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Endo Y, Woldesenbet S, Tsilimigras DI, Munir MM, Khalil M, Khan MMM, Altaf A, Rashid Z, Catalano G, Chatzipanagiotou OP, Pawlik TM. Effect of telemedicine use on medical spending and health care utilization among patients with gastrointestinal cancer. J Gastrointest Surg 2024:S1091-255X(24)00503-1. [PMID: 38901553 DOI: 10.1016/j.gassur.2024.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/07/2024] [Accepted: 06/10/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND We sought to assess the impact of telemedicine on healthcare utilization and medical expenditures among patients with a diagnosis of gastrointestinal (GI) cancer. METHODS Patients with newly diagnosed GI cancer from 2013 to 2020 were identified from the IBM MarketScan database (IBM Watson Health) . Healthcare utilization, total medical outpatient insurance payments within 1 year post-diagnosis, and out-of-pocket (OOP) expenses among telemedicine users and non-users were assessed after propensity score matching (PSM). RESULTS Among the 32,677 patients with GI cancer (esophageal, n = 1862, 5.7%; gastric, n = 2009, 6.1%; liver, n = 2929, 9.0%; bile duct, n = 597, 1.8%; pancreas, n = 3083, 9.4%; colorectal, n = 22,197, 67.9%), a total of 3063 (9.7%) utilized telemedicine. After PSM (telemedicine users, n = 3064; non-users, n = 3064), telemedicine users demonstrated a higher frequency of clinic visits (median: 5.0 days, IQR 4.0-7.0 vs non-users: 2.0 days, IQR 2.0-3.0, P < .001) and fewer potential days missed from daily activities (median: 7.5 days, IQR 4.5-12.5 vs non-users: 8.5 days, IQR 5.5-13.5, P < .001). Total medical spending per month and utilization of emergency room (ER) visits for telemedicine users were higher vs non-users (median: $10,658, IQR $5112-$18,528 vs non-users: $10,103, IQR $4628-$16,750; 46.8% vs 42.6%, both P < .01), whereas monthly OOP costs were comparable (median: $273, IQR $137-$449 for telemedicine users vs non-users: $268, IQR $142-$434, P = .625). CONCLUSION Telemedicine utilization was associated with increased outpatient clinic visits yet reduced potential days missed from daily activities among patients with GI cancer. Telemedicine users tended to have more ER visits and total medical spending per month, although monthly OOP costs were comparable with non-users.
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Affiliation(s)
- Yutaka Endo
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, United States
| | - Selamawit Woldesenbet
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, United States
| | - Diamantis I Tsilimigras
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, United States
| | - Muhammad Musaab Munir
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, United States
| | - Mujtaba Khalil
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, United States
| | - Muhammad Muntazir Mehdi Khan
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, United States
| | - Abdullah Altaf
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, United States
| | - Zayed Rashid
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, United States
| | - Giovanni Catalano
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, United States
| | - Odysseas P Chatzipanagiotou
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, United States
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, United States.
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DeGuzman PB, Lyons GR, Azar FN, Kimble A, Huang G, Rheuban K, Gray SH. Impact of Telemedicine on Access to Care for Rural Transgender and Gender-Diverse Youth. J Pediatr 2024; 267:113911. [PMID: 38218369 DOI: 10.1016/j.jpeds.2024.113911] [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: 09/06/2023] [Revised: 01/04/2024] [Accepted: 01/09/2024] [Indexed: 01/15/2024]
Abstract
OBJECTIVE To explore the impact of telemedicine on access to gender-affirming care for rural transgender and gender diverse youth. STUDY DESIGN A retrospective analysis of data drawn from the electronic medical records of a clinic that provides approximately 10 000 adolescent and young adult visits per year and serves patients seeking gender health care. The no-show rate was examined as a proxy for access to care due to anticipated challenges with recruiting a representative sample of a historically marginalized population. Logistic regression with generalized estimating equations was conducted to model the association between the odds of a no-show visit and covariates of interest. RESULTS Telemedicine visits, rural home address, gender health visits, longer travel time, and being younger than 18 years old were associated with lower odds of a no-show in univariate models (n = 17 928 visits). In the adjusted model, the OR of no-shows for gender health visits was 0.56 (95% CI 0.42-0.74), adjusting for rurality, telemedicine, age (< or >18 years), and travel time to the clinic. CONCLUSIONS In this study, telemedicine was associated with reduced no-shows overall, and especially for rural, transgender and gender diverse youth, and patients who hold both identities. Although the no-show rate does not fully capture barriers to access, these findings provide insight into how this vulnerable population may benefit from expanded access to telemedicine for rural individuals whose communities may lack providers with the skills to serve this population.
