TY - JOUR
KW - Adult
KW - Analgesics, Opioid
KW - Buprenorphine/therapeutic use
KW - COVID-19
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Opiate Substitution Treatment
KW - Opioid-Related Disorders/drug therapy
KW - Pandemics
KW - Rural Population
KW - SARS-CoV-2
KW - Telemedicine
AU - E. Weintraub
AU - C. Seneviratne
AU - J. Anane
AU - K. Coble
AU - J. Magidson
AU - S. Kattakuzhy
AU - A. Greenblatt
AU - C. Welsh
AU - A. Pappas
AU - T. L. Ross
AU - A. M. Belcher
A1 - 
AB - IMPORTANCE: The demand for medications for opioid use disorder (MOUD) in rural US counties far outweighs their availability. Novel approaches to extend treatment capacity include telemedicine (TM) and mobile treatment on demand; however, their combined use has not been reported or evaluated. OBJECTIVE: To evaluate the use of a TM mobile treatment unit (TM-MTU) to improve access to MOUD for individuals living in an underserved rural area. DESIGN, SETTING, AND PARTICIPANTS: This quality improvement study evaluated data collected from adult outpatients with a diagnosis of OUD enrolled in the TM-MTU initiative from February 2019 (program inception) to June 2020. Program staff traveled to rural areas in a modified recreational vehicle equipped with medical, videoconferencing, and data collection devices. Patients were virtually connected with physicians based more than 70 miles (112 km) away. Data analysis was performed from June to October 2020. INTERVENTION: Patients received buprenorphine prescriptions after initial teleconsultation and follow-up visits from a study physician specialized in addiction psychiatry and medicine. MAIN OUTCOMES AND MEASURES: The primary outcome was 3-month treatment retention, and the secondary outcome was opioid-positive urine screens. Exploratory outcomes included use of other drugs and patients' travel distance to treatment. RESULTS: A total of 118 patients were enrolled in treatment, of whom 94 were seen for follow-up treatment predominantly (at least 2 of 3 visits [>50%]) on the TM-MTU; only those 94 patients' data are considered in all analyses. The mean (SD) age of patients was 36.53 (9.78) years, 59 (62.77%) were men, 71 (75.53%) identified as White, and 90 (95.74%) were of non-Hispanic ethnicity. Fifty-five patients (58.51%) were retained in treatment by 3 months (90 days) after baseline. Opioid use was reduced by 32.84% at 3 months, compared with baseline, and was negatively associated with treatment duration (F = 12.69; P = .001). In addition, compared with the nearest brick-and-mortar treatment location, TM-MTU treatment was a mean of 6.52 miles (range, 0.10-58.70 miles) (10.43 km; range, 0.16-93.92 km) and a mean of 10 minutes (range, 1-49 minutes) closer for patients. CONCLUSIONS AND RELEVANCE: These data demonstrate the feasibility of combining TM with mobile treatment, with outcomes (retention and opioid use) similar to those obtained from office-based TM MOUD programs. By implementing a traveling virtual platform, this clinical paradigm not only helps fill the void of rural MOUD practitioners but also facilitates access to underserved populations who are less likely to reach traditional medical settings, with critical relevance in the context of the COVID-19 pandemic.
AD - Division of Addiction Research and Treatment, Department of Psychiatry, University of Maryland School of Medicine, Baltimore.; Division of Addiction Research and Treatment, Department of Psychiatry, University of Maryland School of Medicine, Baltimore.; Division of Addiction Research and Treatment, Department of Psychiatry, University of Maryland School of Medicine, Baltimore.; Division of Addiction Research and Treatment, Department of Psychiatry, University of Maryland School of Medicine, Baltimore.; Department of Psychology, University of Maryland, College Park.; Division of Critical Care and Research, Institute of Human Virology, Division of Infectious Disease, University of Maryland School of Medicine, Baltimore.; Division of Addiction Research and Treatment, Department of Psychiatry, University of Maryland School of Medicine, Baltimore.; Division of Addiction Research and Treatment, Department of Psychiatry, University of Maryland School of Medicine, Baltimore.; Division of Addiction Research and Treatment, Department of Psychiatry, University of Maryland School of Medicine, Baltimore.; Now with Venice Family Clinic, Venice, California.; Caroline County Health Department, Denton, Maryland.; Division of Addiction Research and Treatment, Department of Psychiatry, University of Maryland School of Medicine, Baltimore.
BT - JAMA network open
C5 - Education & Workforce; Healthcare Disparities; HIT & Telehealth; Opioids & Substance Use
CP - 8
DO - 10.1001/jamanetworkopen.2021.18487
IS - 8
JF - JAMA network open
LA - eng
M1 - Journal Article
N2 - IMPORTANCE: The demand for medications for opioid use disorder (MOUD) in rural US counties far outweighs their availability. Novel approaches to extend treatment capacity include telemedicine (TM) and mobile treatment on demand; however, their combined use has not been reported or evaluated. OBJECTIVE: To evaluate the use of a TM mobile treatment unit (TM-MTU) to improve access to MOUD for individuals living in an underserved rural area. DESIGN, SETTING, AND PARTICIPANTS: This quality improvement study evaluated data collected from adult outpatients with a diagnosis of OUD enrolled in the TM-MTU initiative from February 2019 (program inception) to June 2020. Program staff traveled to rural areas in a modified recreational vehicle equipped with medical, videoconferencing, and data collection devices. Patients were virtually connected with physicians based more than 70 miles (112 km) away. Data analysis was performed from June to October 2020. INTERVENTION: Patients received buprenorphine prescriptions after initial teleconsultation and follow-up visits from a study physician specialized in addiction psychiatry and medicine. MAIN OUTCOMES AND MEASURES: The primary outcome was 3-month treatment retention, and the secondary outcome was opioid-positive urine screens. Exploratory outcomes included use of other drugs and patients' travel distance to treatment. RESULTS: A total of 118 patients were enrolled in treatment, of whom 94 were seen for follow-up treatment predominantly (at least 2 of 3 visits [>50%]) on the TM-MTU; only those 94 patients' data are considered in all analyses. The mean (SD) age of patients was 36.53 (9.78) years, 59 (62.77%) were men, 71 (75.53%) identified as White, and 90 (95.74%) were of non-Hispanic ethnicity. Fifty-five patients (58.51%) were retained in treatment by 3 months (90 days) after baseline. Opioid use was reduced by 32.84% at 3 months, compared with baseline, and was negatively associated with treatment duration (F = 12.69; P = .001). In addition, compared with the nearest brick-and-mortar treatment location, TM-MTU treatment was a mean of 6.52 miles (range, 0.10-58.70 miles) (10.43 km; range, 0.16-93.92 km) and a mean of 10 minutes (range, 1-49 minutes) closer for patients. CONCLUSIONS AND RELEVANCE: These data demonstrate the feasibility of combining TM with mobile treatment, with outcomes (retention and opioid use) similar to those obtained from office-based TM MOUD programs. By implementing a traveling virtual platform, this clinical paradigm not only helps fill the void of rural MOUD practitioners but also facilitates access to underserved populations who are less likely to reach traditional medical settings, with critical relevance in the context of the COVID-19 pandemic.
PY - 2021
SN - 2574-3805; 2574-3805
T1 - Mobile Telemedicine for Buprenorphine Treatment in Rural Populations With Opioid Use Disorder
T2 - JAMA network open
TI - Mobile Telemedicine for Buprenorphine Treatment in Rural Populations With Opioid Use Disorder
U1 - Education & Workforce; Healthcare Disparities; HIT & Telehealth; Opioids & Substance Use
U2 - 34448869
U3 - 10.1001/jamanetworkopen.2021.18487
VL - 4
VO - 2574-3805; 2574-3805
Y1 - 2021
Y2 - Aug 2
ER -