Patients with alcohol use disorder (AUD) who receive treatment via telehealth are more likely to engage in more psychotherapy visits and have a longer duration of medication treatment compared with those who have only in-person visits, according to a study published this week in Alcohol, Clinical and Experimental Research.
“Evidence-based treatment for AUD differs from other substance use disorders in that it includes multiple psychotherapy and medication options,” wrote Ponni V. Perumalswami, M.D., of the VA Ann Arbor Healthcare System and colleagues. “Evaluating telehealth delivery of treatment to vulnerable patients, including those with AUD, is particularly important in the current context as the United States debates whether to sustain or revoke pandemic-era policies that decreased barriers to telehealth.”
Perumalswami and colleagues analyzed electronic health record data from the Veterans Health Administration (VHA) during the year following the start of the COVID-19 pandemic (between March 1, 2020, and February 28, 2021). They included 138,619 patients aged 18 or older who were diagnosed with AUD in the year prior to or during the study period and who had at least one AUD treatment visit. AUD treatment included an individual or group psychotherapy visit and/or AUD medication coverage (defined as the number of days covered by a filled prescription for AUD). The authors used VHA codes to determine whether patients received their treatments via video, telephone, or in person.
During the study period, 52.8% of participants had at least one video visit, 38.1% had at least one telephone visit but no video visits, and 9.1% had only in-person visits. Telehealth was associated with a greater number of psychotherapy visits and medication coverage days compared with in-person visits for both patients initiating and continuing treatment during the study period. Further, among those who received any treatment via telehealth, those who had video visits had a significantly greater number of psychotherapy visits compared with those who only had telephone visits.
Participants who had only in-person visits were more likely to be initiating AUD treatment and were older, male, Black, rural, homeless; they were also more likely to have an opioid and/or stimulant use disorder. Additionally, among participants who received any treatment via telehealth, those who were 45 years or older, Black, and diagnosed with a cannabis or stimulant use disorder or serious mental illness were less likely to receive video compared with telephone visits. The authors noted that this finding highlights “important disparities in AUD telehealth use.”
“Additional efforts to increase the engagement of certain VHA patient groups in telehealth use should be made, given its association with receiving more AUD treatment,” the authors concluded. “This study offers insights into patient characteristics associated with AUD treatment in an era of expanded telehealth and suggests that future policy changes in telehealth should be carefully considered given the potential to widen disparities in care.”
For related information, see the Psychiatric News article “Federal Telehealth Policy Changes After COVID-19 Public Health Emergency.”
(Image: Getty Images/iStock/brusinski)
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