1
|
Huskamp HA, Uscher-Pines L, Raja P, Normand SLT, Mehrotra A, Busch AB. Trends in Use of Telemedicine for Stimulant Initiation Among Children and Adults. Psychiatr Serv 2024; 75:630-637. [PMID: 38239181 PMCID: PMC11216869 DOI: 10.1176/appi.ps.20230421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
OBJECTIVE The authors sought to examine trends in stimulant initiation and follow-up care for attention-deficit hyperactivity disorder (ADHD) via telemedicine. METHODS This retrospective longitudinal study used national, deidentified commercial health insurance outpatient claims among children (ages 2-17 years; N=535,629) and adults (ages 18-64 years; N=2,116,160) from January 2019 through April 2022. Regression analyses were used to examine risk for stimulant initiation, whether initiation occurred via telemedicine or in-person care, and receipt of a follow-up visit. RESULTS The mean monthly adjusted number of stimulant initiations per 100,000 enrollees was similar for children before and during the COVID-19 pandemic (prepandemic, 57 initiations; during pandemic, 56 initiations) but increased for adults (prepandemic, 27 initiations; during pandemic, 33 initiations). Initiations via telemedicine peaked at 53%-57% in April 2020 and dropped to about 14% among children and 28% among adults in April 2022. Telemedicine initiations were significantly more common among psychiatrists than among other prescribers (OR=3.70, 95% CI=3.38-4.06 [children]; OR=3.02, 95% CI=2.87-3.17 [adults]) and less common for rural residents (OR=0.57, 95% CI=0.40-0.82 [children]; OR=0.75, 95% CI=0.61-0.92 [adults]). Follow-up care was significantly more common among individuals whose care was initiated via telemedicine than among those receiving in-person care (OR=1.09, 95% CI=1.00-1.19 [children]; OR=1.61, 95% CI=1.53-1.69 [adults]). CONCLUSIONS Many stimulant treatments were initiated via telemedicine. Proposed rules to prohibit controlled substance prescribing without an in-person evaluation would require significant changes in current practice, potentially limiting access to stimulant medications for ADHD.
Collapse
Affiliation(s)
- Haiden A Huskamp
- Department of Health Care Policy, Harvard Medical School, Boston (Huskamp, Normand, Mehrotra, Busch); RAND, Arlington, Virginia (Uscher-Pines); U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles (Raja); Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston (Normand); Division of General Internal Medicine, Beth Israel Deaconess Medical Center, Boston (Mehrotra); McLean Hospital, Belmont, Massachusetts (Busch)
| | - Lori Uscher-Pines
- Department of Health Care Policy, Harvard Medical School, Boston (Huskamp, Normand, Mehrotra, Busch); RAND, Arlington, Virginia (Uscher-Pines); U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles (Raja); Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston (Normand); Division of General Internal Medicine, Beth Israel Deaconess Medical Center, Boston (Mehrotra); McLean Hospital, Belmont, Massachusetts (Busch)
| | - Pushpa Raja
- Department of Health Care Policy, Harvard Medical School, Boston (Huskamp, Normand, Mehrotra, Busch); RAND, Arlington, Virginia (Uscher-Pines); U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles (Raja); Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston (Normand); Division of General Internal Medicine, Beth Israel Deaconess Medical Center, Boston (Mehrotra); McLean Hospital, Belmont, Massachusetts (Busch)
| | - Sharon-Lise T Normand
- Department of Health Care Policy, Harvard Medical School, Boston (Huskamp, Normand, Mehrotra, Busch); RAND, Arlington, Virginia (Uscher-Pines); U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles (Raja); Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston (Normand); Division of General Internal Medicine, Beth Israel Deaconess Medical Center, Boston (Mehrotra); McLean Hospital, Belmont, Massachusetts (Busch)
| | - Ateev Mehrotra
- Department of Health Care Policy, Harvard Medical School, Boston (Huskamp, Normand, Mehrotra, Busch); RAND, Arlington, Virginia (Uscher-Pines); U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles (Raja); Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston (Normand); Division of General Internal Medicine, Beth Israel Deaconess Medical Center, Boston (Mehrotra); McLean Hospital, Belmont, Massachusetts (Busch)
| | - Alisa B Busch
- Department of Health Care Policy, Harvard Medical School, Boston (Huskamp, Normand, Mehrotra, Busch); RAND, Arlington, Virginia (Uscher-Pines); U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles (Raja); Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston (Normand); Division of General Internal Medicine, Beth Israel Deaconess Medical Center, Boston (Mehrotra); McLean Hospital, Belmont, Massachusetts (Busch)
| |
Collapse
|
2
|
Zhang Y, Lal LS, Lin YY, Swint JM, Zhang Y, Summers RL, Jones BF, Chandra S, Ladner ME. Tele-Mental Health Service: Unveiling the Disparity and Impact on Healthcare Access and Expenditures during the COVID-19 Pandemic in Mississippi. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:819. [PMID: 39063396 PMCID: PMC11276461 DOI: 10.3390/ijerph21070819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 06/19/2024] [Accepted: 06/20/2024] [Indexed: 07/28/2024]
Abstract
During the COVID-19 pandemic, tele-mental health (TMH) was a viable approach for providing accessible mental and behavioral health (MBH) services. This study examines the sociodemographic disparities in TMH utilization and its effects on healthcare resource utilization (HCRU) and medical expenditures in Mississippi. Utilizing a cohort of 6787 insured adult patients at the University of Mississippi Medical Center and its affiliated sites between January 2020 and June 2023, including 3065 who accessed TMH services, we observed sociodemographic disparities between TMH and non-TMH cohorts. The TMH cohort was more likely to be younger, female, White/Caucasian, using payment methods other than Medicare, Medicaid, or commercial insurers, residing in rural areas, and with higher household income compared to the non-TMH cohort. Adjusting for sociodemographic factors, TMH utilization was associated with a 190% increase in MBH-related outpatient visits, a 17% increase in MBH-related medical expenditures, and a 12% decrease in all-cause medical expenditures (all p < 0.001). Among rural residents, TMH utilization was associated with a 205% increase in MBH-related outpatient visits and a 19% decrease in all-cause medical expenditures (both p < 0.001). This study underscores the importance of addressing sociodemographic disparities in TMH services to promote equitable healthcare access while reducing overall medical expenditures.
Collapse
Affiliation(s)
- Yunxi Zhang
- Department of Data Science, University of Mississippi Medical Center, Jackson, MS 39216, USA
- Center for Telehealth, University of Mississippi Medical Center, Jackson, MS 39216, USA; (Y.-Y.L.); (S.C.)
| | - Lincy S. Lal
- Department of Management, Policy and Community Health, The University of Texas School of Public Health, Houston, TX 77030, USA; (L.S.L.); (J.M.S.)
| | - Yueh-Yun Lin
- Center for Telehealth, University of Mississippi Medical Center, Jackson, MS 39216, USA; (Y.-Y.L.); (S.C.)
| | - J. Michael Swint
- Department of Management, Policy and Community Health, The University of Texas School of Public Health, Houston, TX 77030, USA; (L.S.L.); (J.M.S.)
- John P and Katherine G McGovern Medical School, Institute for Clinical Research and Learning Healthcare, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Ying Zhang
- Center for Informatics and Analytics, University of Mississippi Medical Center, Jackson, MS 39216, USA;
| | - Richard L. Summers
- Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA;
| | - Barbara F. Jones
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS 39216, USA; (B.F.J.); (M.E.L.)
| | - Saurabh Chandra
- Center for Telehealth, University of Mississippi Medical Center, Jackson, MS 39216, USA; (Y.-Y.L.); (S.C.)
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Mark E. Ladner
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS 39216, USA; (B.F.J.); (M.E.L.)
| |
Collapse
|
3
|
Lee H, Kennedy CJ, Tu A, Restivo J, Liu CH, Naslund JA, Patel V, Choi KW, Smoller JW. Patterns and correlates of mental healthcare utilization during the COVID-19 pandemic among individuals with pre-existing mental disorder. PLoS One 2024; 19:e0303079. [PMID: 38833458 PMCID: PMC11149861 DOI: 10.1371/journal.pone.0303079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/19/2024] [Indexed: 06/06/2024] Open
Abstract
How did mental healthcare utilization change during the COVID-19 pandemic period among individuals with pre-existing mental disorder? Understanding utilization patterns of these at-risk individuals and identifying those most likely to exhibit increased utilization could improve patient stratification and efficient delivery of mental health services. This study leveraged large-scale electronic health record (EHR) data to describe mental healthcare utilization patterns among individuals with pre-existing mental disorder before and during the COVID-19 pandemic and identify correlates of high mental healthcare utilization. Using EHR data from a large healthcare system in Massachusetts, we identified three "pre-existing mental disorder" groups (PMD) based on having a documented mental disorder diagnosis within the 6 months prior to the March 2020 lockdown, related to: (1) stress-related disorders (e.g., depression, anxiety) (N = 115,849), (2) serious mental illness (e.g., schizophrenia, bipolar disorders) (N = 11,530), or (3) compulsive behavior disorders (e.g., eating disorder, OCD) (N = 5,893). We also identified a "historical comparison" group (HC) for each PMD (N = 113,604, 11,758, and 5,387, respectively) from the previous year (2019). We assessed the monthly number of mental healthcare visits from March 13 to December 31 for PMDs in 2020 and HCs in 2019. Phenome-wide association analyses (PheWAS) were used to identify clinical correlates of high mental healthcare utilization. We found the overall number of mental healthcare visits per patient during the pandemic period in 2020 was 10-12% higher than in 2019. The majority of increased visits was driven by a subset of high mental healthcare utilizers (top decile). PheWAS results indicated that correlates of high utilization (prior mental disorders, chronic pain, insomnia, viral hepatitis C, etc.) were largely similar before and during the pandemic, though several conditions (e.g., back pain) were associated with high utilization only during the pandemic. Limitations included that we were not able to examine other risk factors previously shown to influence mental health during the pandemic (e.g., social support, discrimination) due to lack of social determinants of health information in EHR data. Mental healthcare utilization among patients with pre-existing mental disorder increased overall during the pandemic, likely due to expanded access to telemedicine. Given that clinical correlates of high mental healthcare utilization in a major hospital system were largely similar before and during the COVID-19 pandemic, resource stratification based on known risk factor profiles may aid hospitals in responding to heightened mental healthcare needs during a pandemic.
Collapse
Affiliation(s)
- Hyunjoon Lee
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Psychiatry, Center for Precision Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Chris J. Kennedy
- Department of Psychiatry, Center for Precision Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Allison Tu
- Harvard College, Cambridge, Massachusetts, United States of America
| | - Juliana Restivo
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Cindy H. Liu
- Departments of Pediatrics and Psychiatry, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - John A. Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Karmel W. Choi
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Psychiatry, Center for Precision Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Jordan W. Smoller
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Psychiatry, Center for Precision Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| |
Collapse
|
4
|
Harris MT, Weinberger E, O'Brien C, Althoff M, Paltrow-Krulwich S, Taylor JL, Judge A, Samet JH, Walley AY, Gunn CM. PrEP facilitators and barriers in substance use bridge clinics for women who engage in sex work and who use drugs. Addict Sci Clin Pract 2024; 19:47. [PMID: 38831359 PMCID: PMC11145858 DOI: 10.1186/s13722-024-00476-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 05/24/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Women who engage in sex work and use drugs (WSWUD) experience disproportionate HIV risks. Substance use treatment bridge clinics offer an opportunity to increase HIV pre-exposure prophylaxis (PrEP) delivery to WSWUD, but research on best practices is lacking. Therefore, we explored facilitators and barriers to PrEP across the PrEP care continuum in these settings. METHODS Bridge clinic and affiliated harm reduction health service providers and WSWUD from Boston were recruited using passive and active outreach between December 2021 and August 2022. Participants were invited to take part in semi-structured phone or in-person interviews to explore HIV prevention and PrEP care experiences overall and within bridge clinic settings. Deductive codes were developed based on HIV risk environment frameworks and the Information-Motivation-Behavioral Skills model and inductive codes were added based on transcript review. Grounded content analysis was used to generate themes organized around the PrEP care continuum. RESULTS The sample included 14 providers and 25 WSWUD. Most WSWUD were aware of PrEP and more than half had initiated PrEP at some point. However, most who initiated PrEP did not report success with daily oral adherence. Providers and WSWUD described facilitators and barriers to PrEP across the steps of the care continuum: Awareness, uptake, adherence, and retention. Facilitators for WSWUD included non-stigmatizing communication with providers, rapid wraparound substance use treatment and HIV services, having a PrEP routine, and service structures to support PrEP adherence. Barriers included low HIV risk perceptions and competing drug use and survival priorities. Provider facilitators included clinical note templates prompting HIV risk assessments and training. Barriers included discomfort discussing sex work risks, competing clinical priorities, and a lack of PrEP adherence infrastructure. CONCLUSION WSWUD and bridge clinic providers favored integrated HIV prevention and substance use services in harm reduction and bridge clinic settings. Harm reduction and bridge clinic programs played a key role in HIV prevention and PrEP education for WSWUD. Effective behavioral and structural interventions are still needed to improve PrEP adherence for WSWUD.
Collapse
Affiliation(s)
- Miriam Th Harris
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MA, 02118, USA.
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, 02118, USA.
| | - Emma Weinberger
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MA, 02118, USA
| | - Christine O'Brien
- Project Trust Boston Area Substance Abuse and Harm Reduction, Boston Medical Center, Boston, MA, 02118, USA
| | - Mary Althoff
- AIDS Action Committee, Cambridge, MA, 02119, USA
| | - Samantha Paltrow-Krulwich
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MA, 02118, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Jessica L Taylor
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MA, 02118, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, 02118, USA
| | - Abigail Judge
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Jeffrey H Samet
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MA, 02118, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, 02118, USA
| | - Alexander Y Walley
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MA, 02118, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, 02118, USA
| | - Christine M Gunn
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MA, 02118, USA
- Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, 03756, USA
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, 02118, USA
| |
Collapse
|
5
|
Sperling SA, Acheson SK, Fox-Fuller J, Colvin MK, Harder L, Cullum CM, Randolph JJ, Carter KR, Espe-Pfeifer P, Lacritz LH, Arnett PA, Gillaspy SR. Tele-Neuropsychology: From Science to Policy to Practice. Arch Clin Neuropsychol 2024; 39:227-248. [PMID: 37715508 DOI: 10.1093/arclin/acad066] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2023] [Indexed: 09/17/2023] Open
Abstract
OBJECTIVE The primary aim of this paper is to accelerate the number of randomized experimental studies of the reliability and validity in-home tele-neuropsychological testing (tele-np-t). METHOD We conducted a critical review of the tele-neuropsychology literature. We discuss this research in the context of the United States' public and private healthcare payer systems, including the Centers for Medicare & Medicaid Services (CMS) and Current Procedural Terminology (CPT) coding system's telehealth lists, and existing disparities in healthcare access. RESULTS The number of tele-np publications has been stagnant since the onset of the COVID-19 pandemic. There are less published experimental studies of tele-neuropsychology (tele-np), and particularly in-home tele-np-t, than other tele-np publications. There is strong foundational evidence of the acceptability, feasibility, and reliability of tele-np-t, but relatively few studies of the reliability and validity of in-home tele-np-t using randomization methodology. CONCLUSIONS More studies of the reliability and validity of in-home tele-np-t using randomization methodology are necessary to support inclusion of tele-np-t codes on the CMS and CPT telehealth lists, and subsequently, the integration and delivery of in-home tele-np-t services across providers and institutions. These actions are needed to maintain equitable reimbursement of in-home tele-np-t services and address the widespread disparities in healthcare access.
Collapse
Affiliation(s)
- Scott A Sperling
- Department of Neurology, Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA
| | | | - Joshua Fox-Fuller
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Mary K Colvin
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Lana Harder
- Children's Health, Children's Medical Center, Dallas, TX, USA
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - C Munro Cullum
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - John J Randolph
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Randolph Neuropsychology Associates, PLLC, Lebanon, NH, USA
| | | | - Patricia Espe-Pfeifer
- Department of Psychiatry and Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Laura H Lacritz
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Peter A Arnett
- Department of Psychology, The Pennsylvania State University, State College, PA, USA
| | | |
Collapse
|
6
|
Hsu M, Jung OS, Kwan LT, Jegede O, Martin B, Malhotra A, Suzuki J. Access challenges to opioid use disorder treatment among individuals experiencing homelessness: Voices from the streets. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 157:209216. [PMID: 37981243 DOI: 10.1016/j.josat.2023.209216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 07/25/2023] [Accepted: 11/13/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Achieving equitable access to medications for opioid use disorder (MOUD) such as buprenorphine is a pressing issue. Evidence suggests disparities in MOUD access based on race and socioeconomic status, further exacerbated by the COVID-19 pandemic. However, the drivers behind this access gap remain poorly understood. This study explores barriers to treatment access among individuals with opioid use disorder (OUD) experiencing homelessness. METHODS We interviewed 28 individuals in and around the Boston Public Health Commission (BPHC) Engagement Center, an area known for its high density of active substance use and homelessness. We asked about people's experiences, perceptions, and attitudes toward OUD treatment. We conducted a thematic analysis of our interview data. RESULTS Fifty-four percent of participants sampled were not prescribed MOUD. None of the participants reported having an active prescription of sublingual buprenorphine or buprenorphine/naloxone. White participants were more likely to have been prescribed buprenorphine in the past compared to participants of other races even in this socioeconomically homogeneous sample. Themes that emerged in our data included challenges to accessing MOUD due to reduced services during the COVID-19 pandemic, lost or stolen medications, fewer inpatient withdrawal management beds for women, transportation challenges, fear of adverse effects of MOUD, the perception that taking MOUD replaces one addiction for another, and community disapproval of MOUD. Participants also reported stigma and discrimination based on race, gender, and socioeconomic status. CONCLUSION Systems and individual-level factors contribute to the MOUD treatment gap across race and socioeconomic status. The COVID-19 pandemic posed additional access challenges. This study provides important, actionable insights about the barriers faced by a particularly vulnerable population of individuals with OUD experiencing homelessness.
Collapse
Affiliation(s)
- Michael Hsu
- Department of Psychiatry, Greater Los Angeles VA Medical Center, Los Angeles, CA, USA.
| | - Olivia S Jung
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, California, USA
| | - Li Ting Kwan
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Oluwole Jegede
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Bianca Martin
- Division of Addiction Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
| | - Aniket Malhotra
- Department of Psychiatry, Emory University School of Medicine, Atlanta, GA, USA
| | - Joji Suzuki
- Division of Addiction Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
| |
Collapse
|
7
|
Lin C, Zhu Y, Mooney LJ, Ober A, Clingan SE, Baldwin LM, Calhoun S, Hser YI. Referral of patients from rural primary care clinics to telemedicine vendors for opioid use disorder treatment: A mixed-methods study. J Telemed Telecare 2024:1357633X231226261. [PMID: 38258323 DOI: 10.1177/1357633x231226261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
INTRODUCTION Rural primary care clinics can expand their medication treatment for opioid use disorder (MOUD) capacity by coordinating care with external telemedicine (TM) vendors specializing in addiction medicine. This study used mixed methods to identify factors that influence patient referrals from rural primary care clinics to TM vendors for MOUD. METHODS Between July/August 2020 and January/February 2021, 582 patients with OUD were identified across six primary care sites; that included 68 referred to an external TM vendor to receive MOUD. Mixed effects logistic regression identified individual and site-level factors associated with being referred to the TM vendor. Clinic providers and staff participated in in-depth interviews and focus groups to discuss their considerations for referring patients to the TM vendor. RESULTS Patient referrals were positively associated with local household broadband coverage (OR = 2.55, p < 0.001) and negatively associated with local population density (OR = 0.01, p = 0.003) and the number of buprenorphine prescribers in the county (OR = 0.85, p < 0.001). Clinic personnel expressed appreciation for psychiatric expertise and the flexibility to access MOUD brought by the TM vendor. Perceived concerns about TM referral included a lack of trust with external providers, uncertainty about TM service quality, workflow delays, and patients' technological and insurance challenges. CONCLUSION This study revealed several clinic-level factors that may potentially influence patient referral to TM vendor services for MOUD. To facilitate the referral process and utilization of TM vendors, efforts should be made to foster open communication and trust between clinic providers and TM vendors, streamline workflows, and improve Internet access for patients.
Collapse
Affiliation(s)
- Chunqing Lin
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Yuhui Zhu
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Larissa J Mooney
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | | | - Sarah E Clingan
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Laura-Mae Baldwin
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Stacy Calhoun
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Yih-Ing Hser
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| |
Collapse
|
8
|
Matthews EB, Lushin V, Rzewinski J. Patterns & Predictors of Telehealth Utilization Among Individuals Who Use Substances: Implications for the Future of Virtual Behavioral Health Services. Community Ment Health J 2024; 60:148-153. [PMID: 37410213 DOI: 10.1007/s10597-023-01166-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 06/24/2023] [Indexed: 07/07/2023]
Abstract
Telehealth dramatically expanded during the COVID-19 pandemic, but there remains a dearth of literature examining how this service modality is utilized by individuals who use substances. This study examined patterns of telehealth use and individual level sources of variation among clients receiving counseling in an outpatient substance use clinic in early 2021 (n = 370). Univariate statistics described the percentage of counseling visits delivered via telehealth. OLS regression explored individual level demographic and clinical characteristics that predicted greater telehealth utilization. Overall, more than two thirds (86%) of counseling visits were conducted via telehealth. Individuals with unstable housing or with a co-occurring serious mental illness used less telehealth. Findings suggest that while telehealth appears to be an acceptable way to deliver substance use counseling, patterns varied among vulnerable subgroups. As telehealth becomes further integrated into behavioral health services delivery, it is critical to uncover sources of this variation and identify potential solutions.
Collapse
Affiliation(s)
- Elizabeth B Matthews
- Graduate School of Social Service, Fordham University, 113 W. 60th st. 7th Fl, New York, NY, 10023, USA.
| | - Viktor Lushin
- Long Island University Brooklyn Campus, Brooklyn, NY, USA
| | | |
Collapse
|
9
|
Nguyen B, Zhao C, Bailly E, Chi W. Telehealth Initiation of Buprenorphine for Opioid Use Disorder: Patient Characteristics and Outcomes. J Gen Intern Med 2024; 39:95-102. [PMID: 37670069 PMCID: PMC10817870 DOI: 10.1007/s11606-023-08383-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/16/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND The COVID-19 pandemic exacerbated access barriers for patients with opioid use disorder. Telehealth presents an opportunity to improve access, treatment quality, and patient outcomes. OBJECTIVE To determine patient characteristics associated with initiating buprenorphine treatment via telehealth and to examine how telehealth initiation is associated with access, treatment quality, and health outcomes. DESIGN AND PARTICIPANTS This cross-sectional study used deidentified insurance claims to identify opioid use disorder adult patients initiating buprenorphine treatment between March 1, 2020, and November 30, 2021. Multivariable logistic regression assessed determinants of telehealth initiation. Propensity score matching addressed observed differences between in-person and telehealth initiators. MAIN MEASURES Treatment quality outcomes included initiation within 14 days of diagnosis, engagement (at least 2 opioid use disorder-related visits), and any buprenorphine refill during the study period. Health outcomes included opioid overdose and opioid use disorder-related emergency department and inpatient visits. KEY RESULTS We identified 23,565 adult buprenorphine initiators, including 3314 (14.1%) patients using telehealth. Younger patients (OR 0.91 to 0.77), females (OR 1.18), South (OR 1.63) and Midwest (OR 1.27) regions, rural area (OR 1.12), and higher-income (OR 1.16) neighborhood residents were more likely to use telehealth. Telehealth patients were more likely than in-person patients (54.5% vs. 48.4%; adjusted odds ratio (AOR), 1.29; 95% CI, 1.19-1.40) to stay engaged with opioid use disorder treatment, and more likely to refill buprenorphine during the study period (83.6% vs. 79.0%, AOR 1.37; 95% CI, 1.23-1.52). Telehealth initiation of buprenorphine was associated with 36% lower overdose rate than in-person initiation (adjusted incidence rate ratio 0.64; 95% CI, 0.45-0.94). The two groups evidenced no significant differences in opioid use disorder-related ED visit and hospitalization. CONCLUSIONS Our findings suggest that telehealth-initiated buprenorphine treatment is associated with reduced opioid overdose rate and improved patient engagement. Our findings strengthen the case for extending telehealth exemptions and prescribing flexibilities for treatment.
Collapse
Affiliation(s)
| | | | | | - Winnie Chi
- Elevance Health Inc, Wilmington, DE, USA.
| |
Collapse
|
10
|
Horvitz-Lennon M, Leckman-Westin E, Finnerty M, Jeong J, Tsuei J, Zelevinsky K, Chen Q, Normand SLT. Healthcare Access for a Diverse Population with Schizophrenia Following the Onset of the COVID-19 Pandemic. Community Ment Health J 2024; 60:72-80. [PMID: 37199854 PMCID: PMC10193305 DOI: 10.1007/s10597-023-01105-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/20/2023] [Indexed: 05/19/2023]
Abstract
COVID-19 has had a disproportionate impact on the most disadvantaged members of society, including minorities and those with disabling chronic illnesses such as schizophrenia. We examined the pandemic's impacts among New York State's Medicaid beneficiaries with schizophrenia in the immediate post-pandemic surge period, with a focus on equity of access to critical healthcare. We compared changes in utilization of key behavioral health outpatient services and inpatient services for life-threatening conditions between the pre-pandemic and surge periods for White and non-White beneficiaries. We found racial and ethnic differences across all outcomes, with most differences stable over time. The exception was pneumonia admissions-while no differences existed in the pre-pandemic period, Black and Latinx beneficiaries were less likely than Whites to be hospitalized in the surge period despite minorities' heavier COVID-19 disease burden. The emergence of racial and ethnic differences in access to scarce life-preserving healthcare may hold lessons for future crises.
Collapse
Affiliation(s)
- Marcela Horvitz-Lennon
- RAND Corporation, 20 Park Plaza, Suite 920, Boston, MA, 02116, USA.
- Department of Psychiatry, Cambridge Health Alliance and Harvard Medical School, 1493 Cambridge Street, Cambridge, MA, 02139, USA.
| | - Emily Leckman-Westin
- Office of Mental Health, New York State Department of Health, 44 Holland Avenue, Albany, NY, 12229, USA
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, 1 University Pl, Rensselaer, NY, 12144, USA
| | - Molly Finnerty
- Office of Mental Health, New York State Department of Health, 44 Holland Avenue, Albany, NY, 12229, USA
| | - Junghye Jeong
- Office of Mental Health, New York State Department of Health, 44 Holland Avenue, Albany, NY, 12229, USA
| | - Jeannette Tsuei
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
| | - Katya Zelevinsky
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115, USA
| | - Qingxian Chen
- Office of Mental Health, New York State Department of Health, 44 Holland Avenue, Albany, NY, 12229, USA
| | - Sharon-Lise T Normand
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115, USA
- Department of Biostatistics, Harvard School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| |
Collapse
|
11
|
Siu C, Stephenson E, Christie CD, Selby P, Tu K. The impact of the COVID-19 pandemic on the rate of primary care visits for substance use among patients in Ontario, Canada. PLoS One 2023; 18:e0288503. [PMID: 38127861 PMCID: PMC10734921 DOI: 10.1371/journal.pone.0288503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 06/27/2023] [Indexed: 12/23/2023] Open
Abstract
The COVID-19 pandemic has led to an increase in the prevalence of substance use presentations. This study aims to assess the impact of the COVID-19 pandemic on the rate of primary care visits for substance use including tobacco, alcohol, and other drug use among primary care patients in Ontario, Canada. Diagnostic and service fee code data were collected from a longitudinal cohort of family medicine patients during pre-pandemic (March 14, 2019-March 13, 2020) and pandemic periods (March 14, 2020-March 13, 2021). Generalized linear models were used to compare the rate of substance-use related visits pre-pandemic and during the pandemic. The effects of demographic characteristics including age, sex, and income quintile were also assessed. Relative to the pre-pandemic period, patients were less likely to have a primary care visit during the pandemic for tobacco-use related reasons (OR = 0.288, 95% CI [0.270-0.308]), and for alcohol-use related reasons (OR = 0.851, 95% CI [0.780-0.929]). In contrast, patients were more likely to have a primary care visit for other drug-use related reasons (OR = 1.150, 95% CI [1.080-1.225]). In the face of a known increase in substance use during the COVID-19 pandemic, a decrease in substance use-related primary care visits likely represents an unmet need for this patient population. This study highlights the importance of continued research in the field of substance use, especially in periods of heightened vulnerability such as during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Colin Siu
- Temerty Faculty of Medicine, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | - Ellen Stephenson
- Temerty Faculty of Medicine, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Chelsea D. Christie
- Temerty Faculty of Medicine, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Peter Selby
- Temerty Faculty of Medicine, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Campbell Family Research Institute and Krembil Centre for Neuroinformatics, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Karen Tu
- Temerty Faculty of Medicine, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- North York General Hospital, Toronto, Ontario, Canada
- Toronto Western Family Health Team, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
12
|
Goldman-Mellor S, Plancarte V, Perez-Lua F, Payán DD, De Trinidad Young ME. Mental health among rural Latino immigrants during the COVID-19 pandemic. SSM - MENTAL HEALTH 2023; 3:100177. [PMID: 36570024 PMCID: PMC9758750 DOI: 10.1016/j.ssmmh.2022.100177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/16/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
The mental health of the United States' Latino population significantly deteriorated during the SARS-CoV-2 (COVID-19) pandemic, and Latino immigrants living in rural areas faced unique vulnerabilities. However, few studies have specifically examined the mental health burden and experiences of rural Latino immigrants during the COVID pandemic. To understand the mental health experiences of first- and second-generation Latinos in rural areas, we conducted semi-structured interviews with 35 Latino residents of rural California counties during July 2020-February 2021 and screened all respondents for major depression and generalized anxiety symptoms using the Patient Health Questionnaire [PHQ]-2 and Generalized Anxiety Disorder [GAD]-2 screeners. We explored the prevalence of symptoms of depression and anxiety in our sample, iteratively analyzed participants' narratives regarding the mental health impact of the pandemic, and used their mental health screener status to contextualize these narratives. Results indicated that nearly all respondents viewed mental health as a major concern, and 34% (n = 12) of respondents screened positive for major depression or generalized anxiety disorder. Respondents connected their mental health concerns to experiences of financial precarity, fear of contracting COVID-19, social isolation, and the challenges of remote schooling. Additional themes emerged around problems accessing the mental health care system, the utility of pre-pandemic mental health services, and using healthy coping mechanisms to alleviate psychological problems. Respondents' narratives tended to focus on the mental health challenges facing their family members, particularly their children. Our findings suggest that mental health intervention models that engage with multiple family members, policies that support infrastructure for encouraging exercise and outdoor activity, and ensuring access to culturally and linguistically appropriate mental health care for Latino communities may be important for protecting population mental health.
