Telehealth services have increased access to addiction care, but has everyone benefitted equally?
COVID-19 led to the rapid expansion of telehealth services for substance use disorder. While overall this has improved access to mental health services, concerns remained about possible disparities related to who has access to, and benefits from, this class of health services. This study utilized a large patient database to explore uptake of substance use disorder telehealth services at the start of COVID-19, and whether people differed in terms of their access to these services based on their individual characteristics.
A silver lining of the COVID-19 pandemic has been the major expansion of telehealth services, which on the whole have increased access to care for mental health problems like substance use disorder. Such services include, but are not limited to, individual and group psychotherapy, and medication management delivered over video call or phone. While overall tele-healthcare has reduced barriers to treatment, concerns have remained about disparities in access to these services among people with limited financial means and/or limited technical know-how. Such disparities may compound access-to-care disparities for in-person services. For instance, it is well known that people who identify as part of a racial minority group are less likely to initiate substance use disorder treatment or get appropriate substance use disorder care.
In this study, the researchers utilized existing medical records and billing data from a large healthcare company to assess uptake and utilization of telehealth services for substance use disorder at the onset of the COVID-19 pandemic. The researchers also explored potential disparities in who was able to access and engage with these services.
HOW WAS THIS STUDY CONDUCTED?
This was a retrospective, observational study of healthcare data from 34,170 individuals with substance use disorder or unhealthy substance use behaviors receiving care with Kaiser Permanente (a large, northern California-based healthcare system) just prior to, and immediately following the onset of the COVID-19 pandemic.
The researchers identified medical records of Kaiser Permanente patients who had received a substance use disorder diagnosis or had been identified as having unhealthy substance use behaviors around the beginning of the COVID-19 pandemic. They then measured telehealth service utilization for each patient over a six-month period from their date of substance use disorder diagnosis or identification of unhealthy substance use behavior. Patients were clustered into two cohorts. One cohort included 19,648 patients receiving diagnosis/identification of unhealthy substance use behaviors just prior to the COVID-19 pandemic, with the other including 16,959 patients receiving diagnosis/identification of unhealthy substance use behaviors in the first 10 months of the COVID-19 pandemic when Kaiser Permanente outpatient addiction services rapidly pivoted to providing much of their care through telehealth. There were 2,434 patients in both cohorts.
They compared racial-, ethnic-, age-, socioeconomic-, and gender-groups on overall and telehealth treatment initiation, overall and telehealth treatment engagement, treatment retention, and opioid use disorder pharmacotherapy retention. Potential differences were also explored across levels of psychiatric and medical comorbidity.
Overall and telehealth treatment initiation was defined as initiating addiction treatment through an inpatient admission, outpatient visit, intensive outpatient encounter or partial hospitalization, or telehealth encounter (telephone, video, or unknown modality) or receipt of medication for opioid use disorder within 14 days of the diagnosis/identification of unhealthy substance use behavior date.
Overall and telehealth treatment engagement was defined as having two or more additional addiction treatment-related services or receiving opioid use disorder medication within 34 days of an initiation visit or inpatient discharge date, either in-person or via telehealth.
Treatment retention was defined as the continuous number of days in outpatient addiction treatment (either in-person or telehealth) in the 12 weeks following treatment initiation until there was evidence that treatment had been completed.
Opioid pharmacotherapy retention was defined as the continuous number of days treated in the 12 weeks after an initial prescription was filled until a 30-day gap occurred.
The combined study sample including both cohorts was 42.5% female, 1.6% American Indian or Alaska Native, 7.5% Asian or Pacific Islander, 14.5% Black, 21.5% Latino or Hispanic, 52.2% White, and 2.3% unknown. 69% of the sample were identified as having a drug use disorder, and 19% with prior-year alcohol use disorder; 31% of the sample were identified as having unhealthy substance use behavior. Additionally, 60% of the sample had a prior-year psychiatric disorder diagnosis.
WHAT DID THIS STUDY FIND?
Substance use disorder treatment initiation and engagement increased at the beginning of COVID-19.
