Implementing a low-threshold audio-only telehealth model for medication-assisted treatment of opioid use disorder at a community-based non-profit organization in Washington, D.C

The COVID-19 pandemic has had especially devastating effects on people who use drugs. Due to pandemic protocols in the USA, medication-assisted treatment (MAT) regulations became more flexible, permitting our community-based nonprofit organization to transition its low-threshold MAT clinic to an aud...

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Bibliographic Details
Published in:	Harm reduction journal Vol. 18; no. 1; p. 127
Main Authors:	Yeo, Ellis Jaewon, Kralles, Hannah, Sternberg, David, McCullough, Dana, Nadanasabesan, Ajetha, Mayo, Richard, Akselrod, Hana, Catalanotti, Jillian
Format:	Journal Article
Language:	English
Published:	England BioMed Central Ltd 09-12-2021 BioMed Central BMC
Subjects:	Attrition Audio data Blood diseases Blood pressure Buprenorphine Case reports Case studies Case Study Community Community organizations Community psychiatric services Coronaviruses COVID-19 Diabetes Diabetes mellitus District of Columbia Drug addiction Drug dosages Drug use Drug withdrawal Drugs Electronic health records Electronic medical records Employment Harm reduction Health care Health services Hepatitis C HIV Homeless people Housing Human immunodeficiency virus Humans Hypertension Male Medical records Medication-assisted treatment Mental health Middle Aged Narcotics Nonprofit organizations Opiate Substitution Treatment Opioid use disorder Opioid-Related Disorders - drug therapy Opioid-Related Disorders - epidemiology Opioids Organizations, Nonprofit Pandemics Patients Pharmacy Public health Regulations Retention SARS-CoV-2 Services Social distancing Telehealth Telemedicine Urine District of Columbia United States Washington DC United States > US COVID-19 Harm reduction Buprenorphine Telehealth Opioid use disorder Medication-assisted treatment
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Summary:	The COVID-19 pandemic has had especially devastating effects on people who use drugs. Due to pandemic protocols in the USA, medication-assisted treatment (MAT) regulations became more flexible, permitting our community-based nonprofit organization to transition its low-threshold MAT clinic to an audio-only telehealth model of care in 2020. Lessons learned have the potential to improve MAT delivery to people with OUD. This case study describes our transition from a low-threshold community-based in-person MAT clinic to an audio-only telehealth model. We extracted data from electronic health records to describe patient characteristics and to calculate treatment retention rates. Patients were predominantly male (74.4%) and black (90.6%). The mean age was 53 years old with more than half of the clients aged 55 or older. Less than half (42.3%) of the patients lived in stable housing. Patients commonly had self-reported comorbid conditions such as hypertension (35.4%), hepatitis C (23.5%), diabetes (11.9%), human immunodeficiency virus (HIV) (7.2%). A majority of patients (68.6%) reported engagement with behavioral health care. We measure the success of our intervention relative to published retention rates, both overall as well as for in-person and telehealth care. In-person retention rates at 90- and 180-days were substantially higher than telehealth retention rates (93.9% vs 68.4% and 91.5% vs 51.9%, respectively). Low-threshold medication-assisted treatment in the care of people with opioid use disorder is essential to increasing treatment access and continuity. We found that an audio-only telehealth model was viable. Although we had decreased retention rates following the transition to an audio-only telehealth model, our rates remained excellent compared to published values for in-person MAT care. We call for advocacy and regulations to support continued use of telehealth services throughout and beyond the COVID-19 pandemic.
Bibliography:	ObjectType-Case Study-2 SourceType-Scholarly Journals-1 ObjectType-Feature-4 content type line 23 ObjectType-Report-1 ObjectType-Article-3
ISSN:	1477-7517 1477-7517
DOI:	10.1186/s12954-021-00578-1