Collapse
Affiliation(s)
- Sidra Goldman-Mellor
- Department of Public Health, University of California, 5200 N. Lake Rd., Merced, Merced, CA, 95343, USA,Health Sciences Research Institute, University of California, 5200 N. Lake Rd., Merced, Merced, CA, 95343, USA,Corresponding author. Department of Public Health, University of California, 5200 N. Lake Rd., Merced, Merced, CA, 95343, USA
| | - Vivianna Plancarte
- Department of Public Health, University of California, 5200 N. Lake Rd., Merced, Merced, CA, 95343, USA
| | - Fabiola Perez-Lua
- Department of Public Health, University of California, 5200 N. Lake Rd., Merced, Merced, CA, 95343, USA
| | - Denise Diaz Payán
- Department of Public Health, University of California, 5200 N. Lake Rd., Merced, Merced, CA, 95343, USA,Health Sciences Research Institute, University of California, 5200 N. Lake Rd., Merced, Merced, CA, 95343, USA
| | - Maria-Elena De Trinidad Young
- Department of Public Health, University of California, 5200 N. Lake Rd., Merced, Merced, CA, 95343, USA,Health Sciences Research Institute, University of California, 5200 N. Lake Rd., Merced, Merced, CA, 95343, USA
| |
Collapse
|
13
|
Hammerslag LR, Mack A, Chandler RK, Fanucchi LC, Feaster DJ, LaRochelle MR, Lofwall MR, Nau M, Villani J, Walsh SL, Westgate PM, Slavova S, Talbert JC. Telemedicine Buprenorphine Initiation and Retention in Opioid Use Disorder Treatment for Medicaid Enrollees. JAMA Netw Open 2023; 6:e2336914. [PMID: 37851446 PMCID: PMC10585416 DOI: 10.1001/jamanetworkopen.2023.36914] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/22/2023] [Indexed: 10/19/2023] Open
Abstract
Importance Early COVID-19 mitigation strategies placed an additional burden on individuals seeking care for opioid use disorder (OUD). Telemedicine provided a way to initiate and maintain transmucosal buprenorphine treatment of OUD. Objective To examine associations between transmucosal buprenorphine OUD treatment modality (telemedicine vs traditional) during the COVID-19 public health emergency and the health outcomes of treatment retention and opioid-related nonfatal overdose. Design, Setting, and Participants This retrospective cohort study was conducted using Medicaid claims and enrollment data from November 1, 2019, to December 31, 2020, for individuals aged 18 to 64 years from Kentucky and Ohio. Data were collected and analyzed in June 2022, with data updated during revision in August 2023. Exposures The primary exposure of interest was the modality of the transmucosal buprenorphine OUD treatment initiation. Relevant patient demographic and comorbidity characteristics were included in regression models. Main Outcomes and Measures There were 2 main outcomes of interest: retention in treatment after initiation and opioid-related nonfatal overdose after initiation. For outcomes measured after initiation, a 90-day follow-up period was used. The main analysis used a new-user study design; transmucosal buprenorphine OUD treatment initiation was defined as initiation after more than a 60-day gap in buprenorphine treatment. In addition, uptake of telemedicine for buprenorphine was examined, overall and within patients initiating treatment, across quarters in 2020. Results This study included 41 266 individuals in Kentucky (21 269 women [51.5%]; mean [SD] age, 37.9 [9.0] years) and 50 648 individuals in Ohio (26 425 women [52.2%]; mean [SD] age, 37.1 [9.3] years) who received buprenorphine in 2020, with 18 250 and 24 741 people initiating buprenorphine in Kentucky and Ohio, respectively. Telemedicine buprenorphine initiations increased sharply at the beginning of 2020. Compared with nontelemedicine initiation, telemedicine initiation was associated with better odds of 90-day retention with buprenorphine in both states (Kentucky: adjusted odds ratio, 1.13 [95% CI, 1.01-1.27]; Ohio: adjusted odds ratio, 1.19 [95% CI, 1.06-1.32]) in a regression analysis adjusting for patient demographic and comorbidity characteristics. Telemedicine initiation was not associated with opioid-related nonfatal overdose (Kentucky: adjusted odds ratio, 0.89 [95% CI, 0.56-1.40]; Ohio: adjusted odds ratio, 1.08 [95% CI, 0.83-1.41]). Conclusions and Relevance In this cohort study of Medicaid enrollees receiving buprenorphine for OUD, telemedicine buprenorphine initiation was associated with retention in treatment early during the COVID-19 pandemic. These findings add to the literature demonstrating positive outcomes associated with the use of telemedicine for treatment of OUD.
Collapse
Affiliation(s)
- Lindsey R. Hammerslag
- Institute for Biomedical Informatics, University of Kentucky College of Medicine, Lexington
| | - Aimee Mack
- Division of Health Sciences, The Ohio State University Wexner Medical Center, Columbus
| | - Redonna K. Chandler
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | - Laura C. Fanucchi
- Center on Drug and Alcohol Research, College of Medicine, University of Kentucky, Lexington
| | - Daniel J. Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Marc R. LaRochelle
- Clinical Addiction Research & Education Unit, Boston University School of Medicine, Boston, Massachusetts
| | - Michelle R. Lofwall
- Center on Drug and Alcohol Research, College of Medicine, University of Kentucky, Lexington
| | - Michael Nau
- Division of Health Sciences, The Ohio State University Wexner Medical Center, Columbus
| | - Jennifer Villani
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | - Sharon L. Walsh
- Center on Drug and Alcohol Research, College of Medicine, University of Kentucky, Lexington
| | - Philip M. Westgate
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington
| | - Svetla Slavova
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington
| | - Jeffery C. Talbert
- Institute for Biomedical Informatics, University of Kentucky College of Medicine, Lexington
| |
Collapse
|
14
|
Chi W, Nguyen B, Ma Q, Gray D, Bailly E, LoSasso A, Agrawal S. Impact of COVID-19 on Behavioral Health Services Use Among Medicaid Enrollees with Chronic Behavioral Needs by Race and Ethnicity. Popul Health Manag 2023; 26:325-331. [PMID: 37676993 DOI: 10.1089/pop.2023.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023] Open
Abstract
The COVID-19 pandemic may widen the disparities in access to behavioral health (BH) services among groups that have been historically marginalized. However, the rapid expansion of telehealth presents an opportunity to reduce these disparities. The objective was to assess the impact of COVID-19 on BH visits, including in-person and telehealth, and BH treatments by different race and ethnicity groups. This was a retrospective, observational study using administrative claim data. Two cohorts were created: a before-COVID-19 group and a during-COVID-19 group. A difference-in-differences analysis was conducted to assess the access to BH-related visits between the 2 groups by different race and ethnicity groups. The study sample included 90,268 patients aged 18 to 64 years with repeated BH diagnoses in baseline periods and continuous medical and pharmacy enrollment. During the pandemic, BH telehealth visits surged, whereas the overall utilization of BH services, mental health medication, and counseling declined among all racial groups as the BH telehealth increase did not fully compensate for the reduction of in-person visits. Latino patients had a higher likelihood of using BH telehealth visits than White patients. However, Black patients had a lower likelihood of using substance use disorder (SUD) treatment than their White counterparts. Our results also suggested that care continuation and pre-established care-seeking behaviors are associated with increasing BH visits and treatments. As policy makers and payers are expanding offerings of telehealth visits, it is imperative to do so through a health equity lens and center the needs of groups that have been economically and socially marginalized to advance equitable adoption of telehealth.
Collapse
Affiliation(s)
- Winnie Chi
- Department of Health Services Research, Elevance Health, Inc., Indianapolis, Indiana, USA
| | - Binh Nguyen
- Department of Health Services Research, Elevance Health, Inc., Indianapolis, Indiana, USA
| | - Qinli Ma
- Department of Health Services Research, Elevance Health, Inc., Indianapolis, Indiana, USA
| | - Darrell Gray
- Department of Health Outcomes Organizations, and Elevance Health, Inc., Indianapolis, Indiana, USA
| | - Eric Bailly
- Department of Behavioral Health, Elevance Health, Inc., Indianapolis, Indiana, USA
| | - Anthony LoSasso
- Department of Economics, DePaul University, Chicago, Illinois, USA
| | - Shantanu Agrawal
- Department of Health Outcomes Organizations, and Elevance Health, Inc., Indianapolis, Indiana, USA
| |
Collapse
|
15
|
Green EH, Aquino PR, Keitz SA. Telemedicine Postpandemic: Where Do We Go From Here? Med Care 2023; 61:491-494. [PMID: 37411002 DOI: 10.1097/mlr.0000000000001892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Affiliation(s)
- Eric H Green
- Department of General Internal Medicine, Lahey Hospital & Medical Center
| | - Patrick R Aquino
- Tufts University School of Medicine, Lahey Hospital & Medical Center
| | - Sheri A Keitz
- Department of Medicine, Lahey Hospital & Medical Center, Burlington, MA
| |
Collapse
|
16
|
Palzes VA, Chi FW, Metz VE, Sterling S, Asyyed A, Ridout KK, Campbell CI. Overall and Telehealth Addiction Treatment Utilization by Age, Race, Ethnicity, and Socioeconomic Status in California After COVID-19 Policy Changes. JAMA HEALTH FORUM 2023; 4:e231018. [PMID: 37204804 PMCID: PMC10199344 DOI: 10.1001/jamahealthforum.2023.1018] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/21/2023] [Indexed: 05/20/2023] Open
Abstract
Importance Addiction treatment rapidly transitioned to a primarily telehealth modality (telephone and video) during the COVID-19 pandemic, raising concerns about disparities in utilization. Objective To examine whether there were differences in overall and telehealth addiction treatment utilization after telehealth policy changes during the COVID-19 pandemic by age, race, ethnicity, and socioeconomic status. Design, Setting, and Participants This cohort study examined electronic health record and claims data from Kaiser Permanente Northern California for adults (age ≥18 years) with drug use problems before the COVID-19 pandemic (from March 1, 2019, to December 31, 2019) and during the early phase of the COVID-19 pandemic (March 1, 2020, to December 31, 2020; hereafter referred to as COVID-19 onset). Analyses were conducted between March 2021 and March 2023. Exposure The expansion of telehealth services during COVID-19 onset. Main Outcomes and Measures Generalized estimating equation models were fit to compare addiction treatment utilization during COVID-19 onset with that before the COVID-19 pandemic. Utilization measures included the Healthcare Effectiveness Data and Information Set of treatment initiation and engagement (including inpatient, outpatient, and telehealth encounters or receipt of medication for opioid use disorder [OUD]), 12-week retention (days in treatment), and OUD pharmacotherapy retention. Telehealth treatment initiation and engagement were also examined. Differences in changes in utilization by age group, race, ethnicity, and socioeconomic status (SES) were examined. Results Among the 19 648 participants in the pre-COVID-19 cohort (58.5% male; mean [SD] age, 41.0 [17.5] years), 1.6% were American Indian or Alaska Native; 7.5%, Asian or Pacific Islander; 14.3%, Black; 20.8%, Latino or Hispanic; 53.4%, White; and 2.5%, unknown race. Among the 16 959 participants in the COVID-19 onset cohort (56.5% male; mean [SD] age, 38.9 [16.3] years), 1.6% were American Indian or Alaska Native; 7.4%, Asian or Pacific Islander; 14.6%, Black; 22.2%, Latino or Hispanic; 51.0%, White; and 3.2%, unknown race. Odds of overall treatment initiation increased from before the COVID-19 pandemic to COVID-19 onset for all age, race, ethnicity, and SES subgroups except for patients aged 50 years or older; patients aged 18 to 34 years had the greatest increases (adjusted odds ratio [aOR], 1.31; 95% CI, 1.22-1.40). Odds of telehealth treatment initiation increased for all patient subgroups without variation by race, ethnicity, or SES, although increases were greater for patients aged 18 to 34 years (aOR, 7.17; 95% CI, 6.24-8.24). Odds of overall treatment engagement increased (aOR, 1.13; 95% CI, 1.03-1.24) without variation by patient subgroups. Retention increased by 1.4 days (95% CI, 0.6-2.2 days), and OUD pharmacotherapy retention did not change (adjusted mean difference, -5.2 days; 95% CI, -12.7 to 2.4 days). Conclusions In this cohort study of insured adults with drug use problems, there were increases in overall and telehealth addiction treatment utilization after telehealth policies changed during the COVID-19 pandemic. There was no evidence that disparities were exacerbated, and younger adults may have particularly benefited from the transition to telehealth.
Collapse
Affiliation(s)
- Vanessa A. Palzes
- Center for Addiction and Mental Health Research, Division of Research, Kaiser Permanente Northern California, Oakland
| | - Felicia W. Chi
- Center for Addiction and Mental Health Research, Division of Research, Kaiser Permanente Northern California, Oakland
| | - Verena E. Metz
- Center for Addiction and Mental Health Research, Division of Research, Kaiser Permanente Northern California, Oakland
| | - Stacy Sterling
- Center for Addiction and Mental Health Research, Division of Research, Kaiser Permanente Northern California, Oakland
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | - Asma Asyyed
- Northern California Addiction Medicine and Recovery Services, The Permanente Medical Group, Inc, Santa Rosa
| | - Kathryn K. Ridout
- Center for Addiction and Mental Health Research, Division of Research, Kaiser Permanente Northern California, Oakland
- The Permanente Medical Group, Inc, Santa Rosa, California
| | - Cynthia I. Campbell
- Center for Addiction and Mental Health Research, Division of Research, Kaiser Permanente Northern California, Oakland
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| |
Collapse
|
17
|
Radick AC, James J, Leroux BG, Kim TW, Saxon AJ, Samet JH, Tsui JI. Use of Video Directly Observed Therapy and Characteristics Associated With Use Among Patients Treated With Buprenorphine in an Office-based Setting. J Addict Med 2023; 17:300-304. [PMID: 37267172 PMCID: PMC10123169 DOI: 10.1097/adm.0000000000001103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Video directly observed therapy (video DOT) is a tool for confirming buprenorphine adherence that could complement the use of urine toxicology; research is needed to characterize the patients who are receptive and able to use this technology. We aimed to describe video DOT utilization and assess participant characteristics associated with use. METHODS We performed a secondary analysis of data from a pilot randomized controlled trial of adults who recently initiated sublingual buprenorphine in office-based programs, restricting to intervention arm participants, which consisted of 12 weeks of video DOT via a mobile health technology platform. Participants were instructed to record at least 1 daily video of buprenorphine self-administration. Poisson regression models with robust standard errors were used to measure associations between participant characteristics and frequency of submitted videos. RESULTS The sample included 39 participants. Of 3276 possible videos, 1002 (31%) were submitted. Age ≥40 years (relative risk [RR], 2.54 [95% confidence interval {CI}, 1.31-4.91]) and once-daily buprenorphine dosing (RR, 3.10 [95% CI, 1.76-5.48]) were positively associated with video submissions. Non-White race (RR, 0.43 [95% CI, 0.19-0.97]), less than high school education (RR, 0.27 [95% CI, 0.10-0.74]), history of previous buprenorphine treatment (RR, 0.50 [95% CI, 0.25-0.97]), and ≥3 previous treatment attempts (RR, 0.16 [95% CI, 0.07-0.37]) were negatively associated. CONCLUSIONS Video DOT utilization resulted in about a third of expected videos, although there were differences in use according to age, race, buprenorphine treatment factors, and educational status. Such differences underscore that mobile-health interventions such as video DOT may not be equally used by all patients.Trial Registration : ClinicalTrails.gov , NCT03779997 , registered on December 19, 2018.
Collapse
Affiliation(s)
- Andrea C Radick
- From the Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA (ACR, JJ, JIT); Department of Biostatistics, University of Washington, Seattle WA (BGL); Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA (TWK, JHS); and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA (AJS)
| | | | | | | | | | | | | |
Collapse
|
18
|
Tomlinson MF, McCann-Pineo M, Thomas MP, Polydorou S. Demographic differences in services utilization across in-person (2019), telehealth (2020), and hybrid (2021) outpatient substance use services in New York. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 150:209047. [PMID: 37120015 DOI: 10.1016/j.josat.2023.209047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 01/27/2023] [Accepted: 04/11/2023] [Indexed: 05/01/2023]
Abstract
OBJECTIVES Many outpatient substance use programs have experienced in-person, remote/telehealth, and hybrid models of care since the 2020 Covid-19 Pandemic. Changes in treatment models naturally affect service utilization and may affect treatment trajectories. Currently, limited research examines the implications of different health care models on service utilization and patient outcomes in substance use treatment. Here, we reflect on the implications of each model from a patient-centered care approach and review the implications on service utilization and outcomes. METHODS We employed a retrospective, observational, longitudinal, cohort design to explore differences in demographic characteristics and service utilization among patients receiving in-person, remote, or hybrid services across five substance use clinics in New York. We reviewed admission (N = 2238) and discharge (N = 2044) data from four outpatient SUD clinics within the same health care system across three cohorts (2019, in-person; 2020, remote; 2021, hybrid). RESULTS Patients discharged in 2021 (hybrid) had significantly more median total treatment visits (M = 26, p ≤ 0.0005), a longer course of treatment (M = 154.5 days, p ≤ 0.0001), and more individual counseling sessions (M = 9, p ≤ 0.0001) compared to the other two cohorts. Demographic analyses indicate more ethnoracial diversity (p = 0.0006) among patients admitted in 2021, compared to the other two cohorts. Over time, the proportion of individuals being admitted with a co-existing psychiatric disorder (2019, 49 %; 2020; 55.4 %, 2021, 54.9 %) and no prior mental health treatment (2019, 49.4 %; 2020, 46.0 %; 2021, 69.3 %) increased (p = 0.0001). Admissions in 2021 were more likely to be self-referred (32.5 %, p < 0.0001), employed full-time (39.5 %, p = 0.01), and have higher educational attainment (p = 0.0008). CONCLUSION During hybrid treatment in 2021, patients from a wider range of ethnoracial backgrounds were admitted and retained in care, patients with higher socioeconomic status (who were previously less likely to enter treatment) were admitted, and fewer individuals left against clinical advice (compared to the remote 2020 cohort). More patients successfully completed treatment in 2021. Service utilization, demographic, and outcome trends support a hybrid model of care.