Of the patients in the in the Kaiser Permanente system identified with diagnosis/identification of unhealthy substance use behaviors before the COVID-19 pandemic, 28.6% initiated some form of substance use disorder treatment (either in-person or via telehealth), versus 32.2% during COVID-19 pandemic onset. The researchers found that this increase was primarily explained by greater treatment engagement among patients aged 18 to 34 years and 35 to 49 years. No other individual characteristics appeared to be influencing the uptick in treatment initiation (i.e., not race/ethnicity, gender, psychiatric comorbidity).
Overall treatment engagement (either in-person or via telehealth) also increased slightly from 25.2% to 27.7% from pre- to onset-pandemic with no variation by patient characteristics.
Not surprisingly, telehealth service utilization increased dramatically at the onset of the pandemic.
Initiation of telehealth-based treatment increased from 3.3% before the COVID-19 pandemic to 15.0% during pandemic onset, with telehealth service utilization increasing in all groups, and patients 18 to 34 years showing the greatest increase.
Engagement with telehealth treatment also increased from 7.4% pre-COVID-19 to 45.9% at pandemic onset without variation by patient characteristics.
Treatment retention slightly improved among those receiving telehealth.
From pre-COVID to COVID onset, treatment retention increased by 1.4 days among patients who initiated any treatment versus an increase of 7.9 days among those who initiated telehealth treatment. There were however no meaningful changes in the average number of continuous days treated with opioid use disorder medication from before the COVID-19 pandemic to COVID-19 onset. There were also no significant differences across patient characteristics on either of these measures.
WHAT ARE THE IMPLICATIONS OF THE STUDY FINDINGS?
Though telehealth services had been around for some time at the start of the pandemic, COVID-19 led to a massive expansion of these services. While this has generally been seen as a positive, as it has increased access to health services and is generally experienced as a convenience for patients, concerns have remained about possible disparities in access to this class of services.
As expected, this study found initiation and engagement with telehealth services for substance use disorder dramatically increased at the onset of COVID-19 in the Kaiser Permanente healthcare system. This makes sense given this organization, and others like it, rapidly pivoted from providing most of their in-person treatment services to telehealth.
Notably, overall initiation and engagement with substance use disorder treatment actually increased slightly at the start of COVID-19, rather than decreasing, as was feared at the start of the pandemic. These researchers’ findings suggest this was because treatment systems were able to quickly pivot to providing telehealth services, though as they note, this could also be a function of patients having more time to engage in treatment at the start of the pandemic due to work and school slowdowns/shutdowns.
Though generally speaking the researchers didn’t find major disparities in initiation and engagement with telehealth services, younger people aged 18-49 did engage more with this class of services compared to people over 50, which could be a function of differences in comfort using video-conferencing technology. This issue will recede with time as younger generations, who are generally more tech-savvy, age. In the meantime, this finding highlights the importance of ensuring older people are supported so they might access telehealth services when needed.
This study was conducted among a stably insured population receiving care through a large, integrated healthcare system. As a result, these findings might not generalize to the general US population with its more variable levels of insurance and access to care.
This study focused on the first 10 months of the COVID-19 pandemic. Additional studies, like this one will ideally explore how telehealth initiation and engagement evolved through the pandemic and continues to this day.
Though the researchers did well to control for as many individual-level characteristics as they could with the data they had available to them, certain important factors, like engagement with treatment and mutual-help programs outside of the Kaiser Permanente system, were not accounted for in their analyses. These factors could have affected their results in unknown ways.
Study cohorts were not matched on individual characteristics like race/ethnicity and alcohol problem severity. As such, it’s possible the patient cohorts before and at COVID-19 pandemic onset were, on average, different in terms of their makeup. This could have affected the study outcomes in unknown ways.
Not a limitation per se, but this study focused on treatment initiation, engagement, and retention. Future studies will ideally also explore substance use disorder treatment outcomes associated with tele-healthcare.