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Affiliation(s)
- Pamela B DeGuzman
- Department of Family, Community, and Mental Health Systems, University of Virginia School of Nursing, Charlottesville, VA.
| | - Genevieve R Lyons
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA
| | - Francesca N Azar
- Department of Family, Community, and Mental Health Systems, University of Virginia School of Nursing, Charlottesville, VA
| | - April Kimble
- Teen and Adolescent Health Center, UVA Health, Charlottesville, VA
| | - Guoping Huang
- Spatial Sciences Institute, University of Southern California, Los Angeles, CA
| | - Karen Rheuban
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA
| | - Susan H Gray
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA
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Stopka TJ, Estadt AT, Leichtling G, Schleicher JC, Mixson LS, Bresett J, Romo E, Dowd P, Walters SM, Young AM, Zule W, Friedmann PD, Go VF, Baker R, Fredericksen RJ. Barriers to opioid use disorder treatment among people who use drugs in the rural United States: A qualitative, multi-site study. Soc Sci Med 2024; 346:116660. [PMID: 38484417 PMCID: PMC10997882 DOI: 10.1016/j.socscimed.2024.116660] [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: 07/05/2023] [Revised: 11/26/2023] [Accepted: 02/05/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND In 2020, 2.8 million people required substance use disorder (SUD) treatment in nonmetropolitan or 'rural' areas in the U.S. Among this population, only 10% received SUD treatment from a specialty facility, and 1 in 500 received medication for opioid use disorder (MOUD). We explored the context surrounding barriers to SUD treatment in the rural United States. METHODS We conducted semi-structured, in-depth interviews from 2018 to 2019 to assess barriers to SUD treatment among people who use drugs (PWUD) across seven rural U.S. study sites. Using the social-ecological model (SEM), we examined individual, interpersonal, organizational, community, and policy factors contributing to perceived barriers to SUD treatment. We employed deductive and inductive coding and analytical approaches to identify themes. We also calculated descriptive statistics for participant characteristics and salient themes. RESULTS Among 304 participants (55% male, mean age 36 years), we identified barriers to SUD treatment in rural areas across SEM levels. At the individual/interpersonal level, relevant themes included: fear of withdrawal, the need to "get things in order" before entering treatment, close-knit communities and limited confidentiality, networks and settings that perpetuated drug use, and stigma. Organizational-level barriers included: strict facility rules, treatment programs managed like corrections facilities, lack of gender-specific treatment programs, and concerns about jeopardizing employment. Community-level barriers included: limited availability of treatment in local rural communities, long distances and limited transportation, waitlists, and a lack of information about treatment options. Policy-level themes included insurance challenges and system-imposed barriers such as arrest and incarceration. CONCLUSION Our findings highlight multi-level barriers to SUD treatment in rural U.S. communities. Salient barriers included the need to travel long distances to treatment, challenges to confidentiality due to small, close-knit communities where people are highly familiar with one another, and high-threshold treatment program practices. Our findings point to the need to facilitate the elimination of treatment barriers at each level of the SEM in rural America.
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Affiliation(s)
- T J Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA.
| | - A T Estadt
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | | | - J C Schleicher
- University of Wisconsin-Madison, School of Medicine and Public Health, Department of Medicine, Madison, WI, USA
| | - L S Mixson
- University of Washington, Department of Medicine, Seattle, WA, USA
| | - J Bresett
- Southern Illinois University at Carbondale, Dept of Public Health, Carbondale, IL, USA
| | - E Romo
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - P Dowd
- Chan Medical School-Baystate, University of Massachusetts, Springfield, MA, USA
| | - S M Walters
- New York University's Grossman School of Medicine, New York, NY, USA
| | - A M Young
- College of Public Health, University of Kentucky, Lexington, KY, USA
| | - W Zule
- RTI International, Research Triangle, NC, USA
| | - P D Friedmann
- Chan Medical School-Baystate, University of Massachusetts, Springfield, MA, USA
| | - V F Go
- University, of North Carolina, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - R Baker
- Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, USA
| | - R J Fredericksen
- University of Washington, Department of Medicine, Seattle, WA, USA
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Raver E, Retchin SM, Li Y, Carlo AD, Xu WY. Rural-urban differences in out-of-network treatment initiation and engagement rates for substance use disorders. Health Serv Res 2024. [PMID: 38456488 DOI: 10.1111/1475-6773.14299] [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: 03/09/2024] Open
Abstract
OBJECTIVE To examine rural-urban disparities in substance use disorder treatment access and continuation. DATA SOURCES AND STUDY SETTING We analyzed a 2016-2018 U.S. national secondary dataset of commercial insurance claims. STUDY DESIGN This cross-sectional study examined individuals with a new episode of opioid, alcohol, or other drug use disorders. Treatment initiation and engagement rates, and rates of using out-of-network providers for these services, were compared between rural and urban patients. DATA COLLECTION We included individuals 18-64 years old with continuous employer-sponsored insurance. PRINCIPAL FINDINGS Patients in rural settings experienced lower treatment initiation rates for alcohol (36.6% vs. 38.0%, p < 0.001), opioid (41.2% vs. 44.2%, p < 0.001), and other drug (37.7% vs. 40.1%, p < 0.001) use disorders, relative to those in urban areas. Similarly, rural patients had lower treatment engagement rates for alcohol (15.1% vs. 17.3%, p < 0.001), opioid (21.0% vs. 22.6%, p < 0.001), and other drug (15.5% vs. 17.5%, p < 0.001) use disorders. Rural patients had higher out-of-network rates for treatment initiation for other drug use disorders (20.4% vs. 17.2%, p < 0.001), and for treatment engagement for alcohol (27.6% vs. 25.2%, p = 0.006) and other drug (36.1% vs. 31.1%, p < 0.001) use disorders. CONCLUSIONS These findings indicate that individuals with substance use disorders in rural areas have lower rates of initial and ongoing treatment, and are more likely to seek care out-of-network.
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Affiliation(s)
- Eli Raver
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Sheldon M Retchin
- Division of General Internal Medicine, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Yiting Li
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Andrew D Carlo
- Meadows Mental Health Policy Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Wendy Y Xu
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio, USA
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Walker B, Stoecker C, Shao Y, Nauman E, Kabagambe EK, Shi L. Predictors of Telehealth Utilization and Subsequent Inpatient Stays and Emergency Visits During the COVID-19 Pandemic Among Patients with Type 2 Diabetes: Evidence from Louisiana. Telemed J E Health 2024; 30:278-283. [PMID: 37405746 DOI: 10.1089/tmj.2022.0509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023] Open
Abstract
Objective: To understand which types of Medicare patients with diabetes disproportionately used telehealth during the coronavirus disease 2019 pandemic and how their characteristics mediated their inpatient and emergency department (ED) utilization. Methods: Logistic regression analyses were used to measure the associations between patient characteristics and telehealth utilization using electronic health records among Medicare patients with diabetes (n = 31,654). Propensity score matching was used to examine the relative impact of telehealth use in conjunction with race, ethnicity, and age on inpatient and ED outcomes. Results: Telehealth was associated with age (75-84 vs. 65-74; odds ratio [OR] = 0.810, p < 0.01), gender (female: OR = 1.148, p < 0.01), and chronic diseases (e.g., lung disease: OR = 1.142; p < 0.01). Black patients using telehealth were less likely to visit the ED (estimate = -0.018; p = 0.08), whereas younger beneficiaries using telehealth were less likely to experience an inpatient stay (estimate = -0.017; p = 0.06). Conclusions: Telehealth expansion particularly benefited the clinically vulnerable but saw uneven use and uneven benefit along sociodemographic lines. Clinical Trial Registration Number: NCT03136471.
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Affiliation(s)
- Brigham Walker
- Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Charles Stoecker
- Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Yixue Shao
- Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Elizabeth Nauman
- Louisiana Public Health Institute (LPHI), New Orleans, Louisiana, USA
| | - Edmond K Kabagambe
- Penn Medicine Lancaster General Health Research Institute, Lancaster, Pennsylvania, USA
| | - Lizheng Shi
- Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
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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.
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Affiliation(s)
| | | | | | - Winnie Chi
- Elevance Health Inc, Wilmington, DE, USA.
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Lira MC, Jimes C, Coffey MJ. Retention in Telehealth Treatment for Opioid Use Disorder Among Rural Populations: A Retrospective Cohort Study. Telemed J E Health 2023; 29:1890-1896. [PMID: 37184856 PMCID: PMC10714254 DOI: 10.1089/tmj.2023.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/07/2023] [Accepted: 04/10/2023] [Indexed: 05/16/2023] Open
Abstract
Introduction: There are limited studies to date on telemedicine treatment outcomes for opioid use disorder (OUD) among rural populations. Methods: This was a retrospective cohort study of rural adults enrolled in telemedicine OUD treatment. Study outcomes were percent retained in care and adherence to buprenorphine assessed by urine drug screens at 1, 3, and 6 months. Results: From April 1, 2020, through January 31, 2022, 1,816 rural patients across 14 states attended an initial telemedicine visit and received a clinical diagnosis of OUD. Participants had the following characteristics: mean age 37.7 years (±8.6); 52.4% female; and 66.7% Medicaid. At 1, 3, and 6 months, 74.8%, 61.5%, and 52.3% of participants were retained in care, and 69.0%, 56.0%, and 49.2% of participants were adherent, respectively. Conclusions: Telemedicine is an effective approach for treating OUD in rural populations, with retention comparable to in-person treatment.
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Affiliation(s)
| | - Cynthia Jimes
- Workit Labs, Workit Health, Ann Arbor, Michigan, USA
| | - M. Justin Coffey
- Workit Labs, Workit Health, Ann Arbor, Michigan, USA
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
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Pham H, Lin C, Zhu Y, Clingan SE, Lin LA, Mooney LJ, Murphy SM, Campbell CI, Liu Y, Hser YI. Telemedicine-delivered treatment for substance use disorder: A scoping review. J Telemed Telecare 2023:1357633X231190945. [PMID: 37537907 DOI: 10.1177/1357633x231190945] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
INTRODUCTION The COVID pandemic prompted a significant increase in the utilization of telemedicine (TM) for substance use disorder (SUD) treatment. As we transition towards a "new normal" policy, it is crucial to comprehensively understand the evidence of TM in SUD treatment. This scoping review aims to summarize existing evidence regarding TM's acceptability, quality, effectiveness, access/utilization, and cost in the context of SUD treatment in order to identify knowledge gaps and inform policy decisions regarding TM for SUDs. METHOD We searched studies published in 2012-2022 from PubMed, Cochrane Library, Embase, Web of Science, and other sources. Findings were synthesized using thematic analysis. RESULTS A total of 856 relevant articles were screened, with a final total of 42 articles included in the review. TM in SUD treatment was perceived to be generally beneficial and acceptable. TM was as effective as in-person SUD care in terms of substance use reduction and treatment retention; however, most studies lacked rigorous designs and follow-up durations were brief (≤3 months). Telephone-based TM platforms (vs video) were positively associated with older age, lower education, and no prior overdose. Providers generally consider TM to be affordable for patients, but no relevant studies were available from patient perspectives. CONCLUSIONS TM in SUD treatment is generally perceived to be beneficial and acceptable and as effective as in-person care, although more rigorously designed studies on effectiveness are still lacking. Access and utilization of TM may vary by platform. TM service quality and costs are the least studied and warrant further investigations.