Collapse
Affiliation(s)
- Monica F Tomlinson
- Addiction Recovery Services, Zucker Hillside Hospital, Northwell Health, United States of America.
| | - Molly McCann-Pineo
- Department of Emergency Medicine, Northshore University Hospital, Northwell Health, United States of America; Department of Occupational Medicine, Epidemiology and Prevention, Northshore University Hospital, Northwell Health, United States of America; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, United States of America
| | - Monica P Thomas
- Addiction Recovery Services, Zucker Hillside Hospital, Northwell Health, United States of America
| | - Soteri Polydorou
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, United States of America; Addiction Services, Northwell Health, United States of America; Addiction Medicine, Northwell Health, United States of America
| |
Collapse
|
19
|
Korte KJ, Hook K, Levey EJ, Cooper-Vince CE, Denckla CA, Ghebrehiwet S, Hock RS, Harris BL, Menyongai J, Baul TD, Borba CPC, Fricchione GL, Henderson DC. A Global-Local Paradigm for Mental Health: A Model and Implications for Addressing Disparities Through Training and Research. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2023; 47:196-200. [PMID: 35941340 PMCID: PMC9360676 DOI: 10.1007/s40596-022-01695-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 07/27/2022] [Indexed: 05/25/2023]
Affiliation(s)
- Kristina J Korte
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
| | - Kimberly Hook
- Boston Medical Center, Boston, MA, USA.
- Massachusetts General Hospital, Boston, MA, USA.
- Boston University School of Medicine, Boston, MA, USA.
| | | | | | | | | | | | | | | | | | - Christina P C Borba
- Boston Medical Center, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | | | - David C Henderson
- Boston Medical Center, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| |
Collapse
|
20
|
Hoffmann JA, Krass P, Rodean J, Bardach NS, Cafferty R, Coker TR, Cutler GJ, Hall M, Morse RB, Nash KA, Parikh K, Zima BT. Follow-up After Pediatric Mental Health Emergency Visits. Pediatrics 2023; 151:e2022057383. [PMID: 36775807 PMCID: PMC10187982 DOI: 10.1542/peds.2022-057383] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/27/2022] [Indexed: 02/14/2023] Open
Abstract
OBJECTIVES To examine how outpatient mental health (MH) follow-up after a pediatric MH emergency department (ED) discharge varies by patient characteristics and to evaluate the association between timely follow-up and return encounters. METHODS We conducted a retrospective study of 28 551 children aged 6 to 17 years with MH ED discharges from January 2018 to June 2019, using the IBM Watson MarketScan Medicaid database. Odds of nonemergent outpatient follow-up, adjusted for sociodemographic and clinical characteristics, were estimated using logistic regression. Cox proportional hazard models were used to evaluate the association between timely follow-up and risk of return MH acute care encounters (ED visits and hospitalizations). RESULTS Following MH ED discharge, 31.2% and 55.8% of children had an outpatient MH visit within 7 and 30 days, respectively. The return rate was 26.5% within 6 months. Compared with children with no past-year outpatient MH visits, those with ≥14 past-year MH visits had 9.53 odds of accessing follow-up care within 30 days (95% confidence interval [CI], 8.75-10.38). Timely follow-up within 30 days was associated with a 26% decreased risk of return within 5 days of the index ED discharge (hazard ratio, 0.74; 95% CI, 0.63-0.91), followed by an increased risk of return thereafter. CONCLUSIONS Connection to outpatient care within 7 and 30 days of a MH ED discharge remains poor, and children without prior MH outpatient care are at highest risk for poor access to care. Interventions to link to outpatient MH care should prioritize follow-up within 5 days of an MH ED discharge.
Collapse
Affiliation(s)
- Jennifer A. Hoffmann
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Polina Krass
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA
- National Clinician Scholars Program, University of Pennsylvania, Philadelphia, PA
| | | | - Naomi S. Bardach
- Department of Pediatrics and Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco
| | - Rachel Cafferty
- Division of Emergency Medicine, Department of Pediatrics, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Tumaini R. Coker
- Department of Pediatrics, University of Washington School of Medicine and Seattle Children’s Research Institute, Seattle, Washington
| | - Gretchen J. Cutler
- Children’s Minnesota Research Institute, Children’s Minnesota, Minneapolis, MN
| | | | - Rustin B. Morse
- Department of Pediatrics, The Ohio State University, Columbus, Ohio
- Nationwide Children’s Hospital, Center for Clinical Excellence, Columbus, Ohio
| | - Katherine A. Nash
- Department of Pediatrics, New York Presbyterian Morgan Stanley Childrens Hospital, Columbia University, New York City, New York
| | - Kavita Parikh
- Division of Hospital Medicine, Children’s National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Bonnie T. Zima
- Center for Health Services and Society, UCLA-Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, California
| |
Collapse
|
21
|
El-Nahal WG, Chander G, Jones JL, Fojo AT, Keruly JC, Manabe YC, Moore RD, Gebo KA, Lesko CR. Telemedicine Use Among People With HIV in 2021: The Hybrid-Care Environment. J Acquir Immune Defic Syndr 2023; 92:223-230. [PMID: 36730830 PMCID: PMC9969325 DOI: 10.1097/qai.0000000000003124] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/24/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Telemedicine use for the care of people with HIV (PWH) significantly expanded during the COVID-19 pandemic. During 2021, vaccine uptake increased and patients were encouraged to resume in-person care, resulting in a mixture of in-person and telemedicine visits. We studied how different patient populations used telemedicine in this hybrid-care environment. METHODS Using observational data from patients enrolled in the Johns Hopkins HIV Clinical Cohort, we analyzed all in-person and telemedicine HIV primary care visits completed in an HIV clinic from January 1st, 2021, to December 31st, 2021. We used log-binomial regression to investigate the association between patient characteristics and the probability of completing a telemedicine versus in-person visit and the probability of completing a video versus telephone visit. RESULTS A total of 5518 visits were completed by 1884 patients; 4282 (77.6%) visits were in-person, 800 (14.5%) by phone, and 436 (7.9%) by video. The relative risk (RR) of completing telemedicine vs. in-person visits was 0.65 (95% Confidence Interval (CI): 0.47, 0.91) for patients age 65 years or older vs. age 20-39 years; 0.84 (95% CI: 0.72, 0.98) for male patients vs. female patients; 0.81 (95% CI: 0.66, 0.99) for Black vs. White patients; 0.62 (95% CI: 0.49, 0.79) for patients in the highest vs. lowest quartile of Area Deprivation Index; and 1.52 (95% CI: 1.26, 1.84) for patients >15 miles vs. <5 miles from clinic. CONCLUSIONS In the second year of the pandemic, overall in-person care was used more than telemedicine and significant differences persist across subgroups in telemedicine uptake.
Collapse
Affiliation(s)
- Walid G. El-Nahal
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Geetanjali Chander
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Joyce L. Jones
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anthony T. Fojo
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeanne C. Keruly
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yukari C. Manabe
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard D. Moore
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kelly A. Gebo
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Catherine R. Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
22
|
Discontinuation of Buprenorphine Treatment for Opioid Use Disorder During the Coronavirus Disease-2019 Pandemic: A Multilevel Framework. Med Care 2023; 61:95-101. [PMID: 36630560 PMCID: PMC9830961 DOI: 10.1097/mlr.0000000000001802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND The coronavirus disease-2019 pandemic has been associated with large increases in opioid-related mortality, yet it is unclear whether specific subpopulations were especially likely to discontinue buprenorphine treatment for opioid use disorder as the pandemic ensued. OBJECTIVE The aim was to assess predictors of buprenorphine discontinuation in the early months of the coronavirus disease-2019 pandemic (April-July 2020) compared with a prepandemic period (April-July 2019). DESIGN In each time period, we estimated a multilevel regression models to assess risk of discontinuation in April-July for people who started buprenorphine in January-February. Models included person-level, prescriber-level, and area-level covariates. SUBJECTS Individuals age 18 years or older in the all-payer IQVIA Longitudinal Prescription Claims. MEASURES The primary outcome was buprenorphine discontinuation (ie, no filled prescriptions during the follow-up periods). RESULTS Overall, 13.98% of patients discontinued buprenorphine in April-July 2020, less than the 15.71% in 2019 (P<0.001). In 2020, patient-level factors associated with discontinuation included younger age, male sex, shorter baseline possession ratio, and payment by cash. Compared with patients with a primary care physician prescriber, specialties most associated with discontinuation were pain medicine and physician assistant/nurse practitioner. Compared with the South Atlantic region, discontinuation risk was lowest in New England and highest in the West South Central States. The association between patient, prescriber, and geographic variables to risk of discontinuation was very similar in 2019 and 2020. CONCLUSIONS While clinical and policy interventions may have mitigated opioid use disorder treatment discontinuation following the pandemic, such discontinuation is nevertheless common and varies by identifiable patient, provider and geographic factors.
Collapse
|
23
|
Abstract
Telemental health-the use of videoconferencing or audio only (telephone) in mental health care-has accelerated tremendously since the start of the covid-19 pandemic. Meta-analyses have examined the reliability (ie, concordance) of assessment and the efficacy/effectiveness of telemental health compared with in-person care. Results indicate that telemental health assessment and clinical outcomes are similar compared with in-person care but there is much unexplained variability, as well as evidence that patient clinical and demographic characteristics can influence these findings. Further, gaps exist in the literature regarding specific patient populations (eg, psychotic disorders, children/adolescents), treatment modalities (eg, group therapy), audio only telemedicine, and hybrid care that mixes in-person with telemental health care. These gaps provide important directions for the next generation of telemental health research. Comprehensive clinical guidelines from mental health organizations are available to telemental health practitioners and focus on five content themes: legal and regulatory issues, clinical considerations, standard operating procedures and protocols, technical requirements, and considerations of specific populations and settings.
Collapse
Affiliation(s)
| | - Alisa B Busch
- McLean Hospital, Harvard Medical School, Belmont, MA
| |
Collapse
|
24
|
A cohort study examining changes in treatment patterns for alcohol use disorder among commercially insured adults in the United States during the COVID-19 pandemic. J Subst Abuse Treat 2023; 144:108920. [PMID: 36334384 PMCID: PMC9613781 DOI: 10.1016/j.jsat.2022.108920] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 08/15/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION We know very little about how the pandemic impacted outpatient alcohol use disorder (AUD) care and the role of telemedicine. METHODS Using OptumLabs® Data Warehouse de-identified administrative claims, we identified AUD cohorts in 2018 (N = 23,204) and 2019 (N = 23,445) and examined outpatient visits the following year, focusing on week 12, corresponding to the March 2020 US COVID-19 emergency declaration, through week 52. Using multivariable logistic regression, we examined the association between patient demographic and clinical characteristics and receipt of any outpatient AUD visits in 2020 vs. 2019. RESULTS In 2020, weekly AUD visit utilization decreased maximally at the pandemic start (week 12) by 22.5 % (2019: 3.8 %, 2020: 3.0 %, percentage point change [95 % CI] = -0.86[-1.19, -0.05]) but was similar to 2019 utilization by mid-April 2020 (week 16). Telemedicine accounted for 50.1 % of AUD visits by early July 2020 (week 27). Individual therapy returned to 2019 levels within 1 week (i.e., week 13) whereas group therapy did not consistently do so until mid-August 2020 (week 31). Further, individual therapy exceeded 2019 levels by as much as 50 % starting mid-October 2020. The study found no substantial differences in visits by patient demographic or clinical characteristics. CONCLUSIONS Among patients with known AUD, initial outpatient care disruptions were relatively brief. However, substantial shifts occurred in care delivery-an embrace of telemedicine but also more pronounced, longer disruptions in group therapy vs. individual and an increase in individual therapy use. Further research needs to help us understand the implications of these findings for clinical outcomes.
Collapse
|
25
|
Chumbler NR, Chen M, Harrison A, Surbhi S. Racial and Socioeconomic Characteristics Associated with the use of Telehealth Services Among Adults With Ambulatory Sensitive Conditions. Health Serv Res Manag Epidemiol 2023; 10:23333928231154334. [PMID: 36895424 PMCID: PMC9989408 DOI: 10.1177/23333928231154334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/10/2023] [Accepted: 01/14/2023] [Indexed: 03/06/2023] Open
Abstract
Introduction The COVID-19 pandemic led to a major transition for patients from routine ambulatory-care-based in-person primary care visits to telehealth visits to manage chronic diseases. However, it remains unclear the extent to which individuals access telehealth services and whether such utilization varies along neighborhood characteristics, especially among racial minorities. This study aims to examine the association of outpatient telehealth utilization with sociodemographic, clinical, and neighborhood characteristics among adults with ambulatory care sensitive conditions (ACSCs) during the COVID-19 pandemic. Methods We included adults treated for an ACSC between March 5, 2020, and December 31, 2020, at a single ambulatory-care-based healthcare system, which serves a large population of low-income patients in the South region of the United States (i.e., Memphis, TN, Metropolitan Statistical Area). Telehealth utilization was defined by outpatient procedural codes and providers' notes on the type of visits. Generalized linear mixed models were used to examine the association of sociodemographic, clinical, and neighborhood factors with telehealth utilization in the overall cohort and the racial subpopulations. Results Among the 13,962 adults with ACSCs, 8583 (62.5%) used outpatient telehealth services. Patients who were older, female, with mental disorders, and who had more comorbidities had higher rates of telehealth services (p < .05). Controlling for covariates, we observed 75.2% and 23.1% increased use of telehealth services among Hispanics and other race groups, respectively, compared to Whites. Patients who commuted more than 30 minutes to health facilities were slightly less likely to use telehealth services [OR: 0.994 (0.991,0.998)]. Racial minorities (Blacks and Hispanics) with mental disorders were more likely to use telehealth service when compared to Whites. Discussion We found that among patients being treated for ACSCs, the use of telehealth services was highly prevalent in Hispanic patients in general and were more pronounced among both Hispanics and Black patients who have mental disorders.
Collapse
Affiliation(s)
- Neale R Chumbler
- Department of Diagnostic and Health Sciences, College of Health Professions, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Ming Chen
- Center for Health System Improvement and Institute of Health Outcomes and Policy, The University of Tennessee Health Science Center, Memphis, TN, USA
| | | | - Satya Surbhi
- Center for Health System Improvement, College of Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA
| |
Collapse
|
26
|
Bruckner TA, Huo S, Huynh M, Du S, Young A, Ro A. Psychiatric Emergencies in Los Angeles County During, and After, Initial COVID-19 Societal Restrictions: An Interrupted Time-Series Analysis. Community Ment Health J 2022; 59:622-630. [PMID: 36509936 PMCID: PMC9744376 DOI: 10.1007/s10597-022-01043-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 10/13/2022] [Indexed: 12/14/2022]
Abstract
Emergency department (ED) visits for psychiatric care in the US reportedly declined during the COVID-19 pandemic. This work, however, does not control for strong temporal patterning in visits before the pandemic and does not examine a potential "rebound" in demand for psychiatric care following the relaxation of initial societal restrictions. Here, we examine COVID-19-related perturbations in psychiatric care during and after the 1st stage of societal restrictions in the largest safety-net hospital in Los Angeles. We retrieved psychiatric ED visit data (98,888 total over 156 weeks, Jan 2018 to Dec 2020) from Los Angeles County + USC Medical Center. We applied interrupted time series methods to identify and control for autocorrelation in psychiatric ED visits before examining their relation with the 1st stage of societal restrictions (i.e., March 13 to May 8, 2020), as well as the subsequent "rebound" period of relaxed restrictions (i.e., after May 8, 2020). Psychiatric ED visits fell by 78.13 per week (i.e., 12%) during the 1st stage of societal restrictions (SD = 23.99, p < 0.01). Reductions in ED visits for alcohol use, substance use, and (to a lesser extent) anxiety disorders accounted for the overall decline. After the 1st stage of societal restrictions, however, we observe no "rebound" above expected values in psychiatric ED visits overall (coef = - 16.89, SD = 20.58, p = 0.41) or by diagnostic subtype. This pattern of results does not support speculation that, at the population level, foregoing ED care during initial societal restrictions subsequently induced a psychiatric "pandemic" of urgent visits.