BOTTOM LINE
Though not tested in this study, telehealth services for substance use disorder have generally been found to produce similar outcomesto traditional in-person treatments. Telehealth services may also increase access to substance use disorder care by reducing barriers to engaging with treatment like difficulty getting to treatment sites and stigma that can make people hesitant to engage with in-person care. Importantly, this study begins to relieve concerns about potential disparities in access to tele-healthcare for substance use disorder. Though researchers found people under 50 were more likely to initiate and engage with telehealth services, they did not find differences between races/ethnicities, genders, or socioeconomic levels.
For individuals and families seeking recovery: Telehealth services for substance use disorder have generally been found to produce similar outcomes to traditional in-person treatments and are worth considering, especially where barriers exist that may prevent an individual engaging in in-person treatment.
For treatment professionals and treatment systems: Offering telehealth services for substance use disorder likely increases access to care, however, older people may have more difficulty accessing this class of services and may benefit from programs that support their use of telehealth technology.
For scientists: Telehealth services have improved access to substance use disorder care and have generally been found to produce similar outcomes to traditional in-person treatments. At the same time, more research is needed to explore for whom and under what conditions telehealth confers benefit. And while this study did not identify marked disparities in terms of who initiated and engaged with telehealth services in the Kaiser Permanente system at the start of the COVID-19 pandemic, studies are needed to check for disparities in telehealth access in different populations, especially in populations of people with less access to health insurance and healthcare.
For policy makers: Telehealth services for substance use disorder have been found to produce similar outcomes to traditional in-person treatments and can increase access to care. Because of the public health benefits this class of services can provide, it is important that mandates exist requiring insurers to cover this class of care in the same way they cover in-person care.
A silver lining of the COVID-19 pandemic has been the major expansion of telehealth services, which on the whole have increased access to care for mental health problems like substance use disorder. Such services include, but are not limited to, individual and group psychotherapy, and medication management delivered over video call or phone. While overall tele-healthcare has reduced barriers to treatment, concerns have remained about disparities in access to these services among people with limited financial means and/or limited technical know-how. Such disparities may compound access-to-care disparities for in-person services. For instance, it is well known that people who identify as part of a racial minority group are less likely to initiate substance use disorder treatment or get appropriate substance use disorder care.
In this study, the researchers utilized existing medical records and billing data from a large healthcare company to assess uptake and utilization of telehealth services for substance use disorder at the onset of the COVID-19 pandemic. The researchers also explored potential disparities in who was able to access and engage with these services.
HOW WAS THIS STUDY CONDUCTED?
This was a retrospective, observational study of healthcare data from 34,170 individuals with substance use disorder or unhealthy substance use behaviors receiving care with Kaiser Permanente (a large, northern California-based healthcare system) just prior to, and immediately following the onset of the COVID-19 pandemic.
The researchers identified medical records of Kaiser Permanente patients who had received a substance use disorder diagnosis or had been identified as having unhealthy substance use behaviors around the beginning of the COVID-19 pandemic. They then measured telehealth service utilization for each patient over a six-month period from their date of substance use disorder diagnosis or identification of unhealthy substance use behavior. Patients were clustered into two cohorts. One cohort included 19,648 patients receiving diagnosis/identification of unhealthy substance use behaviors just prior to the COVID-19 pandemic, with the other including 16,959 patients receiving diagnosis/identification of unhealthy substance use behaviors in the first 10 months of the COVID-19 pandemic when Kaiser Permanente outpatient addiction services rapidly pivoted to providing much of their care through telehealth. There were 2,434 patients in both cohorts.
They compared racial-, ethnic-, age-, socioeconomic-, and gender-groups on overall and telehealth treatment initiation, overall and telehealth treatment engagement, treatment retention, and opioid use disorder pharmacotherapy retention. Potential differences were also explored across levels of psychiatric and medical comorbidity.
Overall and telehealth treatment initiation was defined as initiating addiction treatment through an inpatient admission, outpatient visit, intensive outpatient encounter or partial hospitalization, or telehealth encounter (telephone, video, or unknown modality) or receipt of medication for opioid use disorder within 14 days of the diagnosis/identification of unhealthy substance use behavior date.
