Patient Perceived Impact of Outpatient Group Substance Use Disorder Treatment in a Hybrid Model or Virtual-Only Model Relative to In-Person Delivery.

Abstract

Purpose: Telehealth use has grown tremendously since the onset of the COVID-19 pandemic. While the benefits of virtual care delivery are numerous, little is known about patient experiences in group treatment settings when members join both virtually and in person with the counselor (a hybrid model). We sought to fill this gap by comparing patient survey data across care delivery models.

Patients and methods: Adult patients with a substance use disorder enrolled at one of seven intensive outpatient (IOP) programs in rural Minnesota voluntarily completed a questionnaire assessing patient satisfaction, perceived therapeutic alliance, group cohesion, and insight gained from treatment. Starting 7/1/2021, groups were either all virtual, all in-person, or a hybrid model. The survey began on 1/1/2022. Analysis of covariance (ANCOVA) tested for differences among treatment groups. Separate models were used for each survey question, where the dependent variable was the survey response, the test of interest being treatment group-type, with covariates of length of stay and age. Model estimates and model-based standard deviations were used to calculate the Cohen's d effect size.

Results: Survey results from a total of 1037 individuals were included, one survey per respondent. Data was deidentified upon receipt of the survey, preventing specific demographic comparisons. For the hybrid groups, no significant differences were noted with survey responses relative to in-person, with negligible to small effect sizes seen. When comparing virtual to in-person, virtual was rated as significantly worse than in-person on 6 of the 8 questions; effect size estimates exceeded the small effect size cut-off, and the 95% CI exceeded the moderate cut-off.

Conclusion: Creating a group model where patients can attend both virtually and in-person together appears to improve perceived therapeutic alliance, group cohesion, and treatment insight, compared to virtual-only groups, which may have a negative effect relative to in-person.