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. 2024 Jul;45(3):473-485.
doi: 10.1177/29767342241236028. Epub 2024 Mar 17.

How Does Telehealth Expansion Change Access to Healthcare for Patients With Different Types of Substance Use Disorders?

Alyssa Shell Tilhou  1 , Marguerite Burns  2 , Preeti Chachlani  3 , Ying Chen  4 , Laura Dague  5
Affiliations

How Does Telehealth Expansion Change Access to Healthcare for Patients With Different Types of Substance Use Disorders?

Alyssa Shell Tilhou et al. Subst Use Addctn J. 2024 Jul.

Abstract

Background: Patients with substance use disorders (SUDs) exhibit low healthcare utilization despite high medical need. Telehealth could boost utilization, but variation in uptake across SUDs is unknown.

Methods: Using Wisconsin Medicaid enrollment and claims data from December 1, 2018, to December 31, 2020, we conducted a cohort study of telemedicine uptake in the all-ambulatory and the primary care setting during telehealth expansion following the COVID-19 public health emergency (PHE) onset (March 14, 2020). The sample included continuously enrolled (19 months), nonpregnant, nondisabled adults aged 19 to 64 years with opioid (OUD), alcohol (AUD), stimulant (StimUD), or cannabis (CannUD) use disorder or polysubstance use (PSU). Outcomes: total and telehealth visits in the week, and fraction of visits in the week completed by telehealth. Linear and fractional regression estimated changes in in-person and telemedicine utilization. We used regression coefficients to calculate the change in telemedicine utilization, the proportion of in-person decline offset by telemedicine uptake ("offset"), and the share of visits completed by telemedicine ("share").

Results: The cohort (n = 16 756) included individuals with OUD (34.8%), AUD (30.1%), StimUD (9.5%), CannUD (9.5%), and PSU (19.7%). Total and telemedicine utilization varied by group post-PHE. All-ambulatory: total visits dropped for all, then rose above baseline for OUD, PSU, and AUD. Telehealth expansion was associated with visit increases: OUD: 0.489, P < .001; PSU: 0.341, P < .001; StimUD: 0.160, P < .001; AUD: 0.132, P < .001; CannUD: 0.115, P < .001. StimUD exhibited the greatest telemedicine share. Primary care: total visits dropped for all, then recovered for OUD and CannUD. Telemedicine visits rose most for PSU: 0.021, P < .001; OUD: 0.019, P < .001; CannUD: 0.011, P < .001; AUD: 0.010, P < .001; StimUD: 0.009, P < .001. PSU and OUD exhibited the greatest telemedicine share, while StimUD exhibited the lowest. Telemedicine fully offset declines for OUD only.

Conclusions: Telehealth expansion helped maintain utilization for OUD and PSU; StimUD and CannUD showed less responsiveness. Telehealth expansion could widen gaps in utilization by SUD type.

Keywords: alcohol use disorder; cannabis use disorder; opioid use disorder; polysubstance use; stimulant use disorder; telehealth.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Trends in all-ambulatory visits at the person-week level among continuously enrolled Wisconsin Medicaid beneficiaries with substance use disorders before and after the public health emergency. Black vertical line indicates the declaration of the public health emergency. Trend lines indicate visit rates in total and for telemedicine visits by type of substance use disorder. Trend lines indicate visit rates for any modality and just telemedicine by type of substance use disorder. Abbreviations: OUD, opioid use disorder; AUD, alcohol use disorder; StimUD, stimulant use disorder, CannUD, cannabis use disorder; PSU, polysubstance use.
Figure 2.
Figure 2.
Trends in primary care visits at the person-week level among continuously enrolled Wisconsin Medicaid beneficiaries with substance use disorders before and after the public health emergency. Black vertical line indicates the declaration of the public health emergency. Trend lines indicate visit rates for any modality and just telemedicine by type of substance use disorder. Abbreviations: OUD, opioid use disorder; AUD, alcohol use disorder; StimUD, stimulant use disorder, CannUD, cannabis use disorder; PSU, polysubstance use.
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References

    1. Saitz R, Larson MJ, LaBelle C, Richardson J, Samet JH. The case for chronic disease management for addiction. J Addict Med. 2008;2(2):55–65. - PMC - PubMed
    1. Weisner C, Mertens J, Parthasarathy S, Moore C, Lu Y. Integrating primary medical care with addiction treatment: a randomized controlled trial. JAMA. 2001;286(14):1715–1723. - PMC - PubMed
    1. Cohen E, Feinn R, Arias A, Kranzler HR. Alcohol treatment utilization: findings from the National Epidemiologic Survey on Alcohol and Related Conditions. Drug Alcohol Depend. 2007;86(2–3):214–221. - PubMed
    1. Wu LT, Zhu H, Swartz MS. Treatment utilization among persons with opioid use disorder in the United States. Drug Alcohol Depend. 2016;169:117–127. - PMC - PubMed
    1. Connery HS, McHugh RK, Reilly M, Shin S, Greenfield SF. Substance use disorders in global mental health delivery: epidemiology, treatment gap, and implementation of evidence-based treatments. Harv Rev Psychiatry. 2020;28(5):316–327. - PMC - PubMed

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