■患有物质使用障碍(SUDs)的患者尽管有很高的医疗需求,但医疗保健利用率却很低。远程医疗可以提高利用率,但不同SUD的摄取差异是未知的。
使用2018年12月1日至2020年12月31日的威斯康星州医疗补助登记和索赔数据,我们在COVID-19公共卫生紧急情况(PHE)发作(2020年3月14日)后的远程医疗扩展期间,对远程医疗和初级保健环境中的远程医疗吸收进行了队列研究。样本包括连续登记(19个月),未怀孕,19至64岁的非残疾成年人阿片类药物(OUD),酒精(AUD),兴奋剂(刺激),或大麻(CannUD)使用障碍或多物质使用(PSU)。结果:一周内的总和远程医疗访问,以及远程医疗完成的一周内的一小部分访问。线性和分数回归估计了个人和远程医疗利用的变化。我们使用回归系数来计算远程医疗利用率的变化,远程医疗摄入抵消了面对面下降的比例(“抵消”),以及远程医疗完成的访问份额(“份额”)。
■该队列(n=16756)包括OUD患者(34.8%),AUD(30.1%),刺激(9.5%),大炮(9.5%),和PSU(19.7%)。总体和远程医疗利用率因PHE后小组而异。全程门诊:所有游客的总访问量都下降了,然后上升到OUD的基线之上,PSU,AUD。远程医疗扩展与访问增加相关:OUD:0.489,P<.001;PSU:0.341,P<.001;刺激:0.160,P<.001;AUD:0.132,P<.001;CannUD:0.115,P<.001。StimUD表现出最大的远程医疗份额。初级保健:总体就诊率下降,然后恢复了OUD和CannUD。PSU的远程医疗访问量最高:0.021,P<.001;OUD:0.019,P<.001;大麻:0.011,P<.001;AUD:0.010,P<.001;刺激:0.009,P<.001。PSU和OUD展示了最大的远程医疗份额,而StimUD表现最低。远程医疗完全抵消了OUD的下降。
■远程医疗扩展有助于保持OUD和PSU的利用率;StimUD和CannUD的响应能力较低。远程医疗扩展可能会扩大SUD类型的利用率差距。
UNASSIGNED: 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.
UNASSIGNED: 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\").
UNASSIGNED: 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.
UNASSIGNED: 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.