COVID‐19 pandemic‐related changes in utilization of telehealth and treatment overall for alcohol use problems

Palzes, Vanessa A.; Felicia, W.; Metz, Verena E.; Campbell, Cynthia I.; Corriveau, Caroline; Sterling, Stacy

doi:10.1111/acer.14961

Cited by 8 publications

(10 citation statements)

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“…These differences seem to be explained by less telehealth use by older patients, consistent with prior studies that suggest a digital divide by age, [49][50][51] but could also signify that the transition to telehealth may have helped to attract younger patients, who have shown low treatment initiation rates in prepandemic studies. 23,24 Similar age differences have been reported in studies examining telehealth treatment for other conditions in this health care system 27 and other settings. 52 The health care system's strategies to support telehealth use (eg, previsit calls and tech-checks) may have helped to prevent an increasing digital divide for older adults.…”

Section: Discussionmentioning

confidence: 99%

“…23,24 Limited evidence suggests that racial and ethnic disparities in addiction treatment utilization have persisted or worsened during the pandemic, 15,17,18 while other studies of alcohol and behavioral health problems have not found increased disparities. 20,26,27 While patients with limited technology access or skills (eg, patients with low income and older adults [28][29][30][31] ) may have faced increased barriers to care during the pandemic, others may have found telehealth services to be more flexible and convenient, eliminating barriers such as transportation time and cost, the need for childcare, and stigma or anxiety related to attending in-person treatment. 32,33 Greater understanding of changes in addiction treatment utilization during the COVID-19 pandemic among various subgroups of patients with drug use problems can help to tailor care as telehealth becomes more established in addiction treatment.…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, older and younger adults with drug use problems have been found to be less likely to initiate treatment than middle-aged adults . Limited evidence suggests that racial and ethnic disparities in addiction treatment utilization have persisted or worsened during the pandemic, while other studies of alcohol and behavioral health problems have not found increased disparities . While patients with limited technology access or skills (eg, patients with low income and older adults) may have faced increased barriers to care during the pandemic, others may have found telehealth services to be more flexible and convenient, eliminating barriers such as transportation time and cost, the need for childcare, and stigma or anxiety related to attending in-person treatment …”

Section: Introductionmentioning

confidence: 99%

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Overall and Telehealth Addiction Treatment Utilization by Age, Race, Ethnicity, and Socioeconomic Status in California After COVID-19 Policy Changes

et al. 2023

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ImportanceAddiction treatment rapidly transitioned to a primarily telehealth modality (telephone and video) during the COVID-19 pandemic, raising concerns about disparities in utilization.ObjectiveTo 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 ParticipantsThis 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.ExposureThe expansion of telehealth services during COVID-19 onset.Main Outcomes and MeasuresGeneralized 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.ResultsAmong 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).ConclusionsIn 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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Overall and Telehealth Addiction Treatment Utilization by Age, Race, Ethnicity, and Socioeconomic Status in California After COVID-19 Policy Changes

et al. 2023

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“…Notably, the number of individuals living with managed opioid use disorder is increasing, at least partially due to improved treatment strategies including more widely available methods of medication for opioid use disorder and overdose reversal. 59 60 Care coordination between a patient's current prescriber and surgeon is essential to ensure appropriate postoperative pain control and prescription management. Lack of coordination can increase the probability of high-risk prescribing practices, lack of rescue medications when needed, poor pain control, and an increased risk of opioid-related harms after their surgery.…”