Collapse
Affiliation(s)
- Tim A Bruckner
- Program in Public Health, University of California, Irvine, Irvine, USA.
| | - Shutong Huo
- Program in Public Health, University of California, Irvine, Irvine, USA
| | - Michael Huynh
- Program in Public Health, University of California, Irvine, Irvine, USA
| | - Senxi Du
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, USA
| | - Andrew Young
- Harbor UCLA Medical Center, University of California, Los Angeles, Los Angeles, USA
| | - Annie Ro
- Program in Public Health, University of California, Irvine, Irvine, USA
| |
Collapse
|
27
|
Duncan A, Herrera CN, Okobi M, Nandi S, Oblath R. Locked down or locked out? Trends in psychiatric emergency services utilization during the COVID-19 pandemic. J Health Serv Res Policy 2022; 28:80-88. [PMID: 36475326 PMCID: PMC9732494 DOI: 10.1177/13558196221135119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To estimate changes in Boston Emergency Services Team (BEST) psychiatric emergency services (PES) encounter volume (total and by care team) and inpatient disposition during the first 8 months of the COVID-19 pandemic. METHODS Data on 30,657 PES encounters was extracted from the four-county, BEST reporting system. The study period consisted of the first 34 weeks of 2019 and 2020. This period corresponded to the first five stages of Massachusetts's COVID-19 public health restrictions: pre-lockdown, lockdown, Phase I, II and III reopenings. Descriptive and regression analyses were performed to estimate changes in encounter volume by care team and disposition. RESULTS Compared to the same period in 2019, covariate-adjusted, weekly PES encounters decreased by 39% (β = -0.40, 95% Confidence Interval (CI) = [-0.51, -0.28], p < 0.00) during the lockdown. PES volume remained significantly lower during Phase I reopening compared to the previous year but returned to 2019 levels during Phase II. The covariate-adjusted proportion of weekly encounters that led to inpatient admission significantly increased by 16% (CI = [0.11, 0.21], p < 0.00) for mobile crisis teams (MCTs) and significantly declined by 13% (CI = [-0.19, -0.07], p < 0.00) for BEST-designated emergency departments during the lockdown period compared to the prior year. CONCLUSIONS The overall drop in PES utilization and the rise in inpatient admissions for MCT encounters suggests that during the early phases of the pandemic, patients delayed psychiatric care until they had a psychiatric crisis. Public health messaging about the lockdowns and absent equivalent messaging about the availability of telehealth services may have made patients more reluctant to seek psychiatric care.
Collapse
Affiliation(s)
- Alison Duncan
- Director, Psychiatric Emergency Services, Boston Medical Center, Massachusetts, USA.,Assistant Professor, 1836Boston Univeristy Chobanian and Avedisian School of Medicine, Massachusetts, USA
| | - Carolina-Nicole Herrera
- Doctoral Candidate, Department of Health Law, Policy, and Management, 27118Boston University School of Public Health, Massachusetts, USA
| | - Margaret Okobi
- Medical Student, 1811Harvard School of Medicine, Boston, Massachusetts, USA.,Candidate, Masters of Public Health, 1848TH Chan School of Public Health, Harvard University, Cambridge, Massachusetts, USA
| | - Shurobhi Nandi
- Undergraduate, 1848Northeastern University, Boston, Massachusetts, USA
| | - Rachel Oblath
- Postdoctoral Associate, Department of Psychiatry, 1836Boston Medical Center, Massachusetts, USA
| |
Collapse
|
28
|
Palzes VA, Chi FW, Metz VE, Campbell C, Corriveau C, Sterling S. COVID-19 pandemic-related changes in utilization of telehealth and treatment overall for alcohol use problems. Alcohol Clin Exp Res 2022; 46:2280-2291. [PMID: 36527427 PMCID: PMC9877854 DOI: 10.1111/acer.14961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/07/2022] [Accepted: 10/14/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND During the COVID-19 pandemic, specialty alcohol treatment transitioned rapidly to telehealth, which may have created barriers for some patients but increased access for others. This study evaluated the impact of the COVID-19 pandemic on alcohol treatment utilization and potential disparities. METHODS We analyzed electronic health record and claims data from Kaiser Permanente Northern California for adults with alcohol use problems (alcohol use disorder or unhealthy alcohol use diagnoses) during pre-COVID-19 (March to December 2019, n = 32,806) and COVID-19 onset (March to December 2020, n = 26,763). Generalized estimating equation models were fit to examine pre-COVID-19 to COVID-19 onset changes in alcohol treatment initiation, engagement, and retention (days in treatment). Heterogeneity in pre-COVID-19 to COVID-19 onset changes in treatment utilization by age, race, and ethnicity; neighborhood deprivation index (NDI); and comorbid medical and psychiatric disorders were also examined. RESULTS Treatment initiation increased during the COVID-19 onset period (adjusted odds ratio [aOR] = 1.46; 95% CI = 1.41-1.52). The increases in odds of treatment initiation during the COVID-19 onset period compared with the pre-COVID period were largest among patients aged 18-34 years (aOR = 1.59; 95% CI = 1.48-1.71), those without medical conditions (aOR = 1.56; 95% CI = 1.49-1.65), and those without psychiatric disorders (aOR = 1.60; 95% CI = 1.51-1.69). Patients aged 18-34 years (aOR = 5.21; 95% CI = 4.67-5.81), those with the second highest NDIs (aOR = 4.63; 95% CI = 4.12-5.19), and those without medical (aOR = 4.34; 95% CI = 4.06-4.65) or psychiatric comorbidities (aOR = 4.48; 95% CI = 4.11-4.89) had the greatest increases in telehealth treatment initiation from pre-COVID-19 to COVID-19 onset. Treatment engagement and retention also increased during COVID-19 onset, with the greatest increase among patients aged 35-49 years who initiated treatment via telehealth (engagement: aOR = 2.33; 95% CI = 1.91-2.83; retention: adjusted mean difference [aMD] = 3.3 days; 95% CI = 2.6-4.1). We found no significant variation of changes in treatment utilization by race and ethnicity. CONCLUSIONS The transition to telehealth in this healthcare system may have attracted subgroups of individuals who have historically underutilized care for alcohol use problems, particularly younger and healthier adults, without exacerbating pre-pandemic racial and ethnic disparities in treatment utilization.
Collapse
Affiliation(s)
- Vanessa A. Palzes
- Center for Addiction and Mental Health Research, Division of ResearchKaiser Permanente Northern CaliforniaOaklandCaliforniaUSA
| | - Felicia W. Chi
- Center for Addiction and Mental Health Research, Division of ResearchKaiser Permanente Northern CaliforniaOaklandCaliforniaUSA
| | - Verena E. Metz
- Center for Addiction and Mental Health Research, Division of ResearchKaiser Permanente Northern CaliforniaOaklandCaliforniaUSA
| | - Cynthia Campbell
- Center for Addiction and Mental Health Research, Division of ResearchKaiser Permanente Northern CaliforniaOaklandCaliforniaUSA,Department of Psychiatry and Behavioral SciencesWeill Institute for Neurosciences, University of California, San FranciscoSan FranciscoCaliforniaUSA,Department of Health Systems ScienceKaiser Permanente Bernard J. Tyson School of MedicinePasadenaCaliforniaUSA
| | - Caroline Corriveau
- The Permanente Medical GroupAddiction Medicine and Recovery ServicesOaklandCaliforniaUSA
| | - Stacy Sterling
- Center for Addiction and Mental Health Research, Division of ResearchKaiser Permanente Northern CaliforniaOaklandCaliforniaUSA,Department of Psychiatry and Behavioral SciencesWeill Institute for Neurosciences, University of California, San FranciscoSan FranciscoCaliforniaUSA,Department of Health Systems ScienceKaiser Permanente Bernard J. Tyson School of MedicinePasadenaCaliforniaUSA
| |
Collapse
|
29
|
Harker N, Johnson K, Erasmus J, Myers B. COVID 19—impact on substance use treatment utilization and provision in South Africa. Subst Abuse Treat Prev Policy 2022; 17:15. [PMID: 35241095 PMCID: PMC8892117 DOI: 10.1186/s13011-022-00446-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has impacted people with substance use disorders (SUDs) worldwide. The aim of this study was to explore, changes in the number of SUD treatment episodes provided during the height of the pandemic and, SUD treatment providers’ perceptions of the impact of COVID-19-related restrictions on people with SUDs and the delivery of SUD treatment services in South Africa. Methods We used administrative data collected as part of the South African Community Epidemiology Network on Drug Use (SACENDU) project to assess whether the number of treatment episodes changed during the height of COVID-19 restrictions. We used data from an online survey of SUD treatment providers to assess providers’ perceptions of the impact of COVID-19 on SUD treatment delivery. Eight seven SUD facilities were recruited to participate in the online survey. Results Sixty-three organisations (out of a total of 86) participated in the survey, yielding a 73.2% response rate. About half (n = 30; 47.6%) of the sample thought the need for SUD treatment had remained the same or had increased during the COVID-19 lockdown. Half the sample (n = 32; 50.7%) reported decreased availability of SUD services during COVID-19 lockdowns. Participants believed that the lack of services during COVID-19 lockdown impacted negatively on patients that were enrolled in their programmes and on individuals who wished to access the service. Furthermore, changes in service provision seemed to increase patients’ anxiety, exacerbate pre-existing mental health problems and in some cases were thought to precipitate relapse. In addition, patient disengagement and attrition from treatment were thought to have increased during this period. Whilst 47.6% (n = 30) of providers agreed with the value of the alcohol ban, 23.8% (n = 15) of providers thought it had unintended negative consequences. Conclusion Based on the findings it is evident that SUD treatment services in South Africa have been significantly affected during the COVID-19 pandemic and more severely during the onset of the pandemic. Together with service providers, more effective ways should be sought on how to feasibly expand access to SUD treatment for all South Africans and enhance the country’s preparedness for future health emergencies.
Collapse
|
30
|
Alegría M, Falgas-Bague I, Fukuda M, Zhen-Duan J, Weaver C, O’Malley I, Layton T, Wallace J, Zhang L, Markle S, Lincourt P, Hussain S, Lewis-Fernández R, John DA, McGuire T. Racial/Ethnic Disparities in Substance Use Treatment in Medicaid Managed Care in New York City: The Role of Plan and Geography. Med Care 2022; 60:806-812. [PMID: 36038524 PMCID: PMC9588705 DOI: 10.1097/mlr.0000000000001768] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim was to assess the magnitude of health care disparities in treatment for substance use disorder (SUD) and the role of health plan membership and place of residence in observed disparities in Medicaid Managed Care (MMC) plans in New York City (NYC). DATA SOURCE Medicaid claims and managed care plan enrollment files for 2015-2017 in NYC. RESEARCH DESIGN We studied Medicaid enrollees with a SUD diagnosis during their first 6 months of enrollment in a managed care plan in 2015-2017. A series of linear regression models quantified service disparities across race/ethnicity for 5 outcome indicators: treatment engagement, receipt of psychosocial treatment, follow-up after withdrawal, rapid readmission, and treatment continuation. We assessed the degree to which plan membership and place of residence contributed to observed disparities. RESULTS We found disparities in access to treatment but the magnitude of the disparities in most cases was small. Plan membership and geography of residence explained little of the observed disparities. One exception is geography of residence among Asian Americans, which appears to mediate disparities for 2 of our 5 outcome measures. CONCLUSIONS Reallocating enrollees among MMC plans in NYC or evolving trends in group place of residence are unlikely to reduce disparities in treatment for SUD. System-wide reforms are needed to mitigate disparities.
Collapse
Affiliation(s)
- Margarita Alegría
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Irene Falgas-Bague
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Marie Fukuda
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA
| | - Jenny Zhen-Duan
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Cole Weaver
- Department of Health Care Policy, Harvard Medical School, Boston, MA
| | - Isabel O’Malley
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA
| | - Timothy Layton
- Department of Health Care Policy, Harvard Medical School, Boston, MA
| | | | - Lulu Zhang
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA
| | - Sheri Markle
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA
| | - Pat Lincourt
- New York State Office of Alcoholism and Substance Abuse Services, Albany, NY
| | - Shazia Hussain
- New York State Office of Alcoholism and Substance Abuse Services, Albany, NY
| | - Roberto Lewis-Fernández
- Department of Psychiatry, Columbia University, New York, NY
- New York State Psychiatric Institute, New York, NY
| | | | - Thomas McGuire
- Department of Health Care Policy, Harvard Medical School, Boston, MA
| |
Collapse
|
31
|
Banks DE, Paschke ME, Li X, Fentem A, Rich A, Szlyk HS, Cavazos-Rehg P. Opioid Use Disorder and COVID-19: Treatment and Recovery Factors among Vulnerable Populations at the Intersection of Two U.S. Epidemics. J Psychoactive Drugs 2022; 54:300-308. [PMID: 35616267 PMCID: PMC9588537 DOI: 10.1080/02791072.2022.2079443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 02/24/2022] [Accepted: 03/04/2022] [Indexed: 10/18/2022]
Abstract
Social inequities made some sociodemographic groups - including those of older age, minoritized race/ethnicity, and low socioeconomic status - disproportionately vulnerable to morbidity and mortality associated with the opioid epidemic and COVID-19 pandemic. Given shared vulnerability to these public health crises, it is critical to understand how COVID-19 impacts substance use disorder (SUD) treatment and recovery among people with these characteristics. The current study examined COVID-19's perceived impact on treatment factors and psychosocial outcomes by sociodemographic vulnerability. Patients receiving SUD treatment with a history of opioid misuse were recruited. Participants completed self-report questionnaires regarding the impact of COVID-19 on treatment indicators and mood and substance use symptoms. Most participants reported that COVID-19 decreased their treatment access and quality. There were no sociodemographic differences in treatment factors. Those with high sociodemographic vulnerability reported greater pandemic-related increases in depression and demonstrated greater mood symptoms. Post-hoc analyses demonstrated that unmet basic needs were significantly associated with lower treatment access and quality, greater mood symptoms, and higher substance use. Findings suggest pandemic-related stressors and barriers affected those across the sociodemographic spectrum. Treatment systems must address socioeconomic barriers to care exacerbated by the pandemic and bolster integrated treatment options for opioid use and mood disorders.
