A study published in JAMA Network Open found no difference in visit frequency for opioid use disorder treatment, initiation of medication use or adverse outcomes between patients who were treated by clinicians with high or low levels of telehealth use, suggesting telemedicine could be comparable to in-person care.

The research used de-identified claims data from about 11,800 patients with commercial insurance or Medicare Advantage coverage between March 2019 and March 2021. 

Clinicians who provided office-based care were sorted into groups based on how much they used telehealth. Providers with low telemedicine use conducted an average of 2.1% of their office visits virtually during the COVID-19 pandemic period, while those with high use conducted nearly 70% of those visits via telehealth. 

Though telemedicine for opioid use disorder treatment increased during the pandemic, total visit volume stayed stable for both the high and low telehealth groups. For providers who used telehealth more frequently, visit volume increased from 2.6 visits to 2.7 visits per patient episode, while they increased from 3.1 to 3.3 visits per episode for clinicians who used less telehealth.

In the low-use group, 15.3% of patients started using medication for opioid use disorder within two weeks after their first visit during the pre-pandemic time period, compared with 15.2% during the pandemic. In the high use group, the proportion of patients who started medications within two weeks were 14.7% in the pre-pandemic period and 13.7% in the pandemic period.

The study also found the proportion of patients with at least one opioid use disorder-related clinical event was lower during the pandemic for both high-use and low-use clinicians, and it found no differential change between groups.

"In a national sample of patients with OUD with commercial insurance or Medicare Advantage coverage, we found that treatment by clinicians with high telemedicine use was not associated with a different pattern of outpatient care or OUD-related events compared with treatment by clinicians with low telemedicine use," the study's authors wrote.

"The total number of OUD visits per episode was consistent across the pre-pandemic and pandemic periods regardless of telemedicine uptake, suggesting that telemedicine almost entirely substituted, rather than supplemented, care. Overall, based on measures observable in claims data, telemedicine was comparable to in-person care, with no evidence of differential harm or benefit to patients who were seen by clinicians with high and medium vs low telemedicine use."

WHY IT MATTERS

The researchers noted that their findings might not be generalizable to all patient populations, like people covered by Medicaid and traditional Medicare or those who are uninsured. They also couldn't measure some clinical outcomes, like relapse, general functioning or patient use of long-acting buprenorphine implants.

However, they argue their study suggests telehealth could be safely expanded for opioid use disorder, since it doesn't seem to increase unnecessary care. Still, the researchers noted that patients who went to clinicians in the high telehealth group were more likely to live in metropolitan counties with higher incomes and lower proportions of white residents. Rural areas have less access to broadband internet, so telehealth care may not be available to those patients.

"There was no evidence to suggest that telemedicine was unsafe or overused among clinicians with high vs low telemedicine use. Conversely, there was no evidence that telemedicine was associated with increased access or improved quality of care," the researchers wrote. "The results of this study suggest that telemedicine is a comparable alternative for delivering care for OUD but not one that will substantially change care quality or access in the short term."