Impact of telehealth, in-person, and hybrid care modalities on buprenorphine discontinuation among patients with opioid use disorder: A retrospective cohort study on commercially insured individuals

Introduction

Opioid use disorder (OUD) is a leading cause of mortality in the United States. Buprenorphine is an effective treatment for OUD, but its benefits rely on sustained treatment retention. The expansion of telehealth and hybrid care models, particularly during the COVID-19 pandemic, provides an opportunity to improve retention. However, the comparative effectiveness of these care modalities on buprenorphine discontinuation across different treatment phases remains unclear.

Methods

This retrospective cohort study utilized IBM MarketScan Commercial Claims data from September 2019 to December 2022. The study included insured individuals aged ≥18 years diagnosed with OUD who initiated buprenorphine treatment between March 23, 2020, and December 31, 2021. Patients were stratified into telehealth, in-person, and hybrid care (initiating treatment via telehealth and receiving 51–75 % of visits in-person) groups. The primary outcome was buprenorphine discontinuation, defined as a gap of ≥30 days in prescription fills/refills during the 12-month follow-up. Discontinuation was assessed as two separate binary outcomes: (1) early-phase discontinuation, defined as a gap of ≥30 days within the first 3 months of treatment, and (2) late-phase discontinuation, defined as a gap of ≥30 days between months 4 and 12 among those who remained on treatment through the initial 3 months. Multivariable logistic regression models adjusted for covariates were applied for each outcome, and propensity score matching (PSM) was employed to minimize confounding.

Results

Among 10,783 patients (mean age 43.25 ± 12.62 years; 49.52 % female), those treated via telehealth were significantly less likely to discontinue buprenorphine during the early treatment phase compared to patients in both in-person and hybrid care groups (OR: 0.83, 95 % CI: 0.75–0.92). During the late treatment phase, patients receiving hybrid care had significantly lower odds of discontinuation compared to those receiving either telehealth or in-person care (OR: 0.73, 95 % CI: 0.62–0.86). These findings were consistent in both unmatched and matched analyses.

Conclusions

Telehealth was associated with improved early retention in buprenorphine treatment, while hybrid care models were more effective for long-term retention. The findings suggest that a phased approach, where telehealth is leveraged for treatment initiation and early retention, and when the patient continues via a hybrid model for long-term care, may optimize buprenorphine treatment outcomes.