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Affiliation(s)
- Huyen Pham
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, USA
| | - Chunqing Lin
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, USA
| | - Yuhui Zhu
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, USA
| | - Sarah E Clingan
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, USA
| | - Lewei Allison Lin
- Department of Psychiatry, University of Michigan, Ann Arbor, USA
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, USA
| | - Larissa J Mooney
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, USA
- VA Greater Los Angeles Healthcare System, Los Angeles, USA
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, New York, USA
| | - Cynthia I Campbell
- Center for Addiction and Mental Health Research, Division of Research, Kaiser Permanente Northern California, Oakland, USA
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, USA
| | - Yanping Liu
- Center for Clinical Trials Network, National Institute on Drug Abuse, Bethesda, USA
| | - Yih-Ing Hser
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, USA
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Callison K, Anderson A, Shao Y, LaVeist TA, Walker B. Disparities in Telemedicine Use Among Louisiana Medicaid Beneficiaries During the COVID-19 Pandemic. Med Care 2023; 61:S70-S76. [PMID: 36893421 PMCID: PMC9994576 DOI: 10.1097/mlr.0000000000001795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
BACKGROUND The COVID-19 pandemic led to an increased reliance on telemedicine. Whether this exacerbated existing disparities within vulnerable populations is not yet known. OBJECTIVES Characterize changes in outpatient telemedicine evaluation and management (E&M) services for Louisiana Medicaid beneficiaries by race, ethnicity, and rurality during the COVID-19 pandemic. RESEARCH DESIGN Interrupted time series regression models estimated pre-COVID-19 trends and changes in E&M service use at the April and July 2020 peaks in COVID-19 infections in Louisiana and in December 2020 after those peaks had subsided. SUBJECTS Louisiana Medicaid beneficiaries continuously enrolled between January 2018 and December 2020 who were not also enrolled in Medicare. MEASURES Monthly outpatient E&M claims per 1000 beneficiaries. RESULTS Prepandemic differences in service use between non-Hispanic White and non-Hispanic Black beneficiaries narrowed by 34% through December 2020 (95% CI: 17.6%-50.6%), while differences between non-Hispanic White and Hispanic beneficiaries increased by 10.5% (95% CI: 0.1%-20.7%). Non-Hispanic White beneficiaries used telemedicine at higher rates than non-Hispanic Black (difference=24.9 claims per 1000 beneficiaries, 95% CI: 22.3-27.4) and Hispanic beneficiaries (difference=42.3 claims per 1000 beneficiaries, 95% CI: 39.1-45.5) during the first wave of COVID-19 infections in Louisiana. Telemedicine use increased slightly for rural beneficiaries compared with urban beneficiaries (difference=5.3 claims per 1000 beneficiaries, 95% CI: 4.0-6.6). CONCLUSIONS The COVID-19 pandemic narrowed gaps in outpatient E&M service use between non-Hispanic White and non-Hispanic Black Louisiana Medicaid beneficiaries, though gaps in telemedicine use emerged. Hispanic beneficiaries experienced large reductions in service use and relatively small increases in telemedicine use.
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Santos EOD, Pinho LBD, Silva ABD, Eslabão AD. Analysis of access to the psychosocial care network for users of alcohol and other drugs in rural areas. Rev Gaucha Enferm 2022; 43:e20210229. [PMID: 36043644 DOI: 10.1590/1983-1447.2022.20210229.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 12/30/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To analyze the access to the Psychosocial Care Network for rural residents with problems related to alcohol abuse and other drugs. METHODS Qualitative research, based on the Empowerment Evaluation framework. Data collection took place from March to December 2017 and was carried out through triangulation of qualitative methods with 42 Psychosocial Care Network workers in a municipality in Rio Grande do Sul, Brazil. Data analysis was performed by thematic analysis. RESULTS The challenges of access are identified due to cultural issues and the lack of resources to structure the network in its connection with rural territories. Support strategies for access include articulation with other services through matrix support. CONCLUSIONS The access to the network is precarious for prevention and continuity of care. It is suggested a greater articulation of the network with the rural teams and an investment in the structure of the network.
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Affiliation(s)
| | - Leandro Barbosa de Pinho
- Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
| | - Aline Basso da Silva
- Universidade Federal de Pelotas (UFPel), Faculdade de Enfermagem. Pelotas, Rio Grande do Sul, Brasil
| | - Adriane Domingues Eslabão
- Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
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Cui J, Prankumar SK, Wong HT, Addo IY, Tumwine C, Noor MN. Protocol for a scoping review of the use of information and communication technology platforms for the delivery and utilisation of transgender healthcare. BMJ Open 2022; 12:e055914. [PMID: 35649592 PMCID: PMC9161065 DOI: 10.1136/bmjopen-2021-055914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION In recent years, there has been strong interest in making digital health and social tools more accessible, particularly among vulnerable and stigmatised groups such as transgender people. While transgender people experience unique physical, mental and sexual health needs, not much is currently known about the extent to which they use information and communication technologies such as short messaging service and videoconferencing to access health services. In this paper, we discuss our protocol for a scoping review of the literature about the delivery and utilisation of digitally mediated health services for transgender populations. METHODS AND ANALYSIS This scoping review of the provision and experience of telemedicine among transgender people will follow the methodological framework developed by Arksey and O'Malley. The search will be conducted using three online databases, namely PubMed, CINAHL and Scopus, with additional literature explored using Google Scholar to identify grey literature. Relevant English-language studies will be shortlisted after completing a title and abstract review based on defined inclusion criteria. Following that, a final list of included studies will be compiled after a full-text review of the shortlisted articles has been completed. To enable the screening process, a team of researchers will be assigned refereed publications explicitly referring to the provision and experience of transgender healthcare through telemedicine. Screening performed independently will then collaboratively be reviewed to maintain consistency. ETHICS AND DISSEMINATION The research is exempt from ethics approval since our analysis is based on extant research into the use of digital technologies in providing healthcare to transgender people. The results of this study will be disseminated through peer-reviewed academic publications and presentations. Our analysis will guide the design of further research and practice relating to the use of digital communication technologies to deliver healthcare services to transgender people.