Overall and telehealth treatment engagement was defined as having two or more additional addiction treatment-related services or receiving opioid use disorder medication within 34 days of an initiation visit or inpatient discharge date, either in-person or via telehealth.
Treatment retention was defined as the continuous number of days in outpatient addiction treatment (either in-person or telehealth) in the 12 weeks following treatment initiation until there was evidence that treatment had been completed.
Opioid pharmacotherapy retention was defined as the continuous number of days treated in the 12 weeks after an initial prescription was filled until a 30-day gap occurred.
The combined study sample including both cohorts was 42.5% female, 1.6% American Indian or Alaska Native, 7.5% Asian or Pacific Islander, 14.5% Black, 21.5% Latino or Hispanic, 52.2% White, and 2.3% unknown. 69% of the sample were identified as having a drug use disorder, and 19% with prior-year alcohol use disorder; 31% of the sample were identified as having unhealthy substance use behavior. Additionally, 60% of the sample had a prior-year psychiatric disorder diagnosis.
WHAT DID THIS STUDY FIND?
Substance use disorder treatment initiation and engagement increased at the beginning of COVID-19.
Of the patients in the in the Kaiser Permanente system identified with diagnosis/identification of unhealthy substance use behaviors before the COVID-19 pandemic, 28.6% initiated some form of substance use disorder treatment (either in-person or via telehealth), versus 32.2% during COVID-19 pandemic onset. The researchers found that this increase was primarily explained by greater treatment engagement among patients aged 18 to 34 years and 35 to 49 years. No other individual characteristics appeared to be influencing the uptick in treatment initiation (i.e., not race/ethnicity, gender, psychiatric comorbidity).
Overall treatment engagement (either in-person or via telehealth) also increased slightly from 25.2% to 27.7% from pre- to onset-pandemic with no variation by patient characteristics.
Not surprisingly, telehealth service utilization increased dramatically at the onset of the pandemic.
Initiation of telehealth-based treatment increased from 3.3% before the COVID-19 pandemic to 15.0% during pandemic onset, with telehealth service utilization increasing in all groups, and patients 18 to 34 years showing the greatest increase.
Engagement with telehealth treatment also increased from 7.4% pre-COVID-19 to 45.9% at pandemic onset without variation by patient characteristics.
Treatment retention slightly improved among those receiving telehealth.
From pre-COVID to COVID onset, treatment retention increased by 1.4 days among patients who initiated any treatment versus an increase of 7.9 days among those who initiated telehealth treatment. There were however no meaningful changes in the average number of continuous days treated with opioid use disorder medication from before the COVID-19 pandemic to COVID-19 onset. There were also no significant differences across patient characteristics on either of these measures.
WHAT ARE THE IMPLICATIONS OF THE STUDY FINDINGS?
Though telehealth services had been around for some time at the start of the pandemic, COVID-19 led to a massive expansion of these services. While this has generally been seen as a positive, as it has increased access to health services and is generally experienced as a convenience for patients, concerns have remained about possible disparities in access to this class of services.
As expected, this study found initiation and engagement with telehealth services for substance use disorder dramatically increased at the onset of COVID-19 in the Kaiser Permanente healthcare system. This makes sense given this organization, and others like it, rapidly pivoted from providing most of their in-person treatment services to telehealth.
Notably, overall initiation and engagement with substance use disorder treatment actually increased slightly at the start of COVID-19, rather than decreasing, as was feared at the start of the pandemic. These researchers’ findings suggest this was because treatment systems were able to quickly pivot to providing telehealth services, though as they note, this could also be a function of patients having more time to engage in treatment at the start of the pandemic due to work and school slowdowns/shutdowns.
Though generally speaking the researchers didn’t find major disparities in initiation and engagement with telehealth services, younger people aged 18-49 did engage more with this class of services compared to people over 50, which could be a function of differences in comfort using video-conferencing technology. This issue will recede with time as younger generations, who are generally more tech-savvy, age. In the meantime, this finding highlights the importance of ensuring older people are supported so they might access telehealth services when needed.