Collapse
Affiliation(s)
- Devin E. Banks
- Department of Psychological Sciences, University of Missouri – St. Louis, One University Blvd. 325 Stadler Hall, St. Louis, MO 63121
| | - Maria E. Paschke
- Department of Psychological Sciences, University of Missouri – St. Louis, One University Blvd. 325 Stadler Hall, St. Louis, MO 63121
| | - Xiao Li
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110
| | - Andrea Fentem
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110
| | - Amanda Rich
- Department of Psychological Sciences, University of Missouri – St. Louis, One University Blvd. 325 Stadler Hall, St. Louis, MO 63121
| | - Hannah S. Szlyk
- School of Social Work, Rutgers, The State University of New Jersey, 120 Albany St, New Brunswick, NJ 08901
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110
| |
Collapse
|
32
|
Ghoshal S, Rigney G, Cheng D, Brumit R, Gee MS, Hodin RA, Lillemoe KD, Levine WC, Succi MD. Institutional Surgical Response and Associated Volume Trends Throughout the COVID-19 Pandemic and Postvaccination Recovery Period. JAMA Netw Open 2022; 5:e2227443. [PMID: 35980636 PMCID: PMC9389350 DOI: 10.1001/jamanetworkopen.2022.27443] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The COVID-19 pandemic is associated with decreased surgical procedure volumes, but existing studies have not investigated this association beyond the end of 2020, analyzed changes during the post-vaccine release period, or quantified these changes by patient acuity. OBJECTIVE To quantify changes in the volume of surgical procedures at a 1017-bed academic quaternary care center from January 6, 2019, to December 31, 2021. DESIGN, SETTING, AND PARTICIPANTS In this cohort study, 129 596 surgical procedure volumes were retrospectively analyzed during 4 periods: pre-COVID-19 (January 6, 2019, to January 4, 2020), COVID-19 peak (March 15, 2020, to May 2, 2020), post-COVID-19 peak (May 3, 2020, to January 2, 2021), and post-vaccine release (January 3, 2021, to December 31, 2021). Surgery volumes were analyzed by subspecialty and case class (elective, emergent, nonurgent, urgent). Statistical analysis was by autoregressive integrated moving average modeling. MAIN OUTCOMES AND MEASURES The primary outcome of this study was the change in weekly surgical procedure volume across the 4 COVID-19 periods. RESULTS A total of 129 596 records of surgical procedures were reviewed. During the COVID-19 peak, overall weekly surgical procedure volumes (mean [SD] procedures per week, 406.00 [171.45]; 95% CI, 234.56-577.46) declined 44.6% from pre-COVID-19 levels (mean [SD] procedures per week, 732.37 [12.70]; 95% CI, 719.67-745.08; P < .001). This weekly volume decrease occurred across all surgical subspecialties. During the post-COVID peak period, overall weekly surgical volumes (mean [SD] procedures per week, 624.31 [142.45]; 95% CI, 481.85-766.76) recovered to only 85.8% of pre-COVID peak volumes (P < .001). This insufficient recovery was inconsistent across subspecialties and case classes. During the post-vaccine release period, although some subspecialties experienced recovery to pre-COVID-19 volumes, others continued to experience declines. CONCLUSIONS AND RELEVANCE This quaternary care institution effectively responded to the pressures of the COVID-19 pandemic by substantially decreasing surgical procedure volumes during the peak of the pandemic. However, overall surgical procedure volumes did not fully recover to pre-COVID-19 levels well into 2021, with inconsistent recovery rates across subspecialties and case classes. These declines suggest that delays in surgical procedures may result in potentially higher morbidity rates in the future. The differential recovery rates across subspecialties may inform institutional focus for future operational recovery.
Collapse
Affiliation(s)
- Soham Ghoshal
- Harvard Medical School, Boston, Massachusetts
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center, Massachusetts General Hospital, Boston
| | - Grant Rigney
- Harvard Medical School, Boston, Massachusetts
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center, Massachusetts General Hospital, Boston
| | - Debby Cheng
- Harvard Medical School, Boston, Massachusetts
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center, Massachusetts General Hospital, Boston
| | - Ryan Brumit
- Department of Anesthesia, Massachusetts General Hospital Boston
| | - Michael S. Gee
- Harvard Medical School, Boston, Massachusetts
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center, Massachusetts General Hospital, Boston
- Department of Radiology, Massachusetts General Hospital, Boston
| | - Richard A. Hodin
- Harvard Medical School, Boston, Massachusetts
- Department of Surgery, Massachusetts General Hospital, Boston
| | - Keith D. Lillemoe
- Harvard Medical School, Boston, Massachusetts
- Department of Surgery, Massachusetts General Hospital, Boston
| | - Wilton C. Levine
- Harvard Medical School, Boston, Massachusetts
- Department of Anesthesia, Massachusetts General Hospital Boston
| | - Marc D. Succi
- Harvard Medical School, Boston, Massachusetts
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center, Massachusetts General Hospital, Boston
- Department of Radiology, Massachusetts General Hospital, Boston
| |
Collapse
|
33
|
Chung YG, Person CM, O’Banion J, Primo SA. Coronavirus Disease 2019–Related Health Disparities in Ophthalmology with a Retrospective Analysis at a Large Academic Public Hospital. ADVANCES IN OPHTHALMOLOGY AND OPTOMETRY 2022; 7:311-323. [PMID: 35474943 PMCID: PMC9023339 DOI: 10.1016/j.yaoo.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
34
|
Tobin ET, Hadwiger A, DiChiara A, Entz A, Miller-Matero LR. Demographic Predictors of Telehealth Use for Integrated Psychological Services in Primary Care During the COVID-19 Pandemic. J Racial Ethn Health Disparities 2022; 10:1492-1498. [PMID: 35794514 DOI: 10.1007/s40615-022-01334-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/06/2022] [Accepted: 05/18/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Prior to the COVID-19 pandemic, growing mental health needs were well documented, particularly those of diverse patient populations. The current study aims to better understand racial and psychosocial factors associated with patient utilization of integrated psychological services via telehealth during the COVID-19 pandemic within a diverse primary care clinic. METHODS Retrospective chart reviews were completed for patients seen by an integrated psychology team within a general internal medicine clinic at a large urban health system during the year 2020. Demographics were extracted from the medical record. Multivariate logistic regression analyses were conducted to examine demographic predictors for (1) telehealth video visits vs. audio only telehealth visits and (2) in-person vs. telehealth visits (both video and audio). RESULTS Older patients, Black patients, and those with Medicare and Medicaid were more likely to complete audio only telehealth visits vs. video visits. There were no significant demographic predictors when comparing in-person vs. telehealth (both video and audio). DISCUSSION Some underserved and vulnerable patient populations are more likely to utilize audio-only integrated psychological visits to video visits. The utilization of audio visits over video for certain demographics speaks to the need to better understand how this type of care may benefit psychological services in the future and continued advocacy to extend audio mental health visits beyond the public health emergency to address patient populations with significant mental health needs.
Collapse
Affiliation(s)
- Erin T Tobin
- General Internal Medicine, Henry Ford Health, 2799 W Grand Blvd, K15, Detroit, MI, 48202, USA. .,Behavioral Health, Henry Ford Health, One Ford Place, Detroit, MI, 48202, USA.
| | - Ashley Hadwiger
- General Internal Medicine, Henry Ford Health, 2799 W Grand Blvd, K15, Detroit, MI, 48202, USA.,Behavioral Health, Henry Ford Health, One Ford Place, Detroit, MI, 48202, USA
| | - Alexander DiChiara
- General Internal Medicine, Henry Ford Health, 2799 W Grand Blvd, K15, Detroit, MI, 48202, USA.,Behavioral Health, Henry Ford Health, One Ford Place, Detroit, MI, 48202, USA
| | - Abigail Entz
- General Internal Medicine, Henry Ford Health, 2799 W Grand Blvd, K15, Detroit, MI, 48202, USA
| | - Lisa R Miller-Matero
- Behavioral Health, Henry Ford Health, One Ford Place, Detroit, MI, 48202, USA.,Center for Health Policy and Health Services Research, Henry Ford Health, One Ford Place, Detroit, MI, 48202, USA
| |
Collapse
|
35
|
Treatment seeking for alcohol-related issues during the COVID-19 pandemic: An analysis of an addiction-specialized psychiatric treatment facility. Heliyon 2022; 8:e09934. [PMID: 35855398 PMCID: PMC9279183 DOI: 10.1016/j.heliyon.2022.e09934] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 02/16/2022] [Accepted: 07/07/2022] [Indexed: 11/21/2022] Open
Abstract
The COVID-19 pandemic and its societal impact may cause long-term behavioral changes in alcohol use due to increased psychological distress, unemployment, and time spent home. The purpose of this study was to determine whether or not the COVID-19 pandemic had a significant impact on treatment seeking for alcohol use disorders and related problems in a Swedish psychiatric treatment facility. Using an interrupted-time-series design on data derived from an addiction-specific psychiatric treatment facility located in Malmö, Sweden, we hypothesized that treatment seeking would decrease during the pandemic based on previous research identifying limited alcohol availability and affordability, as well as accessibility to treatment centers as influential factors. In addition, we assessed the predictive power of alcohol sales and number of active cases in the region using simple linear regressions. Results indicated that the pandemic had little to no effect on the number of people needing care, however a significant step change was found in treatment seeking patterns for unique female patients during the second wave (October 2020). Regression analyses indicated that alcohol sales and the number of active cases in the region did not significantly predict treatment seeking. A causal relationship between the onset of the pandemic and variation in treatment seeking for alcohol use could not be established. More research is needed to fully understand the pandemic's impact on alcohol use behavior change.
Collapse
|
36
|
Leslie K, Bartram M, Atanackovic J, Chamberland-Rowe C, Tulk C, Bourgeault IL. Enhancing the capacity of the mental health and substance use health workforce to meet population needs: insights from a facilitated virtual policy dialogue. Health Res Policy Syst 2022; 20:51. [PMID: 35525981 PMCID: PMC9077339 DOI: 10.1186/s12961-022-00857-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/12/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Timely knowledge mobilization has become increasingly critical during the COVID-19 pandemic and complicated by the need to establish or maintain lines of communication between researchers and decision-makers virtually. Our recent pan-Canadian research study on the mental health and substance use health (MHSUH) workforce during the pandemic identified key policy barriers impacting this essential workforce. To bridge the evidence-policy gap in addressing these barriers, we held a facilitated virtual policy dialogue. This paper discusses the insights generated at this virtual policy dialogue and highlights how this integrated knowledge mobilization strategy can help drive evidence-based policy in an increasingly digital world. METHODS We held a 3-hour virtual policy dialogue with 46 stakeholders and policy decision-makers as the final phase in our year-long mixed-methods research study. The event was part of our integrated knowledge mobilization strategy and was designed to generate stakeholder-driven policy implications and priority actions based on our research findings. The data collected from the virtual policy dialogue included transcripts from the small-group breakout rooms and main sessions, reflective field notes and the final report from the external facilitator. Coded data were thematically analysed to inform our understanding of the prioritization of the policy implications and action items. RESULTS Facilitated virtual policy dialogues generate rich qualitative insights that guide community-informed knowledge mobilization strategies and promote evidence-informed policy. Our policy dialogue identified actionable policy recommendations with equity as a cross-cutting theme. Adapting policy dialogues to virtual formats and including technology-assisted facilitation can offer advantages for equitable stakeholder participation, allow for deeper analysis and help build consensus regarding evidence-based policy priorities. CONCLUSIONS Our facilitated virtual policy dialogue was a key knowledge mobilization strategy for our research on the capacity of the Canadian MHSUH workforce to respond to the COVID-19 pandemic. Our policy dialogue allowed us to engage a diverse group of MHSUH workforce stakeholders in a meaningful action-oriented way, provided an avenue to get feedback on our research findings, and generated prioritized action items that incorporated the knowledge and experience of these MHSUH workforce stakeholders.
Collapse
Affiliation(s)
- Kathleen Leslie
- Faculty of Health Disciplines, Athabasca University, 1 University Drive Athabasca, Athabasca, AB, T9S 3A3, Canada.
| | - Mary Bartram
- Mental Health Commission of Canada, 350 Albert Street, Suite 1210, Ottawa, ON, K1R 1A4, Canada
| | - Jelena Atanackovic
- School of Sociological and Anthropological Studies, University of Ottawa, 75 Laurier Avenue East, Ottawa, ON, K1N 6N5, Canada
| | - Caroline Chamberland-Rowe
- Telfer School of Management, University of Ottawa, 75 Laurier Avenue East, Ottawa, ON, K1N 6N5, Canada
| | - Christine Tulk
- Faculty of Arts and Social Sciences, Carleton University, 1125 Colonel By Drive, Ottawa, ON, K1S 5B6, Canada
| | - Ivy Lynn Bourgeault
- School of Sociological and Anthropological Studies, University of Ottawa, 75 Laurier Avenue East, Ottawa, ON, K1N 6N5, Canada
| |
Collapse
|
37
|
Carvalho S, Coelho CG, Kluwe-Schiavon B, Magalhães J, Leite J. The Acute Impact of the Early Stages of COVID-19 Pandemic in People with Pre-Existing Psychiatric Disorders: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095140. [PMID: 35564538 PMCID: PMC9104538 DOI: 10.3390/ijerph19095140] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/09/2022] [Accepted: 04/21/2022] [Indexed: 01/27/2023]
Abstract
People with pre-pandemic health conditions are more vulnerable and more likely to suffer greater psychosocial impact due to the current COVID-19 pandemic and the lockdown measures. Thus, the objective of this work was to systematically review the impact of the early stages COVID-19 pandemic on people with pre-existing psychiatric disorders. The search was performed between 23 January and 2 September 2021 in PubMed, PsycINFO, and EMBASE. A total of 4167 published results were identified; however, only 49 were included in this review. Results show that there was considerable heterogeneity among studies, which resulted in a low consensus. However, it seems that the impact of the first stage of the COVID-19 pandemic on psychiatric disorders was two-fold: (1) an overall effect, in which people suffering from psychiatric disorders in general experienced more psychological distress and anxiety when compared to people who had no psychiatric diagnosis, and (2) a condition-specific effect, namely in people suffering from eating disorders and obsessive compulsive disorders. Moreover, the current work highlights that there were also some external factors that were related to worsening symptoms. For instance, unemployment or experiencing work and financial difficulties can be a trigger for greater distress during the pandemic for people with mood disorders, and being alone and in social isolation during the COVID-19 pandemic may actually increase substance use and relapse rates. Further studies are needed to prospectively investigate the long-term effects of the current COVID-19 pandemic on people with (pre)-existing psychiatric conditions and on the onset or deterioration of psychiatric-related symptoms in a larger number of participants, as well as exploring the long-term effects of the current pandemic on mental health.
Collapse
Affiliation(s)
- Sandra Carvalho
- Translational Neuropsychology Laboratory, William James Center for Research, Department of Education and Psychology, University of Aveiro, 3810-193 Aveiro, Portugal
- Correspondence:
| | - Catarina G. Coelho
- Psychological Neuroscience Laboratory, CIPsi, School of Psychology, University of Minho, 4710-057 Braga, Portugal; (C.G.C.); (B.K.-S.); (J.M.)
| | - Bruno Kluwe-Schiavon
- Psychological Neuroscience Laboratory, CIPsi, School of Psychology, University of Minho, 4710-057 Braga, Portugal; (C.G.C.); (B.K.-S.); (J.M.)
| | - Juliana Magalhães
- Psychological Neuroscience Laboratory, CIPsi, School of Psychology, University of Minho, 4710-057 Braga, Portugal; (C.G.C.); (B.K.-S.); (J.M.)
| | - Jorge Leite
- Portucalense Institute for Human Development (INPP), Portucalense University, 4200-072 Porto, Portugal;
| |
Collapse
|
38
|
Ainslie M, Brunette MF, Capozzoli M. Treatment Interruptions and Telemedicine Utilization in Serious Mental Illness: Retrospective Longitudinal Claims Analysis. JMIR Ment Health 2022; 9:e33092. [PMID: 35311673 PMCID: PMC8981005 DOI: 10.2196/33092] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 01/24/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Avoiding interruptions and dropout in outpatient care can prevent mental illness symptom exacerbation and costly crisis services, such as emergency room visits and inpatient psychiatric hospitalization. During the COVID-19 pandemic, to attempt to maintain care continuity, telemedicine services were increasingly utilized, despite the lack of data on efficacy in patients with serious mental illness. Patients with serious mental illness are challenging to enroll and sustain in randomized controlled trials over time due to fluctuations in disease exacerbation. However, capturing and examining utilization and efficacy data in community mental health center (CMHC) patients with serious mental illness during the pandemic is a unique opportunity to inform future clinical and policy decision-making. OBJECTIVE We aimed to identify and describe the characteristics of CMHC patients with serious mental illness who experienced treatment interruptions and who utilized telemedicine during the pandemic. METHODS We conducted a retrospective observational study of treatment interruptions and telemedicine use during the period from December 2019 to June 2020 (compared to the period from December 2018 to June 2019) in New Hampshire CMHC patients. The study population included all Medicaid beneficiaries with serious mental illness engaged in treatment 3 months prior to the declaration of a state of emergency in response to the COVID-19 pandemic. We used chi-square tests of independence and logistic regression to explore associations between treatment interruptions and variables (gender, age, rurality, and diagnosis). Telemedicine utilization was categorized as low (<25%), medium (25%-75%), or high (>75%) use. RESULTS A total of 16,030 patients were identified. New Hampshire CMHCs demonstrated only a 4.9% increase in treatment interruptions compared with the year prior. Patients who were male (odds ratio [OR] 1.27, 95% CI 1.17-1.38; P<.001), under the age of 18 years (ages 0-12 years: OR 1.37, 95% CI 0.62-0.86, P<.001; aged 13-17 years: OR 1.49, 95% CI 0.57-0.79, P<.001), or among milder diagnostic categories, such as anxiety disorders (OR 3.77, 95% CI 3.04-4.68; P<.001) and posttraumatic stress disorder (OR 3.69, 95% CI 2.96-4.61; P<.001), were most likely to experience treatment interruptions. Patients who were female (OR 0.89, CI 0.65-0.74), 18 to 34 years old (OR 0.74, CI 0.70-0.79), or among milder diagnostic categories, such as anxiety disorder (OR 0.69, CI 0.65-0.74) or posttraumatic stress disorder (OR 0.77, CI 0.72-0.83), and with major depressive disorder (OR 0.73, CI 0.68-0.78) were less likely to be in the low telemedicine utilization group. CONCLUSIONS The integration of telemedicine supported care continuity for most CMHC patients; yet, retention varied by subpopulation, as did telemedicine utilization. The development of policies and clinical practice guidelines requires empirical evidence on the effectiveness and limitations of telemedicine in patients with serious mental illness.
