting, and Participants This cohort study examined electronic health record and claims data from Kaiser Permanente Northern California for adults (age ≥18 years) with drug use problems before the COVID-19 pandemic (from March 1, 2019, to December 31, 2019) and during the early phase of the COVID-19 pandemic (March 1, 2020, to December 31, 2020; hereafter referred to as COVID-19 onset). Analyses were conducted between March 2021 and March 2023. Exposure The expansion of telehealth services during COVID-19 onset. Main Outcomes and Measures Generalized estimating equation models were fit to compare addiction treatment utilization during COVID-19 onset with that before the COVID-19 pandemic. Utilization measures included the Healthcare Effectiveness Data and Information Set of treatment initiation and engagement (including inpatient, outpatient, and telehealth encounters or receipt of medication for opioid use disorder [OUD]), 12-week retention (days in treatment), and OUD pharmacotherapy retention. Telehealth treatment initiation and engagement were also examined. Differences in changes in utilization by age group, race, ethnicity, and socioeconomic status (SES) were examined. Results Among the 19 648 participants in the pre-COVID-19 cohort (58.5% male; mean [SD] age, 41.0 [17.5] years), 1.6% were American Indian or Alaska Native; 7.5%, Asian or Pacific Islander; 14.3%, Black; 20.8%, Latino or Hispanic; 53.4%, White; and 2.5%, unknown race. Among the 16 959 participants in the COVID-19 onset cohort (56.5% male; mean [SD] age, 38.9 [16.3] years), 1.6% were American Indian or Alaska Native; 7.4%, Asian or Pacific Islander; 14.6%, Black; 22.2%, Latino or Hispanic; 51.0%, White; and 3.2%, unknown race. Odds of overall treatment initiation increased from before the COVID-19 pandemic to COVID-19 onset for all age, race, ethnicity, and SES subgroups except for patients aged 50 years or older; patients aged 18 to 34 years had the greatest increases (adjusted odds ratio [aOR], 1.31; 95% CI, 1.22-1.40). Odds of telehealth treatment initiation increased for all patient subgroups without variation by race, ethnicity, or SES, although increases were greater for patients aged 18 to 34 years (aOR, 7.17; 95% CI, 6.24-8.24). Odds of overall treatment engagement increased (aOR, 1.13; 95% CI, 1.03-1.24) without variation by patient subgroups. Retention increased by 1.4 days (95% CI, 0.6-2.2 days), and OUD pharmacotherapy retention did not change (adjusted mean difference, -5.2 days; 95% CI, -12.7 to 2.4 days). Conclusions In this cohort study of insured adults with drug use problems, there were increases in overall and telehealth addiction treatment utilization after telehealth policies changed during the COVID-19 pandemic. There was no evidence that disparities were exacerbated, and younger adults may have particularly benefited from the transition to telehealth.
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Affiliation(s)
- Vanessa A. Palzes
- Center for Addiction and Mental Health Research, Division of Research, Kaiser Permanente Northern California, Oakland
| | - Felicia W. Chi
- Center for Addiction and Mental Health Research, Division of Research, Kaiser Permanente Northern California, Oakland
| | - Verena E. Metz
- Center for Addiction and Mental Health Research, Division of Research, Kaiser Permanente Northern California, Oakland
| | - Stacy Sterling
- Center for Addiction and Mental Health Research, Division of Research, Kaiser Permanente Northern California, Oakland
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | - Asma Asyyed
- Northern California Addiction Medicine and Recovery Services, The Permanente Medical Group, Inc, Santa Rosa
| | - Kathryn K. Ridout
- Center for Addiction and Mental Health Research, Division of Research, Kaiser Permanente Northern California, Oakland
- The Permanente Medical Group, Inc, Santa Rosa, California
| | - Cynthia I. Campbell
- Center for Addiction and Mental Health Research, Division of Research, Kaiser Permanente Northern California, Oakland
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
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Beck AK, Larance B, Baker AL, Deane FP, Manning V, Hides L, Kelly PJ. Supporting people affected by problematic alcohol, substance use and other behaviours under pandemic conditions: A pragmatic evaluation of how SMART recovery Australia responded to COVID-19. Addict Behav 2023; 139:107577. [PMID: 36528964 PMCID: PMC9741494 DOI: 10.1016/j.addbeh.2022.107577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/28/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The COVID-19 pandemic prompted rapid, reflexive transition from face-to-face to online healthcare. For group-based addiction services, evidence for the impact on service delivery and participant experience is limited. METHODS A 12-month (plus 2-month follow-up) pragmatic evaluation of the upscaling of online mutual-help groups by SMART Recovery Australia (SRAU) was conducted using The Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework. Data captured by SRAU between 1st July 2020 and 31st August 2021 included participant questionnaires, Zoom Data Analytics and administrative logs. RESULTS Reach: The number of online groups increased from just 6 pre-COVID-19 to 132. These groups were delivered on 2786 (M = 232.16, SD = 42.34 per month) occasions, to 41,752 (M = 3479.33, SD = 576.34) attendees. EFFECTIVENESS Participants (n = 1052) reported finding the online group meetings highly engaging and a positive, recovery supportive experience. 91 % of people with experience of face-to-face group meetings rated their online experience as equivalent or better. Adoption: Eleven services (including SRAU) and five volunteers delivered group meetings for the entire 12-months. IMPLEMENTATION SRAU surpassed their goal of establishing 100 groups. Maintenance: The average number of meetings delivered [t(11.14) = -1.45, p = 0.1737] and attendees [t(1.95) = -3.28, p = 0.1880] per month were maintained across a two-month follow-up period. CONCLUSIONS SRAU scaled-up the delivery of online mutual-help groups in response to the COVID-19 pandemic. Findings support the accessibility, acceptability and sustainability of delivering SMART Recovery mutual-help groups online. Not only are these findings important in light of the global pandemic and public safety, but they demonstrate the potential for reaching and supporting difficult and under-served populations.
