OUTREACH: Opioid Use TReatment via telehEAlth in CHCs - Improving access to opioid use disorder (OUD) treatment is critical to curb opioid overdose rates in the United States. Alarmingly, only 25% of adults with an OUD receive opioid agonist or antagonist treatment. In March of 2020, telehealth policies were enacted to increase access to OUD treatment, including federal regulatory agencies authorizing remote buprenorphine induction and prescription refills if a patient could be adequately evaluated and monitored via telehealth. Many insurers began reimbursing at the same rate for in-person, video and telephone visits. Prior to telehealth implementation, access and utilization of primary care-based OUD treatment were limited. Expansion of telehealth promoted access to OUD care that might not have been accessible otherwise and has the potential to reach patients with low rates of in-person primary care-based OUD treatment. Conversely, limited access to technology and low digital literacy could hinder the use of telehealth services in some populations (e.g., older adults, those living in rural areas). While telehealth has been shown to be as effective as in-person care in engaging and retaining patients on medications for opioid use disorder (MOUD), most studies were conducted within a few years of policy implementation. Significant gaps remain in our knowledge of how these changes have affected rates of and characteristics associated with OUD care as telehealth has evolved within health care settings and become a standard option for care delivery. Moreover, little is known about the patterns of telephone, video and in-person visits for OUD care over time or the multi-level characteristics associated with use of each modality. To date, no studies have comprehensively evaluated the impact of telehealth expansion on OUD care within community health centers (CHCs) which are at the forefront of the opioid epidemic. Our study uses almost a decade of CHC electronic health record (EHR) data (N>3.6 million patients in 35 states) from OCHIN, one of the nation’s largest safety-net networks with a single EHR. The data set includes over 90,000 patients with an OUD diagnosis, of whom more than 40% had an order for an MOUD. We link the EHR data set with community-level data and Datavant mortality data to: 1) Examine rates of OUD-related care (e.g., OUD diagnosis, MOUD orders, MOUD retention, behavioral health) in CHCs before, during, and after telehealth expansion; 2) Examine rates of OUD-related care in CHCs by visit modality (in-person, video, telephone) over time; and 3) Identify patient- and community-level factors that moderate the associations between visit modality and OUD care over time. This study uses a robust linked data set to conduct a comprehensive and rigorous examination of changes in the rates and moderators of OUD care among CHC patients seen before, during, and after the expansion of telehealth. Our evaluation informs future telehealth policy decisions and clinical guidelines, and determines what, if any, interventions are warranted within CHC settings to ensure access to OUD treatment for all individuals in need.
