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Published Online: 19 October 2023

Patient Engagement in and Adaptations to Delivery of Outpatient Care for Opioid Use Disorder During the COVID-19 Pandemic

Xinzhe Zhou, M.Sc., Laura K. Thompson, M.S., Anna Pagano, Ph.D., Nusrat Rahman, Ph.D., Sejal Patel, M.P.H., Debbie Gibson, M.Sc., Adila Ibrahim, M.Sc., Barbara Casanova, B.A., Robert P. Schwartz, M.D., Frank J. Vocci, Ph.D., and Diana E. Clarke, Ph.D. [email protected]Authors Info & Affiliations
Publication: Psychiatric Services
Volume 75, Number 3
https://doi.org/10.1176/appi.ps.202100507
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Abstract

Objective:

The authors investigated adaptations to outpatient care delivery and changes in treatