TY - JOUR
KW - Buprenorphine/therapeutic use
KW - COVID-19
KW - Cohort Studies
KW - Humans
KW - Male
KW - Opiate Substitution Treatment
KW - Opioid-Related Disorders/drug therapy
KW - Pandemics
KW - Retrospective Studies
KW - SARS-CoV-2
KW - Telemedicine
KW - Veterans
KW - buprenorphine
KW - opioid use disorder
KW - telehealth
AU - L. A. Lin
AU - J. C. Fortney
AU - A. S. B. Bohnert
AU - L. N. Coughlin
AU - L. Zhang
AU - J. D. Piette
A1 - 
AB - BACKGROUND: Telemedicine-delivered buprenorphine (tele-buprenorphine) can potentially increase access to buprenorphine for patients with opioid use disorder (OUD), especially during the COVID-19 pandemic, but we know little about use in clinical care. METHODS: This study was a retrospective national cohort study of veterans diagnosed with opioid use disorder (OUD) receiving buprenorphine treatment from the Veterans Health Administration (VHA) in fiscal years 2012-2019. The study examined trends in use of tele-buprenorphine and compared demographic and clinical characteristics in patients who received tele-buprenorphine versus those who received in-person treatment only. RESULTS: Utilization of tele-buprenorphine increased from 2.29% of buprenorphine patients in FY2012 (n = 187) to 7.96% (n = 1352) in FY2019 in VHA veterans nationally. Compared to patients receiving only in-person care, tele-buprenorphine patients were less likely to be male (AOR = 0.85, 95% CI: 0.73-0.98) or Black (AOR = 0.54, 95% CI: 0.45-0.65). Tele-buprenorphine patients were more likely to be treated in community-based outpatient clinics rather than large medical centers (AOR = 2.91, 95% CI: 2.67-3.17) and to live in rural areas (AOR = 2.12, 95% CI:1.92-2.35). The median days supplied of buprenorphine treatment was 722 (interquartile range: 322-1459) among the tele-buprenorphine patients compared to 295 (interquartile range: 67-854) among patients who received treatment in-person. CONCLUSIONS: Use of telemedicine to deliver buprenorphine treatment in VHA increased 3.5-fold between 2012 and 2019, though overall use remained low prior to COVID-19. Tele-buprenorphine is a promising modality especially when treatment access is limited. However, we must continue to understand how practitioners and patient are using telemedicine and how these patients' outcomes compare to those using in-person care.
AD - VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; University of Michigan Injury Prevention Center, Ann Arbor, MI, USA; Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA. Electronic address: leweil@med.umich.edu.; Department of Psychiatry, School of Medicine, University of Washington, Seattle, WA, USA; Department of Veterans Affairs, Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA.; VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA.; Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.; 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.; VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; Department of Health Behavior Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
BT - Journal of substance abuse treatment
C5 - Financing & Sustainability; Healthcare Disparities; HIT & Telehealth; Opioids & Substance Use
DO - 10.1016/j.jsat.2021.108492
JF - Journal of substance abuse treatment
LA - eng
M1 - Journal Article
N2 - BACKGROUND: Telemedicine-delivered buprenorphine (tele-buprenorphine) can potentially increase access to buprenorphine for patients with opioid use disorder (OUD), especially during the COVID-19 pandemic, but we know little about use in clinical care. METHODS: This study was a retrospective national cohort study of veterans diagnosed with opioid use disorder (OUD) receiving buprenorphine treatment from the Veterans Health Administration (VHA) in fiscal years 2012-2019. The study examined trends in use of tele-buprenorphine and compared demographic and clinical characteristics in patients who received tele-buprenorphine versus those who received in-person treatment only. RESULTS: Utilization of tele-buprenorphine increased from 2.29% of buprenorphine patients in FY2012 (n = 187) to 7.96% (n = 1352) in FY2019 in VHA veterans nationally. Compared to patients receiving only in-person care, tele-buprenorphine patients were less likely to be male (AOR = 0.85, 95% CI: 0.73-0.98) or Black (AOR = 0.54, 95% CI: 0.45-0.65). Tele-buprenorphine patients were more likely to be treated in community-based outpatient clinics rather than large medical centers (AOR = 2.91, 95% CI: 2.67-3.17) and to live in rural areas (AOR = 2.12, 95% CI:1.92-2.35). The median days supplied of buprenorphine treatment was 722 (interquartile range: 322-1459) among the tele-buprenorphine patients compared to 295 (interquartile range: 67-854) among patients who received treatment in-person. CONCLUSIONS: Use of telemedicine to deliver buprenorphine treatment in VHA increased 3.5-fold between 2012 and 2019, though overall use remained low prior to COVID-19. Tele-buprenorphine is a promising modality especially when treatment access is limited. However, we must continue to understand how practitioners and patient are using telemedicine and how these patients' outcomes compare to those using in-person care.
PY - 2022
SN - 1873-6483; 0740-5472; 0740-5472
SP - 108492
T1 - Comparing telemedicine to in-person buprenorphine treatment in U.S. veterans with opioid use disorder
T2 - Journal of substance abuse treatment
TI - Comparing telemedicine to in-person buprenorphine treatment in U.S. veterans with opioid use disorder
U1 - Financing & Sustainability; Healthcare Disparities; HIT & Telehealth; Opioids & Substance Use
U2 - 34175175
U3 - 10.1016/j.jsat.2021.108492
VL - 133
VO - 1873-6483; 0740-5472; 0740-5472
Y1 - 2022
Y2 - Feb
ER -