This study was conducted among a stably insured population receiving care through a large, integrated healthcare system. As a result, these findings might not generalize to the general US population with its more variable levels of insurance and access to care.
This study focused on the first 10 months of the COVID-19 pandemic. Additional studies, like this one will ideally explore how telehealth initiation and engagement evolved through the pandemic and continues to this day.
Though the researchers did well to control for as many individual-level characteristics as they could with the data they had available to them, certain important factors, like engagement with treatment and mutual-help programs outside of the Kaiser Permanente system, were not accounted for in their analyses. These factors could have affected their results in unknown ways.
Study cohorts were not matched on individual characteristics like race/ethnicity and alcohol problem severity. As such, it’s possible the patient cohorts before and at COVID-19 pandemic onset were, on average, different in terms of their makeup. This could have affected the study outcomes in unknown ways.
Not a limitation per se, but this study focused on treatment initiation, engagement, and retention. Future studies will ideally also explore substance use disorder treatment outcomes associated with tele-healthcare.
BOTTOM LINE
Though not tested in this study, telehealth services for substance use disorder have generally been found to produce similar outcomesto traditional in-person treatments. Telehealth services may also increase access to substance use disorder care by reducing barriers to engaging with treatment like difficulty getting to treatment sites and stigma that can make people hesitant to engage with in-person care. Importantly, this study begins to relieve concerns about potential disparities in access to tele-healthcare for substance use disorder. Though researchers found people under 50 were more likely to initiate and engage with telehealth services, they did not find differences between races/ethnicities, genders, or socioeconomic levels.
For individuals and families seeking recovery: Telehealth services for substance use disorder have generally been found to produce similar outcomes to traditional in-person treatments and are worth considering, especially where barriers exist that may prevent an individual engaging in in-person treatment.
For treatment professionals and treatment systems: Offering telehealth services for substance use disorder likely increases access to care, however, older people may have more difficulty accessing this class of services and may benefit from programs that support their use of telehealth technology.
For scientists: Telehealth services have improved access to substance use disorder care and have generally been found to produce similar outcomes to traditional in-person treatments. At the same time, more research is needed to explore for whom and under what conditions telehealth confers benefit. And while this study did not identify marked disparities in terms of who initiated and engaged with telehealth services in the Kaiser Permanente system at the start of the COVID-19 pandemic, studies are needed to check for disparities in telehealth access in different populations, especially in populations of people with less access to health insurance and healthcare.
For policy makers: Telehealth services for substance use disorder have been found to produce similar outcomes to traditional in-person treatments and can increase access to care. Because of the public health benefits this class of services can provide, it is important that mandates exist requiring insurers to cover this class of care in the same way they cover in-person care.
A silver lining of the COVID-19 pandemic has been the major expansion of telehealth services, which on the whole have increased access to care for mental health problems like substance use disorder. Such services include, but are not limited to, individual and group psychotherapy, and medication management delivered over video call or phone. While overall tele-healthcare has reduced barriers to treatment, concerns have remained about disparities in access to these services among people with limited financial means and/or limited technical know-how. Such disparities may compound access-to-care disparities for in-person services. For instance, it is well known that people who identify as part of a racial minority group are less likely to initiate substance use disorder treatment or get appropriate substance use disorder care.
In this study, the researchers utilized existing medical records and billing data from a large healthcare company to assess uptake and utilization of telehealth services for substance use disorder at the onset of the COVID-19 pandemic. The researchers also explored potential disparities in who was able to access and engage with these services.
HOW WAS THIS STUDY CONDUCTED?
This was a retrospective, observational study of healthcare data from 34,170 individuals with substance use disorder or unhealthy substance use behaviors receiving care with Kaiser Permanente (a large, northern California-based healthcare system) just prior to, and immediately following the onset of the COVID-19 pandemic.
