TY - JOUR
KW - Veterans Health
KW - buprenorphine
KW - Rural Health
KW - telehealth
KW - treatment adherence and compliance
AU - J. P. Vakkalanka
AU - B. C. Lund
AU - M. M. Ward
AU - S. Arndt
AU - R. W. Field
AU - M. Charlton
AU - R. M. Carnahan
A1 - 
AB - 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.
AD - Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA. priyanka-vakkalanka@uiowa.edu.; Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA. priyanka-vakkalanka@uiowa.edu.; Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA.; Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA.; Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, IA, USA.; Department of Biostatistics, University of Iowa College of Public Health, Iowa City, IA, USA.; Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA, USA.; Department of Occupational and Environmental Health, University of Iowa College of Public Health, Iowa City, IA, USA.; Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA.; Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA.
BT - Journal of general internal medicine
C5 - Education & Workforce; Healthcare Disparities; HIT & Telehealth; Opioids & Substance Use
DO - 10.1007/s11606-021-06969-1
JF - Journal of general internal medicine
LA - eng
M1 - Journal Article
N2 - 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.
PY - 2021
SN - 1525-1497; 0884-8734; 0884-8734
SP - 1
EP - 9
EP - 
T1 - Telehealth Utilization Is Associated with Lower Risk of Discontinuation of Buprenorphine: a Retrospective Cohort Study of US Veterans
T2 - Journal of general internal medicine
TI - Telehealth Utilization Is Associated with Lower Risk of Discontinuation of Buprenorphine: a Retrospective Cohort Study of US Veterans
U1 - Education & Workforce; Healthcare Disparities; HIT & Telehealth; Opioids & Substance Use
U2 - 34159547
U3 - 10.1007/s11606-021-06969-1
VO - 1525-1497; 0884-8734; 0884-8734
Y1 - 2021
Y2 - Jun 22
ER -