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Affiliation(s)
- Alison K Beck
- School of Psychology, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Australia.
| | - Briony Larance
- School of Psychology, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Australia.
| | - Amanda L Baker
- School of Medicine and Public Health, University of Newcastle, Australia.
| | - Frank P Deane
- School of Psychology, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Australia.
| | - Victoria Manning
- Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia.
| | - Leanne Hides
- Centre for Youth Substance Abuse Research, Lives Lived Well Group, School of Psychology, University of Queensland, Australia.
| | - Peter J Kelly
- School of Psychology, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Australia.
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Hallgren KA, Galloway GP, Witkiewitz K, Linde P, Nix B, Mendelson JE. Treatment retention and reductions in blood alcohol concentration (BAC) during the first 90 days of a telehealth program for alcohol use disorder. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2023; 49:249-259. [PMID: 36881813 DOI: 10.1080/00952990.2023.2175322] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Background: Alcohol use disorder (AUD) treatments, including medications, are increasingly offered via telehealth.Objective: This study characterizes 90-day treatment retention and changes in objectively measured blood alcohol concentration (BAC) in a large cohort receiving AUD telehealth.Methods: Patients received AUD treatment through Ria, a virtual (telehealth) program offering AUD treatment that is tailored to patient goals (e.g. abstinence or controlled drinking). Patients were encouraged to complete breathalyzer readings twice daily for measurement-based care. We characterized rates of 90-day treatment retention (i.e. completing a BAC reading or medical/coaching encounter on the 90th day or later) and used growth curve analyses to model changes in daily estimated peak BAC over 90 days.Results: Of 4121 patients (51.5% women), 50.1% had 90-day treatment retention (n = 2066, 52.2% women). Most patients received prescriptions for AUD medications (84.6%) and completed encounters with medical providers (86.7%) and coaches (86.1%). Patients with 90-day retention provided 184,817 BAC readings in the first 90 days. Growth curve analyses revealed significant reductions in daily estimated peak BAC (p < .001) from a mean of 0.092 (day 1) to 0.038 (day 90). Similar magnitudes of BAC reduction were observed for men and women and for patients with abstinence and controlled drinking goals.Conclusion: Telehealth appears to be a viable approach to delivering AUD treatments in a manner that promotes drinking reductions. Telehealth approaches can yield reductions in objectively measured BAC, including for some patient subgroups that have historically faced greater stigma in AUD treatment settings, such as women and people with non-abstinence drinking goals.
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Affiliation(s)
- Kevin A Hallgren
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA USA
| | | | - Katie Witkiewitz
- Department of Psychology and Center on Alcohol, Substance Use, And Addictions, University of New Mexico, Albuquerque, NM, USA
| | | | - Bob Nix
- Ria Health, San Francisco, CA
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Tauscher JS, DePue MK, Swank J, Salloum RG. Determinants of preference for telehealth versus in-person treatment for substance use disorders: A discrete choice experiment. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 146:208938. [PMID: 36880898 DOI: 10.1016/j.josat.2022.208938] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 09/06/2022] [Accepted: 12/30/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Access to substance use disorder (SUD) treatment remains a significant issue in the United States. Telehealth has potential for increasing access to services; however, it is underutilized in SUD treatment compared to mental health treatment. This study uses a discrete choice experiment (DCE) to examine stated preferences for telehealth (videoconferencing, text-based + video, text only) versus in-person SUD treatment (community-based, in-home) and the attributes (location, cost, therapist choice, wait time, evidence-based practices) most important when choosing between modalities. Subgroup analyses are reported about preference differences based on type of substance and substance use severity. METHODS Four hundred participants completed a survey containing a DCE with eighteen choice sets, the alcohol use disorders inventory test, drug abuse screening test, and a brief demographic questionnaire. The study collected data between April 15, 2020, and April 22, 2020. Conditional logit regression provided a measure of strength for participant preferences for technology-assisted treatment compared to in-person care. The study provides willingness to pay estimates as a real-world measure for the importance of each attribute in participants' decision-making. RESULTS Telehealth options that include a video conference option were equally preferrable to in-person care modalities. Text-only treatment was significantly less preferable to all other modalities of care. The ability to choose one's own therapist was a significant driver of treatment preference beyond modality, while wait time did not appear significant in making decisions. Participants with the most severe substance use differed in that they were open to text-based care without video conferencing, did not express a preference for evidence-based care, and valued therapist choice significantly more than those with only moderate substance use. CONCLUSIONS Telehealth for SUD treatment is equally preferable to in-person care offered in the community or at home, signifying preference is not a barrier for utilization. Text-only modalities may be enhanced by offering videoconference options for most individuals. Individuals with the most severe substance use issues may be willing to engage in text-based support without synchronous meetings with a provider. This approach may offer a less intensive method to engage individuals in treatment who may not otherwise access services.
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Affiliation(s)
- Justin S Tauscher
- BRiTE Center, Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, USA; School of Human Development and Organizational Studies, College of Education, University of Florida, Gainesville, FL, USA.
| | - M Kristina DePue
- Department of Human Development, Family Science, and Counseling, University of Nevada- Reno, Reno, NV, USA; School of Human Development and Organizational Studies, College of Education, University of Florida, Gainesville, FL, USA.
| | - Jacqueline Swank
- School of Human Development and Organizational Studies, College of Education, University of Florida, Gainesville, FL, USA; Department of Educational, School, and counseling Psychology, College of Education & Human Development, University of Missouri, Columbia, MO, USA.
| | - Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA.