The researchers identified medical records of Kaiser Permanente patients who had received a substance use disorder diagnosis or had been identified as having unhealthy substance use behaviors around the beginning of the COVID-19 pandemic. They then measured telehealth service utilization for each patient over a six-month period from their date of substance use disorder diagnosis or identification of unhealthy substance use behavior. Patients were clustered into two cohorts. One cohort included 19,648 patients receiving diagnosis/identification of unhealthy substance use behaviors just prior to the COVID-19 pandemic, with the other including 16,959 patients receiving diagnosis/identification of unhealthy substance use behaviors in the first 10 months of the COVID-19 pandemic when Kaiser Permanente outpatient addiction services rapidly pivoted to providing much of their care through telehealth. There were 2,434 patients in both cohorts.
They compared racial-, ethnic-, age-, socioeconomic-, and gender-groups on overall and telehealth treatment initiation, overall and telehealth treatment engagement, treatment retention, and opioid use disorder pharmacotherapy retention. Potential differences were also explored across levels of psychiatric and medical comorbidity.
Overall and telehealth treatment initiation was defined as initiating addiction treatment through an inpatient admission, outpatient visit, intensive outpatient encounter or partial hospitalization, or telehealth encounter (telephone, video, or unknown modality) or receipt of medication for opioid use disorder within 14 days of the diagnosis/identification of unhealthy substance use behavior date.
Overall and telehealth treatment engagement was defined as having two or more additional addiction treatment-related services or receiving opioid use disorder medication within 34 days of an initiation visit or inpatient discharge date, either in-person or via telehealth.
Treatment retention was defined as the continuous number of days in outpatient addiction treatment (either in-person or telehealth) in the 12 weeks following treatment initiation until there was evidence that treatment had been completed.
Opioid pharmacotherapy retention was defined as the continuous number of days treated in the 12 weeks after an initial prescription was filled until a 30-day gap occurred.
The combined study sample including both cohorts was 42.5% female, 1.6% American Indian or Alaska Native, 7.5% Asian or Pacific Islander, 14.5% Black, 21.5% Latino or Hispanic, 52.2% White, and 2.3% unknown. 69% of the sample were identified as having a drug use disorder, and 19% with prior-year alcohol use disorder; 31% of the sample were identified as having unhealthy substance use behavior. Additionally, 60% of the sample had a prior-year psychiatric disorder diagnosis.
WHAT DID THIS STUDY FIND?
Substance use disorder treatment initiation and engagement increased at the beginning of COVID-19.
Of the patients in the in the Kaiser Permanente system identified with diagnosis/identification of unhealthy substance use behaviors before the COVID-19 pandemic, 28.6% initiated some form of substance use disorder treatment (either in-person or via telehealth), versus 32.2% during COVID-19 pandemic onset. The researchers found that this increase was primarily explained by greater treatment engagement among patients aged 18 to 34 years and 35 to 49 years. No other individual characteristics appeared to be influencing the uptick in treatment initiation (i.e., not race/ethnicity, gender, psychiatric comorbidity).
Overall treatment engagement (either in-person or via telehealth) also increased slightly from 25.2% to 27.7% from pre- to onset-pandemic with no variation by patient characteristics.
Not surprisingly, telehealth service utilization increased dramatically at the onset of the pandemic.
Initiation of telehealth-based treatment increased from 3.3% before the COVID-19 pandemic to 15.0% during pandemic onset, with telehealth service utilization increasing in all groups, and patients 18 to 34 years showing the greatest increase.
Engagement with telehealth treatment also increased from 7.4% pre-COVID-19 to 45.9% at pandemic onset without variation by patient characteristics.
Treatment retention slightly improved among those receiving telehealth.
From pre-COVID to COVID onset, treatment retention increased by 1.4 days among patients who initiated any treatment versus an increase of 7.9 days among those who initiated telehealth treatment. There were however no meaningful changes in the average number of continuous days treated with opioid use disorder medication from before the COVID-19 pandemic to COVID-19 onset. There were also no significant differences across patient characteristics on either of these measures.
