By Kate Baggaley
Originally published by our sister publication Pharmacy Practice News
Medicare beneficiaries who received virtual care for opioid use disorder (OUD) during the COVID-19 pandemic continued treatment longer and had decreased odds of experiencing a medically treated overdose, a new study indicates.
Researchers tracked 175,778 adults who initiated OUD care before or during the pandemic, when telehealth services were significantly expanded. The team observed a substantial uptick in telehealth utilization during the crisis. In addition, Medicare beneficiaries who used telehealth services for OUD treatment had better outcomes than those who didn’t (JAMA Psychiatry 2022 Aug 31. doi:10.1001/jamapsychiatry.2022.2284).
“There were questions at the start of the pandemic about whether the quality of care or outcomes with the rapid expansion of telehealth would prove beneficial,” said lead author Christopher M. Jones, PharmD, DrPH, the acting director of the CDC’s National Center for Injury Prevention and Control. “Our findings lend evidence to the growing evidence base that telehealth services do provide benefit.”
In 2020, federal agencies implemented policies to broaden the use of telehealth services—including the provision of medications for OUD (MOUD)—in response to concerns that pandemic-related stressors and stay-at-home measures would interrupt treatment and increase overdoses.
Dr. Jones and his collaborators analyzed Medicare data from September 2018 to February 2021. Their sample included 105,240 beneficiaries who began an episode of OUD-related care prior to the pandemic, and 70,538 beneficiaries who began care after the pandemic got underway.
“We clearly see that there was very little telehealth service used for OUD-related care prior to COVID-19,” Dr. Jones said. Only 0.6% of beneficiaries in the pre-pandemic cohort received OUD-related telehealth service, compared with 19.6% of the pandemic cohort (P<0.001). Overall, the two cohorts experienced overdoses at similar rates.
“We really wanted to explore, among the pandemic cohort, did receipt of telehealth services provide a protective effect?” Dr. Jones said. He and his team found that beneficiaries in this group who received OUD-related telehealth services had increased odds of MOUD retention (adjusted odds ratio [AOR], 1.27; 95% CI, 1.14-1.41) and lower odds of medically treated overdose (AOR, 0.67; 95% CI, 0.63-0.71).
However, the researchers also noted disparities in access to OUD-related telehealth services, with non-Hispanic Black people and people living in the South being less likely than other beneficiaries to receive care.
“While our findings are certainly encouraging and support the value of expanded access to telehealth services for OUD care, we need to be mindful as we work to continue to implement access to these services that we are doing it in an equitable way so that everyone can take advantage of and benefit from this expansion,” Dr. Jones said.
Among the questions remaining for future studies are the extent to which the new findings can be applied to other populations and how telehealth services affect people’s overdose mortality risk and substance use patterns.
“The issues around disparities in access to telehealth services is a really important research question,” Dr. Jones added. “[We need to understand] from both provider and patient perspectives who is offered telehealth services, who is not and why.”