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Abidogun TM, Cole TO, Massey E, Kleinman M, Greenblatt AD, Seitz-Brown CJ, Magidson JF, Belcher AM. Patient experiences of COVID-19-induced changes to methadone treatment in a large community-based opioid treatment program in Baltimore. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 145:208946. [PMID: 36880915 PMCID: PMC9822549 DOI: 10.1016/j.josat.2022.208946] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/05/2022] [Accepted: 12/30/2022] [Indexed: 04/13/2023]
Abstract
INTRODUCTION Following the March 2020 federal declaration of a COVID-19 public health emergency, in line with recommendations for social distancing and decreased congregation, federal agencies issued sweeping regulation changes to facilitate access to medications for opioid use disorder (MOUD) treatment. These changes allowed patients new to treatment to receive multiple days of take-home medications (THM) and to use remote technology for treatment encounters-allowances that previously had been reserved exclusively for "stable" patients who met minimum adherence and time-in-treatment criteria. The impact of these changes on low-income, minoritized patients (frequently the largest recipients of opioid treatment program [OTP]-based addiction care), however, is not well characterized. We aimed to explore the experiences of patients who were enrolled in treatment prior to COVID-19 OTP regulation changes, with the goal of understanding patients' perceptions of the impact of these changes on treatment. METHODS This study included semistructured, qualitative interviews with 28 patients. We used a purposeful sampling method to recruit individuals who were active in treatment just before COVID-19-related policy changes went into effect, and who were still in treatment several months later. To ensure a diverse array of perspectives, we interviewed individuals who either had or had not experienced challenges with methadone medication adherence from 3/24/21 to 6/8/21, approximately 12-15 months following the onset of COVID-19. Interviews were transcribed and coded using thematic analysis. RESULTS Participants were majority male (57 %), Black/African American (57 %), with a mean age of 50.1 (SD = 9.3). Fifty percent received THM prior to COVID-19, which increased to 93 % during the pandemic. COVID-19 program changes had mixed effects on treatment and recovery experiences. Themes identified convenience, safety, and employment as reasons for preferring THM. Challenges included difficulty with managing/storing medications, experiencing isolation, and concern about relapse. Furthermore, some participants reported that telebehavioral health encounters felt less personal. CONCLUSIONS Policymakers should consider patients' perspectives to foster a more patient-centered approach to methadone dosing that is safe, flexible, and accommodating to a diverse array of patients' needs. Additionally, technical support should be provided to OTPs to ensure interpersonal connections are maintained in the patient-provider relationship beyond the pandemic.
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Affiliation(s)
- Tolulope M Abidogun
- Department of Psychology, University of Maryland, College Park, United States of America
| | - Thomas O Cole
- Division of Addiction Research and Treatment, Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, United States of America
| | - Ebonie Massey
- Department of Psychology, University of Maryland, College Park, United States of America
| | - Mary Kleinman
- Department of Psychology, University of Maryland, College Park, United States of America
| | - Aaron D Greenblatt
- Division of Addiction Research and Treatment, Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, United States of America
| | - C J Seitz-Brown
- Department of Psychology, University of Maryland, College Park, United States of America
| | - Jessica F Magidson
- Department of Psychology, University of Maryland, College Park, United States of America
| | - Annabelle M Belcher
- Division of Addiction Research and Treatment, Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, United States of America.
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Sistad RE, Enggasser J, Livingston NA, Brief D. Comparing substance use treatment initiation and retention between telehealth delivered during COVID-19 and in-person treatment pre-COVID-19. Am J Addict 2023; 32:301-308. [PMID: 36645267 DOI: 10.1111/ajad.13385] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/19/2022] [Accepted: 12/24/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND AND OBJECTIVES A large portion of veterans referred to substance use disorder (SUD) treatment do not attend their first appointment or leave treatment prematurely. Telehealth options may increase access to care and treatment attendance. This study compared treatment initiation and retention between in-person treatment pre-COVID-19 and telehealth treatment during COVID-19 in a VA hospital outpatient alcohol and drug treatment clinic. METHODS Electronic health record data were collected on 373 veterans out of 481 referrals. Mixed logistic and negative binomial regression models were used for estimating the effect of treatment modality on treatment initiation and retention, respectively. RESULTS The odds of initiating treatment were 2.6 times greater when referred to a telehealth appointment during COVID-19 compared to an in-person appointment pre-COVID-19. Months retained in treatment postinitiation was similar between treatment modalities. Each month in treatment corresponded to a subsequently lower rate of treatment session attendance and by the fourth month, the average number of sessions attended was significantly lower for those receiving in-person treatment compared to those receiving telehealth treatment. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE The odds of initiating SUD treatment and rate of treatment attendance over time was greater for services delivered via telehealth during COVID-19 compared to in-person pre-COVID-19. Extending telehealth services as an option for individual and group SUD treatment may promote treatment initiation and potentially higher rate of attendance over time. This study provides additional evidence for the feasibility and utility of rapidly expanding telehealth for veterans seeking outpatient substance use treatment.
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Affiliation(s)
- Rebecca E Sistad
- U.S. Department of Veteran Affairs, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Massachusetts, Boston, USA
| | - Justin Enggasser
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Massachusetts, Boston, USA.,Pear Therapeutics, Boston, Massachusetts, USA
| | - Nicholas A Livingston
- U.S. Department of Veteran Affairs, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Massachusetts, Boston, USA.,Behavioral Science Division, National Center for PTSD, Massachusetts, Boston, USA
| | - Deborah Brief
- U.S. Department of Veteran Affairs, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Massachusetts, Boston, USA
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Fouad AA, Osman MA, Abdelmonaem YMM, Karim NAHA. Awareness, knowledge, attitude, and skills of telemedicine among mental healthcare providers. MIDDLE EAST CURRENT PSYCHIATRY, AIN SHAMS UNIVERSITY 2023; 30:5. [PMCID: PMC9832399 DOI: 10.1186/s43045-022-00272-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background Telemedicine plays a vital role in patient-centered healthcare delivery in the diagnosis, management, and development of future treatment plans for chronic diseases. Results This study revealed that attitude toward telemedicine was high among the studied mental healthcare providers, while it was average among the other studied variables (awareness, knowledge, and skills). Psychiatrists had a high percentage in the studied variables (awareness, attitude, knowledge, and skills). There were statistically significant differences in the dimensions of the telemedicine questionnaire according to age, profession, and academic degree. There was a statistically significant relation between the levels of awareness, knowledge, and attitude toward telemedicine. Conclusions This study concluded that the studied mental healthcare providers had high attitudes while the other studied variables (awareness, knowledge, and skills) were average. Psychiatrists had a high percentage in the studied variables (awareness, attitude, knowledge, and skills), followed by psychologists, while nurses had the lowest level in all studied variables.
