Thomas J Reese, Nana Addo Padi-Adjirackor, Kevin N Griffith, Bryan Steitz, Stephen W Patrick, Ashley A Leech, Andrew D Wiese, Adam Wright, Mauli V Shah, Jessica S Ancker
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引用次数: 0
Abstract
Background: Policy changes during the COVID-19 pandemic allowed buprenorphine to be prescribed for opioid use disorder (OUD) via telemedicine without an in-person visit. A recently proposed change will limit buprenorphine access to 30 days without an in-person visit. Given that people living in rural areas may be disproportionally impacted by this change, we sought to better understand how buprenorphine adherence may be impacted by requiring in-person visits.
Objective: Compare buprenorphine adherence after telemedicine to adherence after in-person visits for patients who live in rural and urban areas.
Methods: In this retrospective cohort study, we used electronic health record data from a large medical center. The cohort included all adult patients prescribed buprenorphine for opioid use disorder during 2017-2022. The primary outcome was adherence, characterized by the Medication Possession Ratio (MPR) and gaps in buprenorphine treatment at 30 and 180 days. We conducted a longitudinal analysis at visit level, stratified by patient urbanicity, and controlled for patient, prescriber, prescription, and setting characteristics.
Results: From 511 patients, we followed 3302 in-person and 519 telemedicine visits. Compared to in-person visits we observed no difference in the adherence following telemedicine visits overall. However, telemedicine was associated with higher MPR for rural patients (30 days: adjusted marginal effects [AME], 3.7%; 95% CI, 2.0 to 5.5; P < .001 and 180 days: AME, 8.5%; 95% CI 5.7 to 11.3; P < .001) and fewer gaps (30 days: AME, -6.7%; 95% CI, -9.9 to -0.1; P < .001 and 180 days: AME, -9.4%; -14.0 to -4.5; P < .001) compared to in-person visits.
Conclusions: These findings suggest that telemedicine is a viable alternative to in-person visits, especially for patients living in rural areas, which should help guide future policies that preserve or increase access to buprenorphine in a manner that can reduce barriers for patients.
期刊介绍:
The Journal of the American Pharmacists Association is the official peer-reviewed journal of the American Pharmacists Association (APhA), providing information on pharmaceutical care, drug therapy, diseases and other health issues, trends in pharmacy practice and therapeutics, informed opinion, and original research. JAPhA publishes original research, reviews, experiences, and opinion articles that link science to contemporary pharmacy practice to improve patient care.