Collapse
Affiliation(s)
- Marcy Ainslie
- Department of Nursing, University of New Hampshire, Durham, NH, United States
| | - Mary F Brunette
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Michelle Capozzoli
- Department of Mathematics & Statistics, University of New Hampshire, Durham, NH, United States
| |
Collapse
|
39
|
COURCHESNE-Krak NS, KEPNER W, RUBANO A, MARIENFELD C. Differences in outpatient, emergency, and inpatient use among pregnant women with a substance-related diagnosis. Am J Obstet Gynecol MFM 2022; 4:100559. [PMID: 34990875 PMCID: PMC8891059 DOI: 10.1016/j.ajogmf.2021.100559] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/15/2021] [Accepted: 12/29/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND As a vulnerable population, pregnant women with a substance-related diagnosis (ie, substance use, misuse, or dependence) may use healthcare disproportionately. OBJECTIVE The primary goal of this study was to evaluate the differences in the use of outpatient clinical visits, emergency department visits, and inpatient days in the hospital among women with and without a substance-related diagnosis during the antepartum period. STUDY DESIGN This retrospective study retrieved electronic health record data on women (age, 18-44 years) who delivered a single live birth or stillbirth at ≥20 weeks of gestation from April 1, 2012, to September 30, 2019. Imbalance in measured maternal sociodemographic and obstetrical characteristics between women with and without a substance-related diagnosis was attenuated using propensity score matching on key demographic characteristics (eg, age), yielding a matched 1:1 sample. Unadjusted and adjusted logistic regressions models were used to determine the association between a substance-related diagnosis and outpatient visits, emergency visits, and inpatient days. RESULTS From the total sample (n=16,770), the matched cohort consisted of 1986 deliveries. Of these, most were White (51.0%), or mixed or of some other race (31.1%). The mean age was 29.8 (standard deviation, 5.6). A substance-related diagnosis was identified in 993 women (50%) because of matching. Women with a substance-related diagnosis were more likely to have ≤10 outpatient visits than women without a substance-related diagnosis (adjusted odds ratio, 1.81 [95% confidence interval, 1.44-2.28]; P<.0001). Alcohol-, opioid-, and stimulant-related diagnoses were independently associated with ≤10 outpatient visits (adjusted odds ratio, 3.16 [95% confidence interval, 1.67-6.04]; P=.0005; adjusted odds ratio, 3.02 [95% confidence interval, 1.79-5.09]; P<.0001; adjusted odds ratio, 2.18 [95% confidence interval, 1.39-3.41]; P=.0007, respectively). Women with a substance-related diagnosis were more likely to have ≥1 emergency visit than women without a substance-related diagnosis (adjusted odds ratio, 1.36 [95% confidence interval, 1.00-1.85]; P<.0001). Opioid-, stimulant-, and nicotine-related diagnoses were independently associated with ≥1 emergency visit (adjusted odds ratio, 2.28 [95% confidence interval, 1.09-4.77]; P=.0287; adjusted odds ratio, 2.01 [95% confidence interval, 1.07-3.78]; P=.0301; adjusted odds ratio, 3.38 [95% confidence interval, 1.90-6.02]; P<.0001, respectively). Women with a substance-related diagnosis were more likely to have ≥3 inpatient days than women without a substance-related diagnosis (adjusted odds ratio, 1.69 [95% confidence interval, 1.07-2.67]; P=.0256). Opioid-, stimulant-, and nicotine-related diagnosis were independently associated with ≥3 inpatient days (adjusted odds ratio, 3.52 [95% confidence interval, 1.42-8.75]; P=.0067; adjusted odds ratio, 3.51 [95% confidence interval, 1.31-9.34]; P=.0123; adjusted odds ratio, 2.74 [95% confidence interval, 1.11-6.73]; P=.0285, respectively). CONCLUSION Women with a substance-related diagnosis during the antepartum period who delivered a single live birth or stillbirth at ≥20 weeks of gestation were experiencing fewer outpatient visits, more emergency department visits, and more inpatient days than women without a substance-related diagnosis. The type of substance-related diagnosis (eg, alcohol, opioids, stimulants, or nicotine) was associated with different patterns of healthcare use. The results from this study have reinforced the need to identify substance-related diagnoses in pregnant women early to minimize disproportionate healthcare service utilization through intervention and treatment.
Collapse
Affiliation(s)
- Natasia S. COURCHESNE-Krak
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, MC0957, La Jolla, CA 92093, USA
| | - Wayne KEPNER
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, MC0957, La Jolla, CA 92093, USA
| | - Amanda RUBANO
- Medicine, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY 14642, USA
| | - Carla MARIENFELD
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, MC0957, La Jolla, CA 92093, USA
| |
Collapse
|
40
|
Abstract
Coronavirus disease 2019 (COVID-19)-related stressors and restrictions, in the absence of social and institutional support, have led many individuals to either increase their substance consumption or relapse. Consequently, treatment programs for substance use disorders (SUDs) made a transition from in-person to remote care delivery. This review discusses the following evidence regarding changes prompted by the COVID pandemic to the clinical care of individuals with SUDs: (1) reduction in availability of care, (2) increase in demand for care, (3) transition to telemedicine use, (4) telemedicine for treatment of opioid use disorders, and (5) considerations for use of telemedicine in treating SUDs.
Collapse
|
41
|
Curfman A, Hackell JM, Herendeen NE, Alexander J, Marcin JP, Moskowitz WB, Bodnar CEF, Simon HK, McSwain SD. Telehealth: Opportunities to Improve Access, Quality, and Cost in Pediatric Care. Pediatrics 2022; 149:184902. [PMID: 35224638 DOI: 10.1542/peds.2021-056035] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The use of telehealth technology to connect with patients has expanded significantly over the past several years, particularly in response to the global coronavirus disease 2019 pandemic. This technical report describes the present state of telehealth and its current and potential applications. Telehealth has the potential to transform the way care is delivered to pediatric patients, expanding access to pediatric care across geographic distances, leveraging the pediatric workforce for care delivery, and improving disparities in access to care. However, implementation will require significant efforts to address the digital divide to ensure that telehealth does not inadvertently exacerbate inequities in care. The medical home model will continue to evolve to use telehealth to provide high-quality care for children, particularly for children and youth with special health care needs, in accordance with current and evolving quality standards. Research and metric development are critical for the development of evidence-based best practices and policies in these new models of care. Finally, as pediatric care transitions from traditional fee-for-service payment to alternative payment methods, telehealth offers unique opportunities to establish value-based population health models that are financed in a sustainable manner.
Collapse
Affiliation(s)
- Alison Curfman
- Department of Pediatrics, Mercy Clinic, St Louis, Missouri.,Rubicon Founders
| | - Jesse M Hackell
- Department of Pediatrics, New York Medical College and Boston Children's Health Physicians, Pomona, New York
| | - Neil E Herendeen
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, New York
| | - Joshua Alexander
- Departments of Physical Medicine and Rehabilitation and Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - James P Marcin
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of California Davis and University of California Davis Children's Hospital, Sacramento, California
| | - William B Moskowitz
- Division of Pediatric Cardiology, Department of Pediatrics, Children's of Mississippi and University of Mississippi Medical Center, Jackson, Mississippi
| | - Chelsea E F Bodnar
- Robert Wood Johnson Foundation Clinical Scholars Program, University of Montana, Missoula, Montana
| | - Harold K Simon
- Departments of Pediatrics and Emergency Medicine, School of Medicine, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - S David McSwain
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| |
Collapse
|
42
|
Mafi JN, Craff M, Vangala S, Pu T, Skinner D, Tabatabai-Yazdi C, Nelson A, Reid R, Agniel D, Tseng CH, Sarkisian C, Damberg CL, Kahn KL. Trends in US Ambulatory Care Patterns During the COVID-19 Pandemic, 2019-2021. JAMA 2022; 327:237-247. [PMID: 35040886 PMCID: PMC8767442 DOI: 10.1001/jama.2021.24294] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 12/19/2021] [Indexed: 01/24/2023]
Abstract
Importance Following reductions in US ambulatory care early in the pandemic, it remains unclear whether care consistently returned to expected rates across insurance types and services. Objective To assess whether patients with Medicaid or Medicare-Medicaid dual eligibility had significantly lower than expected return to use of ambulatory care rates than patients with commercial, Medicare Advantage, or Medicare fee-for-service insurance. Design, Setting, and Participants In this retrospective cohort study examining ambulatory care service patterns from January 1, 2019, through February 28, 2021, claims data from multiple US payers were combined using the Milliman MedInsight research database. Using a difference-in-differences design, the extent to which utilization during the pandemic differed from expected rates had the pandemic not occurred was estimated. Changes in utilization rates between January and February 2020 and each subsequent 2-month time frame during the pandemic were compared with the changes in the corresponding months from the year prior. Age- and sex-adjusted Poisson regression models of monthly utilization counts were used, offsetting for total patient-months and stratifying by service and insurance type. Exposures Patients with Medicaid or Medicare-Medicaid dual eligibility compared with patients with commercial, Medicare Advantage, or Medicare fee-for-service insurance, respectively. Main Outcomes and Measures Utilization rates per 100 people for 6 services: emergency department, office and urgent care, behavioral health, screening colonoscopies, screening mammograms, and contraception counseling or HIV screening. Results More than 14.5 million US adults were included (mean age, 52.7 years; 54.9% women). In the March-April 2020 time frame, the combined use of 6 ambulatory services declined to 67.0% (95% CI, 66.9%-67.1%) of expected rates, but returned to 96.7% (95% CI, 96.6%-96.8%) of expected rates by the November-December 2020 time frame. During the second COVID-19 wave in the January-February 2021 time frame, overall utilization again declined to 86.2% (95% CI, 86.1%-86.3%) of expected rates, with colonoscopy remaining at 65.0% (95% CI, 64.1%-65.9%) and mammography at 79.2% (95% CI, 78.5%-79.8%) of expected rates. By the January-February 2021 time frame, overall utilization returned to expected rates as follows: patients with Medicaid at 78.4% (95% CI, 78.2%-78.7%), Medicare-Medicaid dual eligibility at 73.3% (95% CI, 72.8%-73.8%), commercial at 90.7% (95% CI, 90.5%-90.9%), Medicare Advantage at 83.2% (95% CI, 81.7%-82.2%), and Medicare fee-for-service at 82.0% (95% CI, 81.7%-82.2%; P < .001; comparing return to expected utilization rates among patients with Medicaid and Medicare-Medicaid dual eligibility, respectively, with each of the other insurance types). Conclusions and Relevance Between March 2020 and February 2021, aggregate use of 6 ambulatory care services increased after the preceding decrease in utilization that followed the onset of the COVID-19 pandemic. However, the rate of increase in use of these ambulatory care services was significantly lower for participants with Medicaid or Medicare-Medicaid dual eligibility than for those insured by commercial, Medicare Advantage, or Medicare fee-for-service.
Collapse
Affiliation(s)
- John N. Mafi
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles
- RAND Health, RAND Corporation, Santa Monica, California
| | | | - Sitaram Vangala
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles
| | - Thomas Pu
- Milliman MedInsight, Seattle, Washington
| | | | | | | | - Rachel Reid
- RAND Health, RAND Corporation, Santa Monica, California
- Division of General Internal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Denis Agniel
- RAND Health, RAND Corporation, Santa Monica, California
| | - Chi-Hong Tseng
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles
| | - Catherine Sarkisian
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles
| | | | - Katherine L. Kahn
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles
- RAND Health, RAND Corporation, Santa Monica, California
| |
Collapse
|
43
|
Busch AB, Huskamp HA, Raja P, Rose S, Mehrotra A. Disruptions in Care for Medicare Beneficiaries With Severe Mental Illness During the COVID-19 Pandemic. JAMA Netw Open 2022; 5:e2145677. [PMID: 35089352 PMCID: PMC8800078 DOI: 10.1001/jamanetworkopen.2021.45677] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
IMPORTANCE Little is known about changes in care for individuals with severe mental illness during the COVID-19 pandemic. OBJECTIVE To examine changes in mental health care during the pandemic and the use of telemedicine in outpatient care among Medicare beneficiaries with severe mental illness. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study included Medicare beneficiaries (age ≥18 years) diagnosed with schizophrenia and schizophrenia-related disorders or bipolar I disorder. Care patterns during January to September 2020 for a cohort defined in 2019 were compared with those during January to September 2019 for a cohort defined in 2018. EXPOSURES Start of COVID-19 pandemic in the United States, defined as week 12 of 2020. MAIN OUTCOMES AND MEASURES Use of mental health-related outpatient visits, emergency department visits, inpatient care, and oral prescription fills for antipsychotics and mood stabilizers during 4-week intervals. Multivariable logistic regression analyses examined whether the pandemic was associated with differential changes in outpatient care across patient characteristics. RESULTS The 2019 cohort of 686 214 individuals included 389 245 (53.8%) women, 114 073 (15.8%) Black and 526 301 (72.8%) White individuals, and 477 353 individuals (66.0%) younger than 65 years; the 2020 cohort of 723 045 individuals included 367 140 (53.5%) women, 106 699 (15.6%) Black and 497 885 (72.6%) White individuals, and 442 645 individuals (64.5%) younger than 65 years. Compared with 2019, there were large decreases during the pandemic's first month (calendar weeks 12-15) in individuals with outpatient visits (265 169 [36.7%] vs 200 590 [29.2%]; 20.3% decrease), with antipsychotic and mood stabilizer medication prescription fills (216 468 [29.9%] vs 163 796 [23.9%]; 20.3% decrease), with emergency department visits (12 383 [1.7%] vs 8503 [1.2%]; 27.7% decrease), and with hospital admissions (11 564 [1.6%] vs 7912 [1.2%]; 27.9% decrease). By weeks 32 to 35 of 2020, utilization rebounded but remained lower than in 2019, ranging from a relative decrease of 2.5% (outpatient visits) to 12.9% (admissions). During the full pandemic period (weeks 12-39) in 2020, 1 556 403 of 2 743 553 outpatient visits (56.7%) were provided via telemedicine. In multivariable analyses, outpatient visit use during weeks 12 to 25 of 2020 was lower among those with disability (odds ratio, 0.95; 95% CI, 0.93-0.96), and during weeks 26 to 39 of 2020, it was lower among Black vs non-Hispanic White individuals (OR, 0.97; 95% CI, 0.95-0.99) and those with dual Medicaid eligibility (OR, 0.96; 95% CI, 0.95-0.98). CONCLUSIONS AND RELEVANCE In this cohort study, despite greater use of telemedicine, individuals with severe mental illness experienced large disruptions in care early in the pandemic. These narrowed but persisted through September 2020. Disruptions were greater for several disadvantaged populations.