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Affiliation(s)
- Amira Ahmed Fouad
- grid.31451.320000 0001 2158 2757Professor of Psychiatry, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mahmood Ahmed Osman
- grid.31451.320000 0001 2158 2757Bachelor of Nursing, Faculty of Nursing, Zagazig University, Zagazig, Egypt
| | | | - Nashwa Ahmed Hussein Abdel Karim
- grid.31451.320000 0001 2158 2757Lecturer of Psychiatric and Mental Health Nursing Department, Faculty of Nursing, Zagazig University, Zagazig, Egypt
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A cohort study examining changes in treatment patterns for alcohol use disorder among commercially insured adults in the United States during the COVID-19 pandemic. J Subst Abuse Treat 2023; 144:108920. [PMID: 36334384 PMCID: PMC9613781 DOI: 10.1016/j.jsat.2022.108920] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 08/15/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION We know very little about how the pandemic impacted outpatient alcohol use disorder (AUD) care and the role of telemedicine. METHODS Using OptumLabs® Data Warehouse de-identified administrative claims, we identified AUD cohorts in 2018 (N = 23,204) and 2019 (N = 23,445) and examined outpatient visits the following year, focusing on week 12, corresponding to the March 2020 US COVID-19 emergency declaration, through week 52. Using multivariable logistic regression, we examined the association between patient demographic and clinical characteristics and receipt of any outpatient AUD visits in 2020 vs. 2019. RESULTS In 2020, weekly AUD visit utilization decreased maximally at the pandemic start (week 12) by 22.5 % (2019: 3.8 %, 2020: 3.0 %, percentage point change [95 % CI] = -0.86[-1.19, -0.05]) but was similar to 2019 utilization by mid-April 2020 (week 16). Telemedicine accounted for 50.1 % of AUD visits by early July 2020 (week 27). Individual therapy returned to 2019 levels within 1 week (i.e., week 13) whereas group therapy did not consistently do so until mid-August 2020 (week 31). Further, individual therapy exceeded 2019 levels by as much as 50 % starting mid-October 2020. The study found no substantial differences in visits by patient demographic or clinical characteristics. CONCLUSIONS Among patients with known AUD, initial outpatient care disruptions were relatively brief. However, substantial shifts occurred in care delivery-an embrace of telemedicine but also more pronounced, longer disruptions in group therapy vs. individual and an increase in individual therapy use. Further research needs to help us understand the implications of these findings for clinical outcomes.
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Telemedicine along the cascade of care for substance use disorders during the COVID-19 pandemic in the United States. Drug Alcohol Depend 2023; 242:109711. [PMID: 36462230 PMCID: PMC9683518 DOI: 10.1016/j.drugalcdep.2022.109711] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/18/2022] [Accepted: 11/19/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The COVID-19 pandemic has changed the landscape of healthcare service delivery. This review aims to describe telemedicine-delivered substance use disorder (SUD) treatments and services along the cascade of care in the U.S. after the start of the COVID-19 pandemic. METHODS A literature review was conducted on PubMed, Embase, Web of Science, and Cochrane Library (Wiley). English-language articles that describe any healthcare services for patients with SUDs using telemedicine in the U.S. since the onset of the COVID-19 pandemic were identified (N = 33). We narratively summarized telemedicine-based service provision along the cascade of SUD care, such as screening/assessment, prescription, monitoring, recovery support, and other services. RESULTS Soon after the onset of COVID-19 and mandated restrictions, cadres of healthcare providers from different specialties mobilized to ramp up video- and audio-based services to remotely treat patients with SUDs. Medication prescription (48.5%) and individual counseling (39.4%) were the most frequently reported services delivered via telemedicine. Other steps of SUD care delivered by telemedicine characterized in our review included SUD screening and assessment (30.3%), induction (21.2%), medication management (27.3%), monitoring (27.3%), recovery support (15.2%), and referral (24.2%). Feasibility issues and challenges to implementing telemedicine included patients' lack of access to technology and health insurance coverage, providers' capacity limits and concerns, and clinics' financial and office-space constraints. CONCLUSION The COVID-19 pandemic has offered a window of opportunity to advance telemedicine expertise by formalizing clinical guidance and routinizing provider in-service training in virtual SUD treatment. Findings suggest enhanced efforts to reduce disparities in telemedicine-based services.
