Title : A pragmatic comparative evaluation of telehealth vs. in-person services for substance use in rural America
Abstract:
The use of telehealth in rural areas is particularly apt for patients with substance use disorders is supported by studies demonstrating equivalent outcomes between telehealth and in-person treatment for patient satisfaction and treatment retention rates (Lin et al., 2019; Mark et al., 2022; SAMHSA, 2021). But the literature on the use of telehealth treatment for substance use disorders is limited, especially from studies reporting clinical outcome measures. This poster will present data collected from a large, publicly funded, multi-site, multidisciplinary, multi-treatment telehealth comparative effectiveness trial. The findings from this measure are reported here from a cohort of patients that received care using either telehealth or in-person services.
Methods: The study involved 57 rural clinic sites across 11 grantees and enrolled 2,220 patients. Several clinical outcome measures were used in the evaluation, and clinicians were directed to use one or more of the available outcome measures as they deemed clinically appropriate. Among the entire sample, a small number of the patients completed and reported the DUDIT-C, the study’s chosen substance use severity measure. A protocol was established which defined patient inclusion criteria and data collection timeframes. The telehealth cohort included all patients who began telehealth treatment as part of either grant-funded program during the data collection period. The comparison cohort included patients who began in-person treatment during the same time period. DUDIT-C was collected at baseline and monthly on all patients where appropriate, meaning patients presenting with substance use symptoms or concerns.
Demographic and clinical data were compared between cohorts using chi-square tests. The primary dependent measure was the DUDIT-C score at the last available assessment). Mixed methods, hierarchical linear regression models with random effects at the grantee level were used to test for differences between the telehealth cohort and the in-person cohort adjusting for covariates (i.e., age, sex, race, ethnicity, primary insurance type, baseline levels of the DUDIT-C, number of DUDIT-C assessments, number of encounters).
Results: Patients in the telehealth cohort differed significantly from patients in the in-person cohort in that patients in the telehealth cohort were more likely under 18 or over 35 years old, American Indian/Alaska Native, and insured by Medicare or Medicaid.
Average change scores in both cohorts were negative indicating that DUDIT-C scores decreased (improved) from baseline to follow-up. These average unadjusted change score decreases were 1.4 for the telehealth cohort and 1.3 for the in-person cohort (p=0.85). Decreases in DUDIT-C scores were highly related to baseline scores, with patients with higher baseline scores showing greater symptom reductions After adjustment for covariates, DUDIT-C changes scores did not differ between the telehealth and in-person cohorts.
Conclusion:The results of this study demonstrate that the outcomes of clinical interventions on reported drug use were similar whether delivered using telehealth or in-person, even after adjusting for potential confounders. Similar outcomes were seen on a standardized measure of drug use severity and observed patterns of clinical change were consistent between the two cohorts (telehealth and in-person).
What will audience learn from your presentation?
- The learner will be introduced to funding mechanisms for substance use/abuse treatment in rural and underserved areas
- Understand implementation and design of large pragmatic research across diverse data collection sites
- Increase knowledge of effectiveness of telehealth interventions for substance use concerns.