Collapse
Affiliation(s)
- Alisa B. Busch
- McLean Hospital, Belmont, Massachusetts
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Haiden A. Huskamp
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Pushpa Raja
- US Department of Veterans Affairs Greater Los Angeles Medical Center, Los Angeles, California
| | - Sherri Rose
- Center for Health Policy and Center for Primary Care and Outcomes Research, Stanford University, Stanford, California
| | - Ateev Mehrotra
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| |
Collapse
|
44
|
Harju A, Neufeld J. Telehealth Utilization During the COVID-19 Pandemic: A Preliminary Selective Review. TELEMEDICINE REPORTS 2022; 3:38-47. [PMID: 35720447 PMCID: PMC8989093 DOI: 10.1089/tmr.2021.0040] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/06/2022] [Indexed: 05/06/2023]
Abstract
Background: The COVID-19 pandemic reduced in-person visit volume and fueled a corresponding explosion in demand for telehealth services, resulting in the enactment of several temporary state and federal policies to allow greater flexibility in delivering telehealth services. This review examines patterns in telehealth utilization during the pandemic by synthesizing available findings from large-scale studies. Methods: To be included in this review, studies must be of original research, include data from 2020 or 2021, have a U.S. study population, and analyze telehealth encounter data across multiple payers and health systems. This review includes 10 studies that fully met the inclusion criteria and 29 studies that examined telehealth use during the pandemic, although not from multipayer, multihealth system data sets. All studies were identified using Ovid MEDLINE and Google Scholar. Results: At its peak, telehealth accounted for roughly 15-50% of visits across the various studied populations and data sets. The more telehealth was utilized, the smaller the decrease in overall visit volume. Audio visits tended to be used more often than video visits, and telehealth utilization varied across geographic regions and medical specialties. There were disparities in telehealth use by race, age, income, and other factors. Discussion: Most telehealth visits during the pandemic would not have been reimbursable without the telehealth policy changes that took place. The variability in telehealth utilization across geographic regions is likely attributed to state-level telehealth policies. Most studies examining disparities in telehealth utilization did not compare disparities from before and during the pandemic, and these disparities may be a characteristic of health care overall rather than of telehealth specifically.
Collapse
Affiliation(s)
- Amelia Harju
- Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota, USA
- *Address correspondence to: Amelia Harju, MPH, Institute for Health Informatics, University of Minnesota, 8-100 PWB, MMC912, 420 Delaware Street SE, Minneapolis, MN 55455, USA,
| | - Jonathan Neufeld
- Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota, USA
| |
Collapse
|
45
|
Sugg MM, Runkle JD, Andersen L, Weiser J, Michael KD. Crisis response among essential workers and their children during the COVID-19 pandemic. Prev Med 2021; 153:106852. [PMID: 34673081 PMCID: PMC8524246 DOI: 10.1016/j.ypmed.2021.106852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 10/12/2021] [Accepted: 10/14/2021] [Indexed: 01/06/2023]
Abstract
Limited research has been conducted on the mental health concerns of frontline and essential workers and their children during the COVID-19 pandemic in the United States (U.S.). This study examined the association between working on the frontlines in the U.S. during the COVID-19 pandemic (March to July 2020) and personal crisis text concerns (e.g., self-harm, suicidal thoughts, anxiety/stress, and substance abuse) for frontline essential workers and the children of frontline workers. We used a novel data set from a crisis texting service, Crisis Text Line (CTL), that is widely used throughout the U.S. Generalized Estimating Equations examined the individual association between eight specific crisis types (Depression, Stress/Anxiety, Self-Harm, Suicidal Thoughts, Substance Abuse, Isolation, Relationship Issues, and Abuse) and being in frontline work or being a child of a frontline worker during the early phase of the pandemic. Using CTL concerns as a proxy for the prevalence of mental health issues, we found that children of workers, specifically the youngest demographic (13 years and under), females, and non-conforming youth had a higher risk of specific crisis events during the COVID-19 pandemic. Additionally, Hispanic children of workers reported higher rates of stress/anxiety, whereas African American children of workers had higher rates of abuse and depression. Frontline workers had a higher risk of suicidal thoughts, and the risk of crisis events was generally highest for non-binary, transgender, and male users. Increases in CTL usage among frontline workers were noted across 7-28 days after spikes in local COVID-19 cases. The research to date has focused on the mental health of frontline essential workers, but our study highlights troubling trends in psychological stress among children of these workers. Supportive interventions and mental health resources are needed not only for frontline essential workers, but for their children too.
Collapse
Affiliation(s)
- Margaret M Sugg
- Department of Geography and Planning, Appalachian State University, P.O. Box 32066, Boone, North Carolina 28608, United States.
| | - Jennifer D Runkle
- North Carolina Institute for Climate Studies, North Carolina State University, 151 Patton Avenue, Asheville, NC 28801, United States
| | - Lauren Andersen
- Department of Geography and Planning, Appalachian State University, P.O. Box 32066, Boone, North Carolina 28608, United States
| | - Jaclyn Weiser
- Crisis Text Line, PO Box 1144, New York, NY 10159, United States
| | - Kurt D Michael
- Department of Psychology, Appalachian State University, P.O. Box 32109, Boone, North Carolina 28608, United States
| |
Collapse
|
46
|
McGuire AB, Flanagan ME, Kukla M, Rollins AL, Myers LJ, Bass E, Garabrant JM, Salyers MP. Inpatient Mental Healthcare before and during the COVID-19 Pandemic. Healthcare (Basel) 2021; 9:healthcare9121613. [PMID: 34946338 PMCID: PMC8701042 DOI: 10.3390/healthcare9121613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/03/2021] [Accepted: 11/08/2021] [Indexed: 11/30/2022] Open
Abstract
Prior studies have demonstrated disruption to outpatient mental health services after the onset of the COVID-19 pandemic. Inpatient mental health services have received less attention. The current study utilized an existing cohort of 33 Veterans Health Affairs (VHA) acute inpatient mental health units to examine disruptions to inpatient services. It further explored the association between patient demographic, clinical, and services variables on relapse rates. Inpatient admissions and therapeutic services (group and individual therapy and peer support) were lower amongst the COVID-19 sample than prior to the onset of COVID-19 while lengths of stay were longer. Relapse rates did not differ between cohorts. Patients with prior emergent services use as well as substance abuse or personality disorder diagnoses were at higher risk for relapse. Receiving group therapy while admitted was associated with lower risk of relapse. Inpatient mental health services saw substantial disruptions across the cohort. Inpatient mental health services, including group therapy, may be an important tool to prevent subsequent relapse.
Collapse
Affiliation(s)
- Alan B. McGuire
- Health Services Research & Development, Richard L. Roudebush VAMC, Indianapolis, IN 46202, USA; (M.E.F.); (M.K.); (A.L.R.); (L.J.M.); (E.B.); (J.M.G.)
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA;
- Correspondence:
| | - Mindy E. Flanagan
- Health Services Research & Development, Richard L. Roudebush VAMC, Indianapolis, IN 46202, USA; (M.E.F.); (M.K.); (A.L.R.); (L.J.M.); (E.B.); (J.M.G.)
| | - Marina Kukla
- Health Services Research & Development, Richard L. Roudebush VAMC, Indianapolis, IN 46202, USA; (M.E.F.); (M.K.); (A.L.R.); (L.J.M.); (E.B.); (J.M.G.)
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA;
| | - Angela L. Rollins
- Health Services Research & Development, Richard L. Roudebush VAMC, Indianapolis, IN 46202, USA; (M.E.F.); (M.K.); (A.L.R.); (L.J.M.); (E.B.); (J.M.G.)
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA;
- Health Services Research, Regenstrief Institute, Indianapolis, IN 46202, USA
| | - Laura J. Myers
- Health Services Research & Development, Richard L. Roudebush VAMC, Indianapolis, IN 46202, USA; (M.E.F.); (M.K.); (A.L.R.); (L.J.M.); (E.B.); (J.M.G.)
- Health Services Research, Regenstrief Institute, Indianapolis, IN 46202, USA
- Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Emily Bass
- Health Services Research & Development, Richard L. Roudebush VAMC, Indianapolis, IN 46202, USA; (M.E.F.); (M.K.); (A.L.R.); (L.J.M.); (E.B.); (J.M.G.)
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA;
| | - Jennifer M. Garabrant
- Health Services Research & Development, Richard L. Roudebush VAMC, Indianapolis, IN 46202, USA; (M.E.F.); (M.K.); (A.L.R.); (L.J.M.); (E.B.); (J.M.G.)
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA;
| | - Michelle P. Salyers
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA;
| |
Collapse
|
47
|
Schmidt RA, Genois R, Jin J, Vigo D, Rehm J, Rush B. The early impact of COVID-19 on the incidence, prevalence, and severity of alcohol use and other drugs: A systematic review. Drug Alcohol Depend 2021; 228:109065. [PMID: 34600257 PMCID: PMC8455354 DOI: 10.1016/j.drugalcdep.2021.109065] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of this paper was to examine the early impact of COVID-19 on substance use to assess implications for planning substance use treatment and support systems. METHOD A systematic review of literature published up to March 2021 was conducted to summarize changes in prevalence, incidence, and severity of substance use associated with COVID-19 and the accompanying public health measures, including lockdown, stay-at-home orders, and social distancing. RESULTS We identified 53 papers describing changes to substance use at the population level. The majority of papers described changes related to alcohol use and most relied on self-reported measures of consumption during the COVID-19 pandemic, compared with pre-pandemic use. There was less evidence to support changes in non-alcohol substance use. In general, risky pre-pandemic alcohol use, caregiving responsibilities, stress, depression, anxiety, and current treatment for a mental disorder were found to be associated with increased substance use. CONCLUSION This review provides preliminary data on changes in substance use, indicating that certain segments of the population increased their alcohol use early on in the COVID-19 pandemic and may be at greater risk of harm and in need of additional services. There is a need for additional population-level information on substance use to inform evidence-based rapid responses from a treatment system perspective.
Collapse
Affiliation(s)
- Rose A. Schmidt
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, ON M5T 2S1, Canada,Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 1P8, Canada,Correspondence to: 33 Ursula Franklin Street, Toronto, ON, Canada
| | - Rosalie Genois
- Université de Sherbrooke, 2500 Boulevard de l'Université, Sherbrooke, QC J1K 2R1, Canada.
| | - Jonathan Jin
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, ON M5T 2S1, Canada.
| | - Daniel Vigo
- Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC V6T 2A1, Canada.
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, ON M5T 2S1, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 1P8, Canada; Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany; Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, ON M5T 1R8, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON M5T 2S1, Canada; Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Trubetskaya str., 8, b. 2, 119992 Moscow, Russian Federation; Agència de Salut Pública de Catalunya, 81-95 Roc Boronat St., 08005 Barcelona, Spain; Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246 Hamburg, Germany.
| | - Brian Rush
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, ON M5T 2S1, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 1P8, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON M5T 2S1, Canada.
| |
Collapse
|
48
|
Qian F, Hastings JF, Ahmed R. Overcoming telemental health disparities during the COVID-19 pandemic. Int J Qual Health Care 2021; 33:6372514. [PMID: 34541600 PMCID: PMC8499973 DOI: 10.1093/intqhc/mzab127] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/16/2021] [Accepted: 09/19/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Feng Qian
- Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany-State University of New York
| | - Julia F Hastings
- Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany-State University of New York.,Department of Health Policy, Management, and Behavior, School of Social Welfare, University at Albany-State University of New York
| | - Rukhsana Ahmed
- Department of Communication, University at Albany-State University of New York, 1400 Washington Avenue, Albany, NY 12222, USA
| |
Collapse
|
49
|
Chan B, Bougatsos C, Priest KC, McCarty D, Grusing S, Chou R. Opioid treatment programs, telemedicine and COVID-19: A scoping review. Subst Abus 2021; 43:539-546. [PMID: 34520702 DOI: 10.1080/08897077.2021.1967836] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: Methadone and buprenorphine are effective medications for opioid use disorder (MOUD) that are highly regulated in the United States. The on-going opioid crisis, and more recently COVID-19, has prompted reconsideration of these restrictions in order to sustain and improve treatment access, with renewed interest in telemedicine. We reviewed the evidence on use of telemedicine interventions and applicability to MOUD policy changes in the post-COVID-19 treatment landscape. Methods: Ovid MEDLINE and the Cochrane Database of Systematic Reviews databases were searched from inception to April 2021 and reference lists were reviewed to identify additional studies. Studies were eligible if they examined telemedicine interventions and reported outcomes (e.g. treatment initiation, retention in care). Randomized trials and controlled observational studies were prioritized; other studies were included when stronger evidence was unavailable. One investigator abstracted key information and a second investigator verified data. We described the results qualitatively. Results: We identified nine studies: three controlled trials (two randomized), and six observational studies. Three studies evaluated patients treated with methadone and six studies with buprenorphine, including one study of pregnant women with OUD. All studies showed telemedicine approaches associated with similar outcomes (treatment retention, positive urine toxicology) compared to treatment as usual. Trials were limited by small samples sizes, lack of reporting harms, and most were conducted prior to the COVID-19 pandemic; observational studies were limited by failure to control for confounding. Conclusions: Limited evidence suggests that telemedicine may enhance access to MOUD with similar effectiveness compared with face-to-face treatment. Few studies have been published since COVID-19, and it is unclear the potential impact of these interventions on the existing racial/ethnic disparities in treatment. The COVID-19 pandemic and need for social distancing led to temporary policy changes for prescribing of MOUD that could inform additional research in this area to support comprehensive policy reforms.
Collapse
Affiliation(s)
- Brian Chan
- Department of Medical Informatics and Clinical Epidemiology, Pacific Northwest Evidence-Based Practice Center, Oregon Health & Science University, BICC, Portland, OR, USA.,Division of General Internal Medicine & Geriatrics, Section of Addiction Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Christina Bougatsos
- Department of Medical Informatics and Clinical Epidemiology, Pacific Northwest Evidence-Based Practice Center, Oregon Health & Science University, BICC, Portland, OR, USA
| | - Kelsey C Priest
- OHSU School of Medicine, MD/PhD Program, Oregon Health & Science University, Portland, OR, USA
| | - Dennis McCarty
- Department of Medical Informatics and Clinical Epidemiology, Pacific Northwest Evidence-Based Practice Center, Oregon Health & Science University, BICC, Portland, OR, USA.,OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR, USA
| | - Sara Grusing
- Department of Medical Informatics and Clinical Epidemiology, Pacific Northwest Evidence-Based Practice Center, Oregon Health & Science University, BICC, Portland, OR, USA
| | - Roger Chou
- Department of Medical Informatics and Clinical Epidemiology, Pacific Northwest Evidence-Based Practice Center, Oregon Health & Science University, BICC, Portland, OR, USA
| |
Collapse
|
50
|
Roth CB, Papassotiropoulos A, Brühl AB, Lang UE, Huber CG. Psychiatry in the Digital Age: A Blessing or a Curse? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8302. [PMID: 34444055 PMCID: PMC8391902 DOI: 10.3390/ijerph18168302] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/31/2021] [Accepted: 08/03/2021] [Indexed: 12/23/2022]
Abstract
Social distancing and the shortage of healthcare professionals during the COVID-19 pandemic, the impact of population aging on the healthcare system, as well as the rapid pace of digital innovation are catalyzing the development and implementation of new technologies and digital services in psychiatry. Is this transformation a blessing or a curse for psychiatry? To answer this question, we conducted a literature review covering a broad range of new technologies and eHealth services, including telepsychiatry; computer-, internet-, and app-based cognitive behavioral therapy; virtual reality; digital applied games; a digital medicine system; omics; neuroimaging; machine learning; precision psychiatry; clinical decision support; electronic health records; physician charting; digital language translators; and online mental health resources for patients. We found that eHealth services provide effective, scalable, and cost-efficient options for the treatment of people with limited or no access to mental health care. This review highlights innovative technologies spearheading the way to more effective and safer treatments. We identified artificially intelligent tools that relieve physicians from routine tasks, allowing them to focus on collaborative doctor-patient relationships. The transformation of traditional clinics into digital ones is outlined, and the challenges associated with the successful deployment of digitalization in psychiatry are highlighted.
Collapse
Affiliation(s)
- Carl B. Roth
- University Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland; (A.P.); (A.B.B.); (U.E.L.); (C.G.H.)
| | - Andreas Papassotiropoulos
- University Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland; (A.P.); (A.B.B.); (U.E.L.); (C.G.H.)
- Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Birmannsgasse 8, CH-4055 Basel, Switzerland
- Division of Molecular Neuroscience, Department of Psychology, University of Basel, Birmannsgasse 8, CH-4055 Basel, Switzerland
- Biozentrum, Life Sciences Training Facility, University of Basel, Klingelbergstrasse 50/70, CH-4056 Basel, Switzerland
| | - Annette B. Brühl
- University Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland; (A.P.); (A.B.B.); (U.E.L.); (C.G.H.)
| | - Undine E. Lang
- University Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland; (A.P.); (A.B.B.); (U.E.L.); (C.G.H.)
| | - Christian G. Huber
- University Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland; (A.P.); (A.B.B.); (U.E.L.); (C.G.H.)
| |
Collapse
|