Journal article
Telehealth Utilization Is Associated with Lower Risk of Discontinuation of Buprenorphine: a Retrospective Cohort Study of US Veterans
Journal of general internal medicine : JGIM, Vol.37(7), pp.1610-1618
06/22/2021
DOI: 10.1007/s11606-021-06969-1
PMCID: PMC8219175
PMID: 34159547
Abstract
Objective
Treatment for opioid use disorder (OUD) may include a combination of pharmacotherapies (such as buprenorphine) with counseling services if clinically indicated. Medication management or engagement with in-person counseling services may be hindered by logistical and financial barriers. Telehealth may provide an alternative mechanism for continued engagement. This study aimed to evaluate the association between telehealth encounters and time to discontinuation of buprenorphine treatment when compared to traditional in-person visits and to evaluate potential effect modification by rural-urban designation and in-person and telehealth combination treatment.
Methods
A retrospective cohort study of Veterans diagnosed with OUD and treated with buprenorphine across all facilities within the Veterans Health Administration (VHA) between 2008 and 2017. Exposures were telehealth and in-person encounters for substance use disorder (SUD) and mental health, treated as time-varying covariates. The primary outcome was treatment discontinuation, evaluated as 14 days of absence of medication from initiation through 1 year.
Results
Compared to in-person encounters, treatment discontinuation was lower for telehealth for SUD (aHR: 0.69; 95%CI: 0.60, 0.78) and mental health (aHR: 0.69; 95%CI: 0.62, 0.76). There was no evidence of effect modification by rural-urban designation. Risk of treatment discontinuation appeared to be lower among those with telehealth only compared to in-person only for both SUD (aHR: 0.48, 95%CI: 0.37, 0.62) and for mental health (aHR: 0.46; 95%CI: 0.33, 0.65).
Conclusions
As telehealth demonstrated improved treatment retention compared to in-person visits, it may be a suitable option for engagement for patients in OUD management. Efforts to expand services may improve treatment retention and health outcomes for VHA and other health care systems.
Details
- Title: Subtitle
- Telehealth Utilization Is Associated with Lower Risk of Discontinuation of Buprenorphine: a Retrospective Cohort Study of US Veterans
- Creators
- J. Priyanka Vakkalanka - Iowa City, IA USA Iowa City, IA USABrian C Lund - Iowa City, IA USA Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IA USAMarcia M Ward - Iowa City, IA USAStephan Arndt - Iowa City, IA USA Iowa City, IA USAR. William Field - Iowa City, IA USAMary Charlton - Iowa City, IA USARyan M Carnahan - Iowa City, IA USA
- Resource Type
- Journal article
- Publication Details
- Journal of general internal medicine : JGIM, Vol.37(7), pp.1610-1618
- DOI
- 10.1007/s11606-021-06969-1
- PMID
- 34159547
- PMCID
- PMC8219175
- NLM abbreviation
- J Gen Intern Med
- ISSN
- 0884-8734
- eISSN
- 1525-1497
- Publisher
- Springer International Publishing
- Grant note
- ; 1R36DA050878-01 / ; T42OH008491 / ;
- Language
- English
- Date published
- 06/22/2021
- Academic Unit
- Psychiatry; Occupational and Environmental Health; Health Management and Policy; Epidemiology; Emergency Medicine; Biostatistics; Nursing; Injury Prevention Research Center
- Record Identifier
- 9984214850702771
Metrics
12 Record Views