A multilevel analysis of changing telehealth availability in opioid use disorder treatment settings: Conditional effects of rurality, the number and types of medication for opioid use disorder available, and time, US, 2016-2023.
George Pro, Jonathan Cantor, Don Willis, Mofan Gu, Brian Fairman, Jure Baloh, Brooke Ee Montgomery
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引用次数: 0
Abstract
Purpose: The opioid overdose crisis requires strengthening treatment systems with innovative technologies. How people use telehealth for opioid use disorder (OUD) is evolving and differs in rural versus urban areas, as telehealth is emerging as a local resource and complementary option to in-person treatment. We assessed changing trends in telehealth and medication for OUD (MOUD) and pinpoint locations of low telehealth and MOUD access.
Methods: We used national data from the Mental health and Addiction Treatment Tracking Repository (2016-2023) to identify specialty outpatient SUD treatment facilities in the United States (N = 83,988). We modeled the availability of telehealth using multilevel multivariable logistic regression, adjusting for covariates. We included a 3-way interaction to test for conditional effects of rurality, the number of MOUD medication types dispensed, and year. We included two random effects to account for clustering within counties and states.
Findings: We identified 495 facilities that offered both telehealth and all three MOUD medication types (methadone, buprenorphine, naltrexone) in 2023, clustered in the eastern United States. We identified a statistically significant 3-way interaction (p < 0.0001), indicating that telehealth in facilities that did not offer MOUD shifted from more telehealth in rural facilities in earlier years to more telehealth in urban facilities in later years.
Conclusions: Treatment facilities that offer both telehealth and all three MOUD medication types may improve access for hard-to-reach populations. We stress the importance of continued health system strengthening and technological resources in vulnerable rural communities, while acknowledging a changing landscape of increased OUD incidence and MOUD demand in urban communities.
期刊介绍：
The Journal of Rural Health, a quarterly journal published by the NRHA, offers a variety of original research relevant and important to rural health. Some examples include evaluations, case studies, and analyses related to health status and behavior, as well as to health work force, policy and access issues. Quantitative, qualitative and mixed methods studies are welcome. Highest priority is given to manuscripts that reflect scholarly quality, demonstrate methodological rigor, and emphasize practical implications. The journal also publishes articles with an international rural health perspective, commentaries, book reviews and letters.
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