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Affiliation(s)
- Jialiang Cui
- Department of Social Work, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Sujith Kumar Prankumar
- Centre for Social Research in Health, UNSW, Sydney, New South Wales, Australia
- ARC Centre of Excellence for Automated Decision-Making and Society, Swinburne University, Melbourne, Victoria, Australia
| | - Horas Th Wong
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- t150 Transgender Health Service, Population and Community Health, NSW Health, Sydney, New South Wales, Australia
| | - Isaac Yeboah Addo
- Quality and System Performance Unit, Cancer Institute NSW, Sydney, New South Wales, Australia
| | | | - Muhammad Naveed Noor
- Department of pathology and laboratory medicine, The Aga Khan University, Karachi, Sindh, Pakistan
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12
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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.
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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
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13
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Callison K, Anderson A, Shao Y, LaVeist TA, Walker B. Pre-COVID-19 Disparities in Telemedicine Use Among Louisiana Medicaid Beneficiaries. Telemed J E Health 2022; 28:1698-1703. [PMID: 35297687 DOI: 10.1089/tmj.2022.0034] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: We examine trends in telemedicine use by race, geography, and age among Louisiana Medicaid beneficiaries in the months preceding the COVID-19 pandemic. Methods: Using Louisiana Medicaid claims data from January 2018 through February 2020, we calculated a relative ratio of telemedicine use as the share of telemedicine claims by race, age, and geography and conducted two-sample t-tests. Results: In 2018, White beneficiaries used telemedicine at a relative ratio of 1.92 compared with Black beneficiaries (p < 0.001) and 2.02 compared with Hispanic beneficiaries (p < 0.001). Rural beneficiaries used telemedicine at a relative ratio of 1.27 (p < 0.001) compared with urban beneficiaries. Children and adolescents used telemedicine at a higher rate than other age groups. Racial and geographic disparities narrowed in the first months of 2020. Conclusions: Telemedicine use in Louisiana Medicaid was low but growing before the pandemic with narrowing disparities by race and geography and emerging disparities by age.
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Affiliation(s)
- Kevin Callison
- Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Andrew Anderson
- Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Yixue Shao
- Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Thomas A LaVeist
- Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Brigham Walker
- Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
- Department of Real World Data and Technology, ConcertAI, Boston, Massachusetts, USA
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Santos EOD, Pinho LBD, Silva ABD, Eslabão AD. Análise do acesso à rede de atenção psicossocial para usuários de álcool e outras drogas da zona rural. Rev Gaucha Enferm 2022. [DOI: 10.1590/1983-1447.2022.20210229.pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: Analisar o acesso à Rede de Atenção Psicossocial para os moradores da zona rural com problemas relacionados ao uso abusivo de álcool e outras drogas. Método: Pesquisa qualitativa, baseada no referencial da Avaliação de Empoderamento. A coleta de dados ocorreu de março a dezembro de 2017, e foi realizada através da triangulação de métodos qualitativos com 42 trabalhadores da rede de um município do Rio Grande do Sul, Brasil. A análise dos dados foi realizada pela análise temática. Resultados: Identificam-se os desafios do acesso, devido a questões culturais e à falta de recursos para estruturação da rede na sua conexão com os territórios rurais. As estratégias de apoio para o acesso incluem a articulação com outros serviços por meio do matriciamento. Conclusão: O acesso à rede é precário para a prevenção e a continuidade de cuidados. Sugere-se uma maior articulação da rede com as equipes rurais e um investimento na estrutura da rede.
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Radix AE, Bond K, Carneiro PB, Restar A. Transgender Individuals and Digital Health. Curr HIV/AIDS Rep 2022; 19:592-599. [PMID: 36136217 PMCID: PMC9493149 DOI: 10.1007/s11904-022-00629-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE OF REVIEW The goal of this review is to assess the use of digital technologies to promote the health and well-being of transgender and gender diverse (TGD) people. RECENT FINDINGS TGD individuals experience numerous health disparities, including low uptake of HIV prevention strategies, such as pre-exposure prophylaxis, increased HIV incidence, and suboptimal HIV-related outcomes. These health disparities are the result of widespread intersectional stigma on the basis of gender identity, gender expression, socioeconomic class, race, and ethnicity, which negatively impact access to general medical and transgender-specific health care. TGD individuals often delay or avoid essential medical services due to fear of discrimination. Clinicians frequently lack training, competence, and skills in transgender medicine, further exacerbating the health disparities faced by TGD people. Digital technologies have been used to improve research and clinical care for TGD populations through various modalities; telemedicine, telehealth and mHealth. Digital health technologies, including HIT-enabled clinical decision support, telehealth, telemedicine, and mHealth, offer innovative ways to improve health care access, improve quality of care, and reduce health disparities for TGD populations, including and beyond HIV outcomes, through enhanced care delivery, clinician education, and enhancing social support networks.