Section: Caring For Individuals At Risk For Poor Pain and Opioid-rela...mentioning

confidence: 99%

Perioperative Opioid-Related Harms: Opportunities to Minimize Risk

Alessio-Bilowus,

Luby,

Cooley

et al. 2024

Semin Plast Surg

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Although substantial attention has been given to opioid prescribing in the United States, opioid-related mortality continues to climb due to the rising incidence and prevalence of opioid use disorder. Perioperative care has an important role in the consideration of opioid prescribing and the care of individuals at risk for poor postoperative pain- and opioid-related outcomes. Opioids are effective for acute pain management and commonly prescribed for postoperative pain. However, failure to align prescribing with patient need can result in overprescribing and exacerbate the flow of unused opioids into communities. Conversely, underprescribing can result in the undertreatment of pain, complicating recovery and impairing well-being after surgery. Optimizing pain management can be particularly challenging for individuals who are previously exposed to opioids or have critical risk factors, including opioid use disorder. In this review, we will explore the role of perioperative care in the broader context of the opioid epidemic in the United States, and provide considerations for a multidisciplinary, comprehensive approach to perioperative pain management and optimal opioid stewardship.

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“…Other studies outside of the VHA have found that the transition to telehealth may have attracted subgroups of individuals who have historically underutilized care for alcohol use problems, particularly younger and healthier adults, without exacerbating prepandemic racial and ethnic disparities in treatment utilization. (Palzes et al, 2022). Additional reasons for observed differences across treatment modalities may be related to the greater use of telehealth in some groups to mitigate barriers to AUD treatment, including distance, transportation, and stigma.…”

Section: Any Telehealth Visit Only In-person Visits P-value C Any Vid...mentioning

confidence: 99%

Telehealth and delivery of alcohol use disorder treatment in the Veterans Health Administration

Perumalswami,

Adams,

Frost

et al. 2024

Alcohol, Clinical and Experimental Research

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BackgroundThe use of telehealth treatment of alcohol use disorder (AUD) has increased since the start of the COVID‐19 pandemic. However, it is unclear which patients are using telehealth and how telehealth visits are associated with treatment duration. This study examined characteristics associated with telehealth use among Veterans Health Administration patients receiving AUD treatment.MethodsUsing a national retrospective cohort study, we examined data from March 01, 2020 to February 28, 2021 to: First, identify patient characteristics associated with (a) any telehealth versus only in‐person care for AUD treatment, and (b) video (≥1 video visit) versus only telephone visits for AUD treatment (≥1 telephone visit, no video) among any telehealth users. This analysis used mixed‐effects logistic regression models to adjust for potential correlation across patients treated at the same facility. Second, we assessed whether visit modality was associated with the amount of AUD treatment received (number of AUD psychotherapy visits or medication coverage days). This analysis used mixed‐effects negative binomial regression models.ResultsAmong 138,619 patients who received AUD treatment, 52.8% had ≥1 video visit, 38.1% had ≥1 telephone but no video visits, and 9.1% had only in‐person visits. In the regression analyses, patients who were male or had an opioid or stimulant use disorder (compared to having no non‐AUD substance use disorder) were less likely to receive any telehealth‐delivered AUD treatment compared to only in‐person AUD treatment. Among patients who received any telehealth‐delivered AUD treatment, those who were ≥45 years old (compared to 18–29 years old), Black (compared to White), diagnosed with a cannabis or stimulant use disorder, or diagnosed with a serious mental illness were less likely to receive a video visit than only telephone visits. Receiving any AUD telehealth was associated with receiving more psychotherapy visits and medication coverage days than only in‐person care.ConclusionsTelehealth, a common modality for AUD treatment, supported a greater number of psychotherapy visits and a longer duration of medication treatment for AUD. However, some groups were less likely to receive any video telehealth than telephone visits, suggesting that multiple treatment modalities should remain available to ensure treatment access.

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COVID‐19 pandemic‐related changes in utilization of telehealth and treatment overall for alcohol use problems

Cited by 8 publications

References 40 publications

Overall and Telehealth Addiction Treatment Utilization by Age, Race, Ethnicity, and Socioeconomic Status in California After COVID-19 Policy Changes

Overall and Telehealth Addiction Treatment Utilization by Age, Race, Ethnicity, and Socioeconomic Status in California After COVID-19 Policy Changes

Perioperative Opioid-Related Harms: Opportunities to Minimize Risk

Telehealth and delivery of alcohol use disorder treatment in the Veterans Health Administration

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