Telehealth Utilization Is Associated with Lower Risk of Discontinuation of Buprenorphine: A Retrospective Cohort Study of US Veterans

Details

• Personal Author:
  Arndt S ; Carnahan RM ; Charlton M ; Field RW ; Lund BC ; Vakkalanka JP ; Ward MM
• Description:
  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. [Description provided by NIOSH]
• Subjects:
  Health Care Facilities Workforce And Services Health Personnel Mental Health Nervous System Occupational Health Safety Substance-Related Disorders
• Keywords:
  Author Keywords: Veterans Health Buprenorphine Drug Abuse Drugs Health Care Health Care Facilities Medical Personnel Medical Treatment Medicinal Chemicals Mental Health Rural Health Statistical Analysis Telehealth Treatment Treatment Adherence And Compliance

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• ISSN:
  0884-8734
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  Iowa ; OSHA Region 7
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  37
• Issue:
  7
• NIOSHTIC Number:
  nn:20062954
• Citation:
  J Gen Intern Med 2022 May; 37(7):1610-1618
• Contact Point Address:
  J. Priyanka Vakkalanka, PhD, ScM; Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
• Email:
  priyanka-vakkalanka@uiowa.edu
• CAS Registry Number:
  Buprenorphine (CAS RN 52485-79-7)
• Federal Fiscal Year:
  2022
• Performing Organization:
  University of Iowa
• Peer Reviewed:
  True
• Start Date:
  20050701
• Source Full Name:
  Journal of General Internal Medicine
• End Date:
  20290630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:74536df8cf0e0ac0852bbba1b1ab86690950c5215efa03e79adab0ec8a8e2adc9d28b65430c36f8f470a8046c9e4ab364c3e88dbe33b4b6938463b01c457bb86
• Download URL:
  https://stacks.cdc.gov/view/cdc/226108/cdc_226108_DS1.pdf
• File Type:
  [PDF - 498.95 KB ]