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Affiliation(s)
- Asa E. Radix
- Department of Medicine, Callen-Lorde Community Health Center, New York, NY USA ,NYU Grossman School of Medicine, New York, NY USA
| | - Keosha Bond
- Community Health & Social Medicine, CUNY School of Medicine, New York, NY USA
| | - Pedro B. Carneiro
- Department of Community Health and Social Sciences, City University of New York, New York, NY USA
| | - Arjee Restar
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA USA
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16
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Kirkland EB, Marsden J, Zhang J, Schumann SO, Bian J, Mauldin P, Moran WP. Remote patient monitoring sustains reductions of hemoglobin A1c in underserved patients to 12 months. Prim Care Diabetes 2021; 15:459-463. [PMID: 33509728 PMCID: PMC8131229 DOI: 10.1016/j.pcd.2021.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 01/15/2021] [Accepted: 01/16/2021] [Indexed: 12/18/2022]
Abstract
AIMS We sought to determine whether underserved patients enrolled in a statewide remote patient monitoring (RPM) program for diabetes achieve sustained improvements in hemoglobin A1c at 6 and 12 months and whether those improvements are affected by demographic and clinical variables. METHODS Demographic and clinical variables were obtained at baseline, 6 months and 12 months. Baseline HbA1c values were compared with those obtained at 6 and 12 months via paired t-tests. A multivariable regression model was developed to identify patient-level variables associated with HbA1c change at 12 months. RESULTS HbA1c values were obtained for 302 participants at 6 months and 125 participants at 12 months. Compared to baseline, HbA1c values were 1.8% (19 mmol/mol) lower at 6 months (p < 0.01) and 1.3% (14 mmol/mol) lower at 12 months (p < 0.01). Reductions at 12 months were consistent across clinical settings. A regression model for change in HbA1c showed no statistically significant difference for patient age, sex, race, household income, insurance, or clinic type. CONCLUSIONS Patients enrolled in RPM had improved diabetes control at 6 and 12 months. Neither clinic type nor sociodemographic variables significantly altered the likelihood that patients would benefit from this type of technology. These results suggest the promise of RPM for delivering care to underserved populations.
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Affiliation(s)
- Elizabeth B Kirkland
- Division of General Internal Medicine, Department of Medicine, Medical University of South Carolina, 135 Rutledge Ave, MSC 591, Charleston, SC, USA.
| | - Justin Marsden
- Section of Health Systems Research and Policy, Department of Medicine, Medical University of South Carolina, 135 Rutledge Ave, MSC 591, Charleston, SC, USA
| | - Jingwen Zhang
- Section of Health Systems Research and Policy, Department of Medicine, Medical University of South Carolina, 135 Rutledge Ave, MSC 591, Charleston, SC, USA
| | - Samuel O Schumann
- Division of General Internal Medicine, Department of Medicine, Medical University of South Carolina, 135 Rutledge Ave, MSC 591, Charleston, SC, USA
| | - John Bian
- Section of Health Systems Research and Policy, Department of Medicine, Medical University of South Carolina, 135 Rutledge Ave, MSC 591, Charleston, SC, USA
| | - Patrick Mauldin
- Section of Health Systems Research and Policy, Department of Medicine, Medical University of South Carolina, 135 Rutledge Ave, MSC 591, Charleston, SC, USA
| | - William P Moran
- Division of General Internal Medicine, Department of Medicine, Medical University of South Carolina, 135 Rutledge Ave, MSC 591, Charleston, SC, USA
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Schoebel V, Wayment C, Gaiser M, Page C, Buche J, Beck AJ. Telebehavioral Health During the COVID-19 Pandemic: A Qualitative Analysis of Provider Experiences and Perspectives. Telemed J E Health 2021; 27:947-954. [PMID: 34028302 DOI: 10.1089/tmj.2021.0121] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Due to the COVID-19 pandemic and prompted by recent federal and state policy shifts impacting behavioral health care delivery, the use of telebehavioral health has rapidly increased. This qualitative study describes behavioral health provider perspectives on the use of telebehavioral health before and during the pandemic and how policy changes impacted access to and utilization of behavioral health services in Michigan. Materials and Methods: A convenience sample of 31 licensed and nonlicensed behavioral health providers operating in Michigan participated in semi-structured interviews between July and August 2020. Interviews were audio-recorded, transcribed, and analyzed by using inductive methods. Results: The thematic analysis resulted in four overarching themes: (1) increased access to care; (2) maintenance of quality of care; (3) minimal privacy concerns; and (4) client and provider satisfaction. Discussion: During and post-pandemic, providers need flexibility to determine whether in-person or telebehavioral health services, including audio-only, best meet client needs. Providers identified several populations for which telebehavioral health was less accessible: clients with serious mental illness and substance use disorder, those with no broadband Internet access, children, and older adults. Additional training in telebehavioral health service provision can positively impact quality of care. Conclusion: Policies that support reimbursement parity and expand provider use of telebehavioral health services should be maintained after the COVID-19 pandemic ends to avoid imposing barriers to accessing behavioral health care barriers post-pandemic.