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Palzes VA, Chi FW, Metz VE, Campbell C, Corriveau C, Sterling S. COVID-19 pandemic-related changes in utilization of telehealth and treatment overall for alcohol use problems. Alcohol Clin Exp Res 2022; 46:2280-2291. [PMID: 36527427 PMCID: PMC9877854 DOI: 10.1111/acer.14961] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/07/2022] [Accepted: 10/14/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND During the COVID-19 pandemic, specialty alcohol treatment transitioned rapidly to telehealth, which may have created barriers for some patients but increased access for others. This study evaluated the impact of the COVID-19 pandemic on alcohol treatment utilization and potential disparities. METHODS We analyzed electronic health record and claims data from Kaiser Permanente Northern California for adults with alcohol use problems (alcohol use disorder or unhealthy alcohol use diagnoses) during pre-COVID-19 (March to December 2019, n = 32,806) and COVID-19 onset (March to December 2020, n = 26,763). Generalized estimating equation models were fit to examine pre-COVID-19 to COVID-19 onset changes in alcohol treatment initiation, engagement, and retention (days in treatment). Heterogeneity in pre-COVID-19 to COVID-19 onset changes in treatment utilization by age, race, and ethnicity; neighborhood deprivation index (NDI); and comorbid medical and psychiatric disorders were also examined. RESULTS Treatment initiation increased during the COVID-19 onset period (adjusted odds ratio [aOR] = 1.46; 95% CI = 1.41-1.52). The increases in odds of treatment initiation during the COVID-19 onset period compared with the pre-COVID period were largest among patients aged 18-34 years (aOR = 1.59; 95% CI = 1.48-1.71), those without medical conditions (aOR = 1.56; 95% CI = 1.49-1.65), and those without psychiatric disorders (aOR = 1.60; 95% CI = 1.51-1.69). Patients aged 18-34 years (aOR = 5.21; 95% CI = 4.67-5.81), those with the second highest NDIs (aOR = 4.63; 95% CI = 4.12-5.19), and those without medical (aOR = 4.34; 95% CI = 4.06-4.65) or psychiatric comorbidities (aOR = 4.48; 95% CI = 4.11-4.89) had the greatest increases in telehealth treatment initiation from pre-COVID-19 to COVID-19 onset. Treatment engagement and retention also increased during COVID-19 onset, with the greatest increase among patients aged 35-49 years who initiated treatment via telehealth (engagement: aOR = 2.33; 95% CI = 1.91-2.83; retention: adjusted mean difference [aMD] = 3.3 days; 95% CI = 2.6-4.1). We found no significant variation of changes in treatment utilization by race and ethnicity. CONCLUSIONS The transition to telehealth in this healthcare system may have attracted subgroups of individuals who have historically underutilized care for alcohol use problems, particularly younger and healthier adults, without exacerbating pre-pandemic racial and ethnic disparities in treatment utilization.
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Affiliation(s)
- Vanessa A. Palzes
- Center for Addiction and Mental Health Research, Division of ResearchKaiser Permanente Northern CaliforniaOaklandCaliforniaUSA
| | - Felicia W. Chi
- Center for Addiction and Mental Health Research, Division of ResearchKaiser Permanente Northern CaliforniaOaklandCaliforniaUSA
| | - Verena E. Metz
- Center for Addiction and Mental Health Research, Division of ResearchKaiser Permanente Northern CaliforniaOaklandCaliforniaUSA
| | - Cynthia Campbell
- Center for Addiction and Mental Health Research, Division of ResearchKaiser Permanente Northern CaliforniaOaklandCaliforniaUSA
- Department of Psychiatry and Behavioral SciencesWeill Institute for Neurosciences, University of California, San FranciscoSan FranciscoCaliforniaUSA
- Department of Health Systems ScienceKaiser Permanente Bernard J. Tyson School of MedicinePasadenaCaliforniaUSA
| | - Caroline Corriveau
- The Permanente Medical GroupAddiction Medicine and Recovery ServicesOaklandCaliforniaUSA
| | - Stacy Sterling
- Center for Addiction and Mental Health Research, Division of ResearchKaiser Permanente Northern CaliforniaOaklandCaliforniaUSA
- Department of Psychiatry and Behavioral SciencesWeill Institute for Neurosciences, University of California, San FranciscoSan FranciscoCaliforniaUSA
- Department of Health Systems ScienceKaiser Permanente Bernard J. Tyson School of MedicinePasadenaCaliforniaUSA
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Palmer CS, Brown Levey SM, Kostiuk M, Zisner AR, Tolle LW, Richey RM, Callan S. Virtual Care for Behavioral Health Conditions. Prim Care 2022; 49:641-657. [PMID: 36357068 PMCID: PMC9581698 DOI: 10.1016/j.pop.2022.04.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The COVID-19 pandemic has highlighted the urgent need for behavioral health care services. A substantial portion of mental health care transitioned to virtual care during the COVID-19 pandemic, remains virtual today, and will continue that way in the future. Mental health needs continue to grow, and there has been growing evidence showing the efficacy of virtual health for behavioral health conditions at the system, provider, and patient level. There is also a growing understanding of the barriers and challenges to virtual behavioral health care.
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Affiliation(s)
- Christina S Palmer
- Department of Family Medicine, University of Colorado School of Medicine.
| | | | | | - Aimee R Zisner
- Department of Family Medicine, University of Colorado School of Medicine
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Bean CAL, Aurora P, Maddox CJ, Mekota R, Updegraff A. A comparison of telehealth versus in-person group therapy: Results from a DBT-based dual diagnosis IOP. J Clin Psychol 2022; 78:2073-2086. [PMID: 35531794 PMCID: PMC9790325 DOI: 10.1002/jclp.23374] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 04/20/2022] [Accepted: 04/27/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The effectiveness of remotely delivered group interventions and treatments for individuals with more complex psychiatric presentations is understudied. Nevertheless, the emergence of the COVID-19 pandemic shifted such treatments from in-person to remote service delivery without the establishment of comparable effectiveness between in-person and remote delivery. The current study presents the results of a private practice's transition from in-person treatment delivery to a videoconference-delivered Dialectical Behavior Therapy (DBT)-based intensive outpatient program (IOP) for individuals with comorbid mental health and substance use disorder diagnoses in response to the pandemic. METHODS Change in symptoms of depression, anxiety, and stress following completion of the IOP was compared between the in-person and videoconference groups. RESULTS Large reductions in symptoms were found following completion of the IOP for both the in-person and videoconference groups. Furthermore, no significant differences in symptom reduction were found between the groups. CONCLUSION Although large-scale replication is needed, these results suggest that IOPs and other intensive group therapies delivered via videoconference may be as effective as in-person therapies, even among individuals with more complex psychiatric presentations. Providers who have transitioned group therapies to videoconference formats or are considering creating remote groups can be more confident that they are not sacrificing treatment efficacy.