WHAT ARE THE IMPLICATIONS OF THE STUDY FINDINGS?
Though telehealth services had been around for some time at the start of the pandemic, COVID-19 led to a massive expansion of these services. While this has generally been seen as a positive, as it has increased access to health services and is generally experienced as a convenience for patients, concerns have remained about possible disparities in access to this class of services.
As expected, this study found initiation and engagement with telehealth services for substance use disorder dramatically increased at the onset of COVID-19 in the Kaiser Permanente healthcare system. This makes sense given this organization, and others like it, rapidly pivoted from providing most of their in-person treatment services to telehealth.
Notably, overall initiation and engagement with substance use disorder treatment actually increased slightly at the start of COVID-19, rather than decreasing, as was feared at the start of the pandemic. These researchers’ findings suggest this was because treatment systems were able to quickly pivot to providing telehealth services, though as they note, this could also be a function of patients having more time to engage in treatment at the start of the pandemic due to work and school slowdowns/shutdowns.
Though generally speaking the researchers didn’t find major disparities in initiation and engagement with telehealth services, younger people aged 18-49 did engage more with this class of services compared to people over 50, which could be a function of differences in comfort using video-conferencing technology. This issue will recede with time as younger generations, who are generally more tech-savvy, age. In the meantime, this finding highlights the importance of ensuring older people are supported so they might access telehealth services when needed.
This study was conducted among a stably insured population receiving care through a large, integrated healthcare system. As a result, these findings might not generalize to the general US population with its more variable levels of insurance and access to care.
This study focused on the first 10 months of the COVID-19 pandemic. Additional studies, like this one will ideally explore how telehealth initiation and engagement evolved through the pandemic and continues to this day.
Though the researchers did well to control for as many individual-level characteristics as they could with the data they had available to them, certain important factors, like engagement with treatment and mutual-help programs outside of the Kaiser Permanente system, were not accounted for in their analyses. These factors could have affected their results in unknown ways.
Study cohorts were not matched on individual characteristics like race/ethnicity and alcohol problem severity. As such, it’s possible the patient cohorts before and at COVID-19 pandemic onset were, on average, different in terms of their makeup. This could have affected the study outcomes in unknown ways.
Not a limitation per se, but this study focused on treatment initiation, engagement, and retention. Future studies will ideally also explore substance use disorder treatment outcomes associated with tele-healthcare.
BOTTOM LINE
Though not tested in this study, telehealth services for substance use disorder have generally been found to produce similar outcomesto traditional in-person treatments. Telehealth services may also increase access to substance use disorder care by reducing barriers to engaging with treatment like difficulty getting to treatment sites and stigma that can make people hesitant to engage with in-person care. Importantly, this study begins to relieve concerns about potential disparities in access to tele-healthcare for substance use disorder. Though researchers found people under 50 were more likely to initiate and engage with telehealth services, they did not find differences between races/ethnicities, genders, or socioeconomic levels.
For individuals and families seeking recovery: Telehealth services for substance use disorder have generally been found to produce similar outcomes to traditional in-person treatments and are worth considering, especially where barriers exist that may prevent an individual engaging in in-person treatment.
For treatment professionals and treatment systems: Offering telehealth services for substance use disorder likely increases access to care, however, older people may have more difficulty accessing this class of services and may benefit from programs that support their use of telehealth technology.
For scientists: Telehealth services have improved access to substance use disorder care and have generally been found to produce similar outcomes to traditional in-person treatments. At the same time, more research is needed to explore for whom and under what conditions telehealth confers benefit. And while this study did not identify marked disparities in terms of who initiated and engaged with telehealth services in the Kaiser Permanente system at the start of the COVID-19 pandemic, studies are needed to check for disparities in telehealth access in different populations, especially in populations of people with less access to health insurance and healthcare.
For policy makers: Telehealth services for substance use disorder have been found to produce similar outcomes to traditional in-person treatments and can increase access to care. Because of the public health benefits this class of services can provide, it is important that mandates exist requiring insurers to cover this class of care in the same way they cover in-person care.