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Affiliation(s)
- Victoria Schoebel
- Behavioral Health Workforce Research Center, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Caitlyn Wayment
- Behavioral Health Workforce Research Center, University of Michigan School of Public Health, Ann Arbor, Michigan, USA.,Department of Community Dentistry and Population Health, University of Colorado School of Dental Medicine, Aurora, Colorado, USA
| | - Maria Gaiser
- Behavioral Health Workforce Research Center, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Cory Page
- Behavioral Health Workforce Research Center, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Jessica Buche
- Behavioral Health Workforce Research Center, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Angela J Beck
- Behavioral Health Workforce Research Center, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
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18
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Mehtani NJ, Ristau JT, Snyder H, Surlyn C, Eveland J, Smith-Bernardin S, Knight KR. COVID-19: A catalyst for change in telehealth service delivery for opioid use disorder management. Subst Abus 2021; 42:205-212. [PMID: 33684331 DOI: 10.1080/08897077.2021.1890676] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND COVID-19 has exacerbated income inequality, structural racism, and social isolation-issues that drive addiction and have previously manifested in the epidemic of opioid-associated overdose. The co-existence of these epidemics has necessitated care practice changes, including the use of telehealth-based encounters for the diagnosis and management of opioid use disorder (OUD). METHODS We describe the development of the "Addiction Telehealth Program" (ATP), a telephone-based program to reduce treatment access barriers for people with substance use disorders staying at San Francisco's COVID-19 Isolation and Quarantine (I&Q) sites. Telehealth encounters were documented in the electronic medical record and an internal tracking system for the San Francisco Department of Public Health (SFDPH) COVID-19 Containment Response. Descriptive statistics were collected on a case series of patients initiated on buprenorphine at I&Q sites and indicators of feasibility were measured. RESULTS Between April 10 and May 25, 2020, ATP consulted on the management of opioid, alcohol, GHB, marijuana, and stimulant use for 59 I&Q site guests. Twelve patients were identified with untreated OUD and newly prescribed buprenorphine. Of these, all were marginally housed, 67% were Black, and 58% had never previously been prescribed medications for OUD. Four self-directed early discharge from I&Q-1 prior to and 3 after initiating buprenorphine. Of the remaining 8 patients, 7 reported continuing to take buprenorphine at the time of I&Q discharge and 1 discontinued. No patients started on buprenorphine sustained significant adverse effects, required emergency care, or experienced overdose. CONCLUSIONS ATP demonstrates the feasibility of telephone-based management of OUD among a highly marginalized patient population in San Francisco and supports the implementation of similar programs in areas of the U.S. where access to addiction treatment is limited. Legal changes permitting the prescribing of buprenorphine via telehealth without the requirement of an in-person visit should persist beyond the COVID-19 public health emergency.
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Affiliation(s)
- Nicky J Mehtani
- Division of HIV, ID & Global Medicine, University of California, San Francisco, California, USA
| | - Jessica T Ristau
- Division of HIV, ID & Global Medicine, University of California, San Francisco, California, USA
| | - Hannah Snyder
- Department of Family & Community Medicine, University of California, San Francisco, California, USA
| | - Colleen Surlyn
- San Francisco Department of Public Health, San Francisco, California, USA
| | - Joanna Eveland
- San Francisco Department of Public Health, San Francisco, California, USA
| | | | - Kelly R Knight
- Department of Anthropology, History, and Social Medicine, University of California, San Francisco, California, USA
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19
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Talley RM, Brunette MF, Adler DA, Dixon LB, Berlant J, Erlich MD, Goldman B, First MB, Koh S, Oslin DW, Siris SG. Telehealth and the Community SMI Population: Reflections on the Disrupter Experience of COVID-19. J Nerv Ment Dis 2021; 209:49-53. [PMID: 33003053 DOI: 10.1097/nmd.0000000000001254] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The novel coronavirus pandemic and the resulting expanded use of telemedicine have temporarily transformed community-based care for individuals with serious mental illness (SMI), challenging traditional treatment paradigms. We review the rapid regulatory and practice shifts that facilitated broad use of telemedicine, the literature on the use of telehealth and telemedicine for individuals with SMI supporting the feasibility/acceptability of mobile interventions, and the more limited evidence-based telemedicine practices for this population. We provide anecdotal reflections on the opportunities and challenges for telemedicine drawn from our daily experiences providing services and overseeing systems for this population during the pandemic. We conclude by proposing that a continued, more prominent role for telemedicine in the care of individuals with SMI be sustained in the post-coronavirus landscape, offering future directions for policy, technical assistance, training, and research to bring about this change.
