TY - JOUR
KW - COVID-19/epidemiology
KW - Feasibility Studies
KW - Health Services Accessibility/organization & administration
KW - Humans
KW - Opiate Substitution Treatment/statistics & numerical data
KW - Opioid-Related Disorders/therapy
KW - Rural Population/statistics & numerical data
KW - Telemedicine/organization & administration
KW - COVID-19
KW - implementation
KW - Medication for opioid use disorder
KW - opioid use disorder
KW - primary care
KW - Rural community
KW - Telemedicine
AU - Y. I. Hser
AU - A. J. Ober
AU - A. R. Dopp
AU - C. Lin
AU - K. P. Osterhage
AU - S. E. Clingan
AU - L. J. Mooney
AU - M. E. Curtis
AU - L. A. Marsch
AU - B. McLeman
AU - E. Hichborn
AU - L. S. Lester
AU - L. M. Baldwin
AU - Y. Liu
AU - P. Jacobs
AU - A. J. Saxon
A1 - 
AB - Telemedicine (TM) enabled by digital health technologies to provide medical services has been considered a key solution to increasing health care access in rural communities. With the immediate need for remote care due to the COVID-19 pandemic, many health care systems have rapidly incorporated digital technologies to support the delivery of remote care options, including medication treatment for individuals with opioid use disorder (OUD). In responding to the opioid crisis and the COVID-19 pandemic, public health officials and scientific communities strongly support and advocate for greater use of TM-based medication treatment for opioid use disorder (MOUD) to improve access to care and have suggested that broad use of TM during the pandemic should be sustained. Nevertheless, research on the implementation and effectiveness of TM-based MOUD has been limited. To address this knowledge gap, the National Drug Abuse Treatment Clinical Trials Network (CTN) funded (via the NIH HEAL Initiative) a study on Rural Expansion of Medication Treatment for Opioid Use Disorder (Rural MOUD; CTN-0102) to investigate the implementation and effectiveness of adding TM-based MOUD to rural primary care for expanding access to MOUD. In preparation for this large-scale, randomized controlled trial incorporating TM in rural primary care, a feasibility study is being conducted to develop and pilot test implementation procedures. In this commentary, we share some of our experiences, which include several challenges, during the initial two-month period of the feasibility study phase. While these challenges could be due, at least in part, to adjusting to the COVID-19 pandemic and new workflows to accommodate the study, they are notable and could have a substantial impact on the larger, planned pragmatic trial and on TM-based MOUD more broadly. Challenges include low rates of identification of risk for OUD from screening, low rates of referral to TM, digital device and internet access issues, workflow and capacity barriers, and insurance coverage. These challenges also highlight the lack of empirical guidance for best TM practice and quality remote care models. With TM expanding rapidly, understanding implementation and demonstrating what TM approaches are effective are critical for ensuring the best care for persons with OUD.
AD - Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA. yhser@mednet.ucla.edu.; RAND Corporation, Santa Monica, CA, USA.; RAND Corporation, Santa Monica, CA, USA.; Center for Community Health, Semel Institute for Neuroscience and Human Behavior, University of California At Los Angeles, Los Angeles, CA, USA.; Department of Family Medicine, University of Washington, Seattle, WA, USA.; Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA.; Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA.; Veterans Affairs Greater Los Angeles Health Care System, Los Angeles, CA, USA.; Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA.; Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA.; Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA.; Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA.; Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA.; Department of Family Medicine, University of Washington, Seattle, WA, USA.; Center for Clinical Trials Network, National Institute On Drug Abuse, Bethesda, MD, USA.; Center for Clinical Trials Network, National Institute On Drug Abuse, Bethesda, MD, USA.; Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA.
BT - Addiction science & clinical practice
C5 - Healthcare Disparities; HIT & Telehealth; Opioids & Substance Use
CP - 1
DO - 10.1186/s13722-021-00233-x
IS - 1
JF - Addiction science & clinical practice
LA - eng
M1 - Journal Article
N2 - Telemedicine (TM) enabled by digital health technologies to provide medical services has been considered a key solution to increasing health care access in rural communities. With the immediate need for remote care due to the COVID-19 pandemic, many health care systems have rapidly incorporated digital technologies to support the delivery of remote care options, including medication treatment for individuals with opioid use disorder (OUD). In responding to the opioid crisis and the COVID-19 pandemic, public health officials and scientific communities strongly support and advocate for greater use of TM-based medication treatment for opioid use disorder (MOUD) to improve access to care and have suggested that broad use of TM during the pandemic should be sustained. Nevertheless, research on the implementation and effectiveness of TM-based MOUD has been limited. To address this knowledge gap, the National Drug Abuse Treatment Clinical Trials Network (CTN) funded (via the NIH HEAL Initiative) a study on Rural Expansion of Medication Treatment for Opioid Use Disorder (Rural MOUD; CTN-0102) to investigate the implementation and effectiveness of adding TM-based MOUD to rural primary care for expanding access to MOUD. In preparation for this large-scale, randomized controlled trial incorporating TM in rural primary care, a feasibility study is being conducted to develop and pilot test implementation procedures. In this commentary, we share some of our experiences, which include several challenges, during the initial two-month period of the feasibility study phase. While these challenges could be due, at least in part, to adjusting to the COVID-19 pandemic and new workflows to accommodate the study, they are notable and could have a substantial impact on the larger, planned pragmatic trial and on TM-based MOUD more broadly. Challenges include low rates of identification of risk for OUD from screening, low rates of referral to TM, digital device and internet access issues, workflow and capacity barriers, and insurance coverage. These challenges also highlight the lack of empirical guidance for best TM practice and quality remote care models. With TM expanding rapidly, understanding implementation and demonstrating what TM approaches are effective are critical for ensuring the best care for persons with OUD.
PY - 2021
SN - 1940-0640; 1940-0632; 1940-0632
SP - 021
EP - x
EP - 24+
T1 - Is telemedicine the answer to rural expansion of medication treatment for opioid use disorder? Early experiences in the feasibility study phase of a National Drug Abuse Treatment Clinical Trials Network Trial
T2 - Addiction science & clinical practice
TI - Is telemedicine the answer to rural expansion of medication treatment for opioid use disorder? Early experiences in the feasibility study phase of a National Drug Abuse Treatment Clinical Trials Network Trial
U1 - Healthcare Disparities; HIT & Telehealth; Opioids & Substance Use
U2 - 33879260
U3 - 10.1186/s13722-021-00233-x
VL - 16
VO - 1940-0640; 1940-0632; 1940-0632
Y1 - 2021
Y2 - Apr 20
ER -