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Affiliation(s)
| | - Pallavi Aurora
- Department of Psychological SciencesKent State UniversityKentOhioUSA
| | | | | | - Alanna Updegraff
- Department of Psychological SciencesKent State UniversityKentOhioUSA
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McCarthy JM, Wood AJ, Shinners MG, Heinrich H, Weiss RD, Mueser KT, Meyers RJ, Carol EE, Hudson JI, Öngür D. Pilot development and feasibility of telehealth Community Reinforcement and Family Training (CRAFT) for early psychosis and substance use. Psychiatry Res 2022; 317:114804. [PMID: 36030701 PMCID: PMC10127150 DOI: 10.1016/j.psychres.2022.114804] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 10/31/2022]
Abstract
Substance use is associated with poor outcomes for individuals with early psychosis. Community Reinforcement and Family Training (CRAFT) is an evidence-based approach that helps families to reduce substance use, engage in treatment, and improve family wellbeing, but it has not yet been studied for psychosis and substance use. The present study aimed to develop and evaluate a telehealth intervention utilizing CRAFT for families experiencing early psychosis and substance use. Twenty family members completed six to eight telehealth sessions of CRAFT adapted for early psychosis (CRAFT-EP). Participants completed an assessment battery at baseline, mid- and post-intervention, a three-month follow-up, surveys after each session, and a focus group to measure mean percentage of sessions completed, mean program satisfaction ratings, telehealth preference, and qualitative feedback. Participants had 100% session completion, and program satisfaction was at or near excellent for 99% of sessions. Half of participants preferred a primarily virtual hybrid program, whereas 45% preferred exclusively virtual visits. Communication was the most helpful topic, and participants requested additional written examples and resources. CRAFT-EP is feasible and acceptable to serve as the active intervention in a pilot randomized controlled trial comparing treatment as usual plus CRAFT-EP to treatment as usual.
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Affiliation(s)
- Julie M McCarthy
- Division of Psychotic Disorders, McLean Hospital, 115 Mill St., Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Andrea J Wood
- Division of Psychotic Disorders, McLean Hospital, 115 Mill St., Belmont, MA 02478, USA
| | - M Grace Shinners
- Division of Psychotic Disorders, McLean Hospital, 115 Mill St., Belmont, MA 02478, USA
| | - Hadley Heinrich
- Division of Psychotic Disorders, McLean Hospital, 115 Mill St., Belmont, MA 02478, USA
| | - Roger D Weiss
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, MA, USA
| | - Kim T Mueser
- Center for Psychiatric Rehabilitation, Departments of Occupational Therapy and Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Robert J Meyers
- Center on Alcoholism, Substance Abuse and Addiction, University of New, Albuquerque, NM, USA
| | - Emily E Carol
- Division of Psychotic Disorders, McLean Hospital, 115 Mill St., Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - James I Hudson
- Division of Psychotic Disorders, McLean Hospital, 115 Mill St., Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Dost Öngür
- Division of Psychotic Disorders, McLean Hospital, 115 Mill St., Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Inpatient care provider perspectives on the development and implementation of an addiction medicine consultation service in a small urban setting. Subst Abuse Treat Prev Policy 2022; 17:70. [PMID: 36303182 PMCID: PMC9612624 DOI: 10.1186/s13011-022-00497-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND To evaluate provider perspectives on the development and implementation of an inpatient Addiction Medicine Consult Service, including their awareness of the service, its perceived role in the continuum of care, and changes over time in their perceptions of care quality for inpatients with substance use disorders. METHODS Repeated cross-sectional survey of hospital-based physicians, nurses and social workers performed at service launch (April-June, 2017) and 4 years later (March-June, 2021). RESULTS Providers had generally positive perceptions of the service and its impact on care quality, but encountered significant barriers at both time points in meeting patient needs (related to high patient complexity and difficulty connecting patients with community services post-discharge). Relative to physicians and social workers, nurses were less likely to be familiar with the service or see it as beneficial. CONCLUSIONS Findings indicate that the service fills a gap that existed previously in the local system of care; however, numerous opportunities exist to further strengthen the system beyond the hospital setting to promote longer-term health among people who use substances. For nurses in particular, outreach, education, and other resources (e.g., dedicated nursing role support, nurse liaison) are warranted to ensure that nurses feel supported and confident caring for this patient population.
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Kosonen J, Ekqvist E, Kuusisto K. Reducing Problematic Substance Use under Exceptional Circumstances-Effects of the COVID-19 Restrictions on Inpatient Substance Use Disorder Treatment in Finland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11436. [PMID: 36141708 PMCID: PMC9517332 DOI: 10.3390/ijerph191811436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/03/2022] [Accepted: 09/05/2022] [Indexed: 06/16/2023]
Abstract
The COVID-19 pandemic has affected people's daily lives on multiple levels. At highest risk are the most vulnerable members of the society, whose lives were already affected by various risks even before the pandemic. This study investigates how clients in inpatient substance use disorder treatment experienced the COVID-19 restrictions and their influence on recovery. The research data consists of six focus group interviews conducted remotely using a semi-structured thematic interview method. The focus group clients (N = 19) were currently in inpatient substance abuse treatment during the pandemic and the ensuring restrictions. The data were analyzed using qualitative content analysis. The results show that the COVID-19 restrictions have influenced the clients' desistance processes throughout the pandemic. The restrictions seemed to exacerbate substance abuse problems before treatment initiation and highlight the importance of peer support during treatment. Moreover, the restrictions seemed to change the function and hamper the management of social capital, raise concerns about returning home, as well as intensifying the inter-municipal segregation of services. To conclude, attention should be paid to facilitating and ensuring informal support and managing social capital. In light of this study, it seems necessary to explore the social conditions among clients in inpatient substance abuse treatment during the pandemic.