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Affiliation(s)
| | | | | | | | | | | | - Beth Goldman
- Group for Advancement of Psychiatry, New York, New York
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20
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Moore SK, Saunders EC, Hichborn E, McLeman B, Meier A, Young R, Nesin N, Farkas S, Hamilton L, Marsch LA, Gardner T, McNeely J. Early implementation of screening for substance use in rural primary care: A rapid analytic qualitative study. Subst Abus 2020; 42:678-691. [PMID: 33264087 PMCID: PMC8626097 DOI: 10.1080/08897077.2020.1827125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Few primary care patients are screened for substance use. As part of a phased feasibility study examining the implementation of electronic health record-integrated screening with the Tobacco, Alcohol, and Prescription Medication Screening (TAPS) Tool and clinical decision support (CDS) in rural primary care clinics, focus groups were conducted to identify early indicators of success and challenges to screening implementation. Method: Focus groups (n = 6) were conducted with medical assistants (MAs: n = 3: 19 participants) and primary care providers (PCPs: n = 3: 13 participants) approximately one month following screening implementation in three Federally Qualified Health Centers in Maine. Rapid analysis and matrix analysis using Proctor's Taxonomy of Implementation Outcomes were used to explore implementation outcomes. Results: There was consensus that screening is being used, but use of the CDS was lower, in part due to limited positive screens. Fidelity was high among MAs, though discomfort with the CDS surfaced among PCPs, impacting adoption and fidelity. The TAPS Tool's content, credibility and ease of workflow integration were favorably assessed. Challenges include screening solely at annual visits and self-administered screening for certain patients. Conclusions: Results reveal indicators of implementation success and strategies to address challenges to screening for substance use in primary care.
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Affiliation(s)
- Sarah K. Moore
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA
| | - Elizabeth C. Saunders
- The Dartmouth Institute (TDI) for Health Policy and Clinical Practice, Lebanon, Pennsylvania, USA
| | - Emily Hichborn
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA
| | - Bethany McLeman
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA
| | - Andrea Meier
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA
| | - Robyn Young
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA
| | - Noah Nesin
- Penobscot Community Health Care (PCHC), Bangor, Maine, USA
| | - Sarah Farkas
- Department of Psychiatry, New York University School of Medicine, New York, New York, USA
| | - Leah Hamilton
- Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Lisa A. Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA
| | - Trip Gardner
- Penobscot Community Health Care (PCHC), Bangor, Maine, USA
| | - Jennifer McNeely
- Department of Population Health, New York University School of Medicine, New York, New York, USA
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21
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Uscher-Pines L, Sousa J, Raja P, Mehrotra A, Barnett M, Huskamp HA. Treatment of opioid use disorder during COVID-19: Experiences of clinicians transitioning to telemedicine. J Subst Abuse Treat 2020; 118:108124. [PMID: 32893047 PMCID: PMC7456454 DOI: 10.1016/j.jsat.2020.108124] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/09/2020] [Accepted: 08/25/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The COVID-19 pandemic has transformed care delivery for patients with opioid use disorder (OUD); however, little is known about the experiences of front-line clinicians in the transition to telemedicine. This study described how, in the context of the early stages of the pandemic, clinicians used telemedicine for OUD in conjunction with in-person care, barriers encountered, and implications for quality of care. METHODS In April 2020, we conducted semistructured interviews with clinicians waivered to prescribe buprenorphine. We used maximum variation sampling. We used standard qualitative analysis techniques, consisting of both inductive and deductive approaches, to identify and characterize themes. RESULTS Eighteen clinicians representing 10 states participated. Nearly all interview participants were doing some telemedicine, and more than half were only doing telemedicine visits. Most participants reported changing their typical clinical care patterns to help patients remain at home and minimize exposure to COVID-19. Changes included waiving urine toxicology screening, sending patients home with a larger supply of OUD medications, and requiring fewer visits. Although several participants were serving new patients via telemedicine during the early weeks of the pandemic, others were not. Some clinicians identified positive impacts of telemedicine on the quality of their patient interactions, including increased access for patients. Others noted negative impacts including less structure and accountability, less information to inform clinical decision-making, challenges in establishing a connection, technological challenges, and shorter visits. CONCLUSIONS In the context of the pandemic, buprenorphine prescribers quickly transitioned to providing telemedicine visits in high volume; nonetheless, there are still many unknowns, including the quality and safety of widespread use of telemedicine for OUD treatment.
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Affiliation(s)
| | - Jessica Sousa
- RAND Corporation, Boston, MA, United States of America
| | - Pushpa Raja
- Greater Los Angeles VA Medical Center, Los Angeles, CA, United States of America
| | - Ateev Mehrotra
- Department of Health Care Policy, Harvard Medical School, Boston, MA, United States of America; Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Michael Barnett
- Harvard T. H. Chan School of Public Health Boston, MA, United States of America
| | - Haiden A Huskamp
- Department of Health Care Policy, Harvard Medical School, Boston, MA, United States of America
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22
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Progovac AM, Cortés DE, Chambers V, Adams LB, Jean‐Claude S, Willison CE, Flores M, Creedon TB, Cook BL. Addressing Major Health Disparities Related to Coronavirus for People With Behavioral Health Conditions Requires Strength-Based Capacity Building and Intentional Community Partnership. WORLD MEDICAL & HEALTH POLICY 2020; 12:242-255. [PMID: 32904922 PMCID: PMC7461022 DOI: 10.1002/wmh3.364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/27/2020] [Indexed: 11/07/2022]
Abstract
Far from being an equalizer, as some have claimed, the COVID‐19 pandemic has exposed just how vulnerable many of our social, health, and political systems are in the face of major public health shocks. Rapid responses by health systems to meet increased demand for hospital beds while continuing to provide health services, largely via a shift to telehealth services, are critical adaptations. However, these actions are not sufficient to mitigate the impact of coronavirus for people from marginalized communities, particularly those with behavioral health conditions, who are experiencing disproportional health, economic, and social impacts from the evolving pandemic. Helping these communities weather this storm requires partnering with existing community‐based organizations and local governments to rapidly and flexibly meet the needs of vulnerable populations.
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