Telehealth proves successful for opioid use disorder treatment

opioid addiction and overdose related deaths Reached the highest level ever in 2022. The opioid crisis has strained health systems, overwhelmed emergency responders and placed a heavy burden on social services.

Problem

Prior to the advent of telehealth in addiction treatment, people seeking medical help for opioid use disorder faced a number of challenges that limited their access to care. Dr. Robin Arthur Williams, Chief Medical Officer of Ophelia, a telehealth provider who cares for OUD patients, explains the challenges:

• Geography Many individuals with OUD live in rural or remote areas where specialized addiction treatment services are rare or non-existent. Due to the lack of nearby treatment facilities, individuals have to travel long distances, sometimes even across state borders, to receive proper care. This poses significant barriers, especially for those who do not have reliable transportation or the financial means to cover travel expenses.

• Limited availability of providers. There is a shortage of healthcare providers who specialize in addiction, who are trained and certified to provide evidence-based treatment for OUD. This shortage of qualified providers has led to long wait times for appointments. Delays make it challenging for individuals to receive timely care, especially during critical moments when immediate intervention is necessary.

• Fear of stigma and exposure. The stigma associated with substance use disorders, including OUD, has prevented many individuals from seeking treatment. Fear of judgment, discrimination, or the potential consequences of disclosing their condition often prevents individuals from reaching out for help. The lack of privacy and confidentiality in traditional health care settings further exacerbates these concerns.

• Time constraints and inflexible scheduling. Two-thirds of OUD patients have jobs or are dependent on child care, making regular clinic visits, mandatory group therapy, and traditional rehabilitation impossible. In-person therapy often requires individuals to take time off work, school, or other responsibilities to attend appointments. This creates difficulties for individuals who have limited flexibility or face financial consequences from job loss.

• financial resources. The cost of treating OUD can be a significant barrier for many individuals, especially those who do not have insurance coverage or have limited financial resources. The costs associated with personal visits, transportation, medications, and counseling sessions can be prohibitive, and may make treatment unaffordable for some people.

Proposal

Ophelia is a digital provider of medication-assisted treatment (MAT) for OUD, committed to making evidence-based treatment universally accessible. Ophelia is licensed to provide care in 36 states and has contracts with Medicaid, Medicare and commercial insurers covering 85 million American lives.

Williams said, “Before we launched in 2019, we knew that telehealth had the potential to play an important role in supporting individuals struggling with OUD by increasing access to MAT, especially those living in rural or disadvantaged areas. “

“For context, it is important to understand that MAT is considered by the CDC, SAMHSA, AMA, and ASAM to be the gold standard of care for OUD,” he added. “Numerous studies have shown the efficacy and safety of this treatment, which Reduces overdoses by 76% and ER visits by 32%.

Simply put, MAT saves lives, he said. but because legacy addiction care is a A $42 billion business, the emphasis is not on the use of drugs like buprenorphine, which can be administered during a simple visit to a provider.

“Traditional rehabilitation cycles patients in and out, promotes ethics-based abstinence-only programs, and capitalizes on recidivism,” Williams said. “Treatment plans without MAT lead to a 90% relapse rate within three months.

“In addition, traditional, inpatient rehabilitation requires stopping one’s life, leaving one’s environment, and living elsewhere for months, which is not feasible for most people,” he adds. “We believed providers could prescribe and monitor medication, offer counseling sessions, and remotely adjust treatment plans to assist individuals on their recovery journey “

He added that providers will also be able to offer convenient follow-up care to monitor patients’ progress, address concerns and provide ongoing support. This, he said, helps prevent recurrence, increase medication adherence, and promote long-term recovery.

“One of the biggest benefits people with OUD can get from virtual care is reducing the stigma associated with seeking treatment for OUD,” he added. “By receiving care in the privacy and comfort of their own home, patients do not have to worry about judgment or disclosure about their condition in a public setting.”

marketplace

There are many vendors of telemedicine technology and services in the health IT market today. Healthcare IT News published a special report highlighting many of these vendors with detailed descriptions of their products. Click here to read the special report.

meet the challenge

Ophelia’s mission is to make evidence-based treatment universally accessible to anyone struggling with OUD, with a special commitment to serving the Medicaid population, which is often overlooked despite disproportionately high rates of OUD Is.

“While other addiction treatment providers rely on referrals from hospitals or primary care providers, Ophelia takes a different approach, recruiting patients directly online and creating a platform to mobilize untapped physicians,” Williams explained. “It is critical to reach the invisible 80% of Americans with OUD who are not connected to the health care system until a dangerous complication arises.

“As such, Ophelia created a digitally native clinical model that is widely successful Massachusetts Collaborative Care Model for telemedicine,” he continued. “By combining team-based care with physician training programs and collaborative clinical software, Ophelia creates treatment opportunities for the more than 50,000 licensed MAT therapists who previously had no access to treat patients due to a lack of infrastructure.” There was no way.”

Ophelia treated its first patient in early 2020, and has since seen rapid adoption by both patients and physicians. Today it is licensed to provide care in 36 states and has national and regional insurance contracts covering 85 million people, including Medicaid, Medicare, and bundled rates in commercial populations.

Result

Ophelia shared recently The findings of its poster presentation at the annual ASAM conference showed that home-based buprenorphine induction guided by telehealth is feasible and well-tolerated.

“More than 90% of patients returned for one or more follow-up sessions and more than 80% met HEDIS engagement criteria, which included attending two or more visits within 34 days of intake,” Williams reported.

“The data also suggest that patients using fentanyl can be successfully induced with buprenorphine using a protocol that emphasizes: low initial buprenorphine dose, rapid titration to target dose, Actively used sedative medications and close follow-up during buprenorphine dose titration.

“Another Ophelia study, published in The American Journal of Drug and Alcohol Abusedemonstrated that opioid users receiving MAT via telehealth have higher rates of treatment retention,” they continued. “We found that 56.4% of Ophelia patients remained in treatment for six months, and 48.3% for a years remained in treatment – ​​these retention rates are much higher than those of traditional individualized care.”

The study also revealed that telehealth patient retention rates exceed one The first multicenter individual patient population was studied (using the same visit-based retention definition). Despite the hypothesis that retention would be lower among racial/ethnic minorities and rural patients, the study found no significant associations between gender, race/ethnicity, state, or rurality with treatment retention.

“These phenomenal results point to the long-term promise of telehealth-based medication-assisted treatment for OUD,” Williams said. “It can also be incredibly impactful for patients who have traditionally had difficulties accessing care.

“These study findings help take one more step forward in proving what we already know: telehealth-based medication-assisted treatment for opioid use disorder is highly effective in reducing overdoses and preventing recurrences.” ,” They said.

Follow Bill’s HIT coverage on LinkedIn: Bill Siwicki
Email him at: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.