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42
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Bosse JD, Hoffman K, Wiest K, Todd Korthuis P, Petluri R, Pertl K, Martin SA. Patient evaluation of a smartphone application for telehealth care of opioid use disorder. Addict Sci Clin Pract 2022; 17:50. [PMID: 36085078 PMCID: PMC9462609 DOI: 10.1186/s13722-022-00331-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 08/17/2022] [Indexed: 11/10/2022] Open
Abstract
Background People with opioid use disorder (OUD) face barriers to entering and remaining in life-saving treatment (e.g., stigma, detrimental interactions with health care, and privacy concerns). Telehealth and related technology can reduce barriers to entering and staying in care. Patient feedback is critical to the development of these newer treatment approaches to ensure they are usable and do not inadvertently recreate treatment barriers. Purpose Evaluate the perceived usability of existing and planned features of a mobile application (app) that facilitates delivery of OUD treatment via telehealth. Methods People with current or prior experience with OUD treatment were eligible for the study. Participants (n = 31; 55% women) provided feedback on an interactive prototype demonstration via individual qualitative interviews and completed a quantitative survey on the app’s perceived usability. Descriptive statistics summarized the usability survey. We analyzed qualitative interview transcripts to elicit common themes. Results Participants were primarily white (77%) with a mean age of 42.2 years (range 22–69). Participants rated the six major features of the current app as helpful (median response 5 out of 5) and appreciated the flexibility of conducting a visit from a place of their choosing. Participants regarded the five proposed components of the app, such as daily affirmations and medication treatment-related reminders (e.g., pick up medication at pharmacy, medication schedule), as useful features with medians 5 out of 5, and reported they would recommend the app to others for OUD care. Participant qualitative interviews provided additional information on perceived usability of existing and proposed app features. Conclusion Our study suggests that an appealing, easy-to-use app—with tools and features that effectively support care—could circumvent existing barriers and foster sustained recovery. Supplementary Information The online version contains supplementary material available at 10.1186/s13722-022-00331-4.
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Abstract
PURPOSE OF REVIEW The purpose of this update is to provide an overview of recent research publications (January 2020-January 2022) on real-time telemedicine solutions for the management of addictions (alcohol, tobacco, opioids, and other drugs). RECENT FINDINGS Motivational interviewing by real-time telemedicine showed effectiveness in youth and adults for risky alcohol use and alcohol use disorders, even when a concurrent mental health disorder exists. Live telemedicine is well accepted for managing tobacco use disorders. The range of interventions for treating opioid use disorder by real-time telemedicine is large and has been increased due to the coronavirus disease 2019 (COVID-19) pandemic (prescription of opioid agonists, peer-to-peer support, counseling, and group therapy). SUMMARY The COVID-19 pandemic has accelerated the implementation of real-time telemedicine and, in parallel, research has been conducted to test its effectiveness. Videoconferencing and telephone interventions are supported by solid evidence for risky alcohol use and alcohol use disorder, tobacco use disorder and opioid use disorder. The Integration of other types of telemedicine (asynchronous telemedicine and remote monitoring) and with the entire health system is lacking. Many areas and vulnerable populations (e.g., homeless, elderly, and cannabis use disorders) need more attention.
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Dickson-Gomez J, Weeks M, Green D, Boutouis S, Galletly C, Christenson E. Insurance barriers to substance use disorder treatment after passage of mental health and addiction parity laws and the affordable care act: A qualitative analysis. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 3:100051. [PMID: 36845978 PMCID: PMC9948907 DOI: 10.1016/j.dadr.2022.100051] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 03/24/2022] [Accepted: 03/28/2022] [Indexed: 11/18/2022]
Abstract
Introduction People who use drugs (PWUDs) in the United States historically have had a higher probability of being uninsured. Passage of the Affordable Care Act, the Paul Wellstone and Pete Domenici Health Parity and Addiction Equity was expected to increase access to treatment for substance use disorder. Few studies to date have conducted qualitative research with substance use disorder (SUD) treatment providers regarding Medicaid and other insurance coverage of SUD treatment following passage of the ACA and parity laws. The present paper fills this gap by reporting data from in-depth interviews with treatment providers from three states, Connecticut, Kentucky, and Wisconsin, that differ in implementation of the ACA. Methods Study teams in each state conducted in-depth, semi-structured interviews with key informants who provided SUD treatment, including providers of behavioral health residential or outpatient programs, office-based buprenorphine providers and opioid treatment programs [OTP, i.e. methadone clinics] (n = 24 in Connecticut, n = 63 in Kentucky and n = 63 in Wisconsin). Key informants were asked for their perceptions on how Medicaid and private insurance facilitates or limits access to drug treatment. All interviews were transcribed verbatim and analyzed for key themes using MAXQDA software using a collaborative approach. Results Results from this study suggest that the promise of the ACA and parity laws to increase access to SUD treatment has only partially been realized. There is wide variation among the three states' Medicaid programs and among private insurance in the types of SUD treatment that is covered. Neither Kentucky's nor Connecticut's Medicaid covered methadone. Wisconsin Medicaid did not cover residential or intensive outpatient treatment. Thus, none of the states studied here provided all levels of care that the ASAM recommends for treating SUD. Further, there were several quantitative limits placed on SUD treatment such as number of urine drug screens or visits allowed. Providers complained that many treatments required prior authorizations, including MOUD like buprenorphine. Conclusions More reform is needed to make SUD treatment accessible to all who need it. Such reforms should consider defining standards for opioid use disorder treatment with reference to evidence-based practices, not be attempting parity with an arbitrarily defined medical standard.
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Affiliation(s)
- Julia Dickson-Gomez
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Margaret Weeks
- Institute for Community Research, Hartford, CT, United States
| | - Danielle Green
- Institute for Community Research, Hartford, CT, United States
| | - Sophie Boutouis
- Department of Psychology, University of Texas, Dallas, United States
| | - Carol Galletly
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Erika Christenson
- Center of Excellence in Women's Health, Boston Medical Center, BUSM, New England
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45
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Lockard R, Priest KC, Gregg J, Buchheit BM. A qualitative study of patient experiences with telemedicine opioid use disorder treatment during COVID-19. Subst Abus 2022; 43:1150-1157. [DOI: 10.1080/08897077.2022.2060447] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Rachel Lockard
- School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Kelsey C. Priest
- Department of Psychiatry, University of Pittsburgh, Pittsburg, PA, USA
| | | | - Bradley M. Buchheit
- Division of General Internal Medicine & Geriatrics, Section of Addiction Medicine, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
- OHSU Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
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46
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Barton RM, Meader LC, Simpson TL, Greenfield SF. An Adaptation of the Women’s Recovery Group for women veterans with substance use disorders: a quality improvement project. ALCOHOLISM TREATMENT QUARTERLY 2022. [DOI: 10.1080/07347324.2022.2068396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Rebekah M. Barton
- Addiction Treatment Center, VA Puget Sound Healthcare, Seattle, Washington, USA
| | - Laura C. Meader
- Addiction Treatment Center, VA Puget Sound Healthcare, Seattle, Washington, USA
| | - Tracy L. Simpson
- Addiction Treatment Center, Center of Excellence in Substance Addiction Treatment & Education, Puget Sound, Washington, USA
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Shelly F. Greenfield
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Division of Alcohol Drugs and Addiction, McLean Hospital, Belmont, Massachusetts, USA
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47
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Gliske K, Welsh JW, Braughton JE, Waller LA, Ngo QM. Telehealth Services for Substance Use Disorders During the COVID-19 Pandemic: Longitudinal Assessment of Intensive Outpatient Programming and Data Collection Practices. JMIR Ment Health 2022; 9:e36263. [PMID: 35285807 PMCID: PMC8923149 DOI: 10.2196/36263] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/04/2022] [Accepted: 02/04/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The onset of the COVID-19 pandemic necessitated the rapid transition of many types of substance use disorder (SUD) treatments to telehealth formats, despite limited information about what makes treatment effective in this novel format. OBJECTIVE This study aims to examine the feasibility and effectiveness of virtual intensive outpatient programming (IOP) treatment for SUD in the context of a global pandemic, while considering the unique challenges posed to data collection during an unprecedented public health crisis. METHODS The study is based on a longitudinal study with a baseline sample of 3642 patients who enrolled in intensive outpatient addiction treatment (in-person, hybrid, or virtual care) from January 2020 to March 2021 at a large substance use treatment center in the United States. The analytical sample consisted of patients who completed the 3-month postdischarge outcome survey as part of routine outcome monitoring (n=1060, 29.1% response rate). RESULTS No significant differences were detected by delivery format in continuous abstinence (χ22=0.4, P=.81), overall quality of life (F2,826=2.06, P=.13), financial well-being (F2,767=2.30, P=.10), psychological well-being (F2,918=0.72, P=.49), and confidence in one's ability to stay sober (F2,941=0.21, P=.81). Individuals in hybrid programming were more likely to report a higher level of general health than those in virtual IOP (F2,917=4.19, P=.01). CONCLUSIONS Virtual outpatient care for the treatment of SUD is a feasible alternative to in-person-only programming, leading to similar self-reported outcomes at 3 months postdischarge. Given the many obstacles presented throughout data collection during a pandemic, further research is needed to better understand under what conditions telehealth is an acceptable alternative to in-person care.
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Affiliation(s)
- Kate Gliske
- Butler Center for Research, Hazelden Betty Ford Foundation, Center City, MN, United States
| | - Justine W Welsh
- Department of Psychiatry and Behavioral Services, Emory University School of Medicine, Emory University, Atlanta, GA, United States
| | - Jacqueline E Braughton
- Butler Center for Research, Hazelden Betty Ford Foundation, Center City, MN, United States
| | - Lance A Waller
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Quyen M Ngo
- Butler Center for Research, Hazelden Betty Ford Foundation, Center City, MN, United States
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48
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Sugarman DE, Busch AB, McHugh RK, Bogunovic OJ, Trinh CD, Weiss RD, Greenfield SF. Patients' perceptions of telehealth services for outpatient treatment of substance use disorders during the COVID-19 pandemic. Am J Addict 2021; 30:445-452. [PMID: 34405475 PMCID: PMC8429128 DOI: 10.1111/ajad.13207] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/28/2021] [Accepted: 06/22/2021] [Indexed: 01/17/2023] Open
Abstract
Background and Objectives The rapid scale‐up of telehealth services for substance use disorders (SUDs) during the COVID‐19 pandemic presented a unique opportunity to investigate patient experiences with telehealth. This study examined patient perceptions of telehealth in an outpatient SUD treatment program offering individual therapy, group therapy, and medication management. Methods Two hundred and seventy adults receiving SUD outpatient treatment were eligible to complete a 23‐item online survey distributed by clinicians; 58 patients completed/partially completed the survey. Data were summarized with descriptive statistics. Results Participants were predominately male, White, and well‐educated. The majority (86.2%) were “very satisfied” or “satisfied” with the quality of telehealth care. “Very satisfied” ratings were highest for individual therapy (90%), followed by medication management (75%) and group therapy (58%). Top reasons for liking telehealth included the ability to do it from home (90%) and not needing to spend time commuting (83%). Top reasons for disliking telehealth were not connecting as well with other members in group therapy (28%) and the ability for telehealth to be interrupted at home or work (26%). Discussion and Conclusions Telehealth visits were a satisfactory treatment modality for most respondents receiving outpatient SUD care, especially those engaging in individual therapy. Challenges remain for telehealth group therapy. Scientific Significance This is the first study examining patients' perceptions of telehealth for outpatient SUD treatment during the COVID‐19 pandemic by treatment service type. Importantly, while many participants found telehealth more accessible than in‐person treatment, there was variability with respect to the preferred mode of treatment delivery.
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Affiliation(s)
- Dawn E Sugarman
- Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Alisa B Busch
- Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - R Kathryn McHugh
- Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Olivera J Bogunovic
- Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Catherine D Trinh
- Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, Massachusetts, USA
| | - Roger D Weiss
- Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Shelly F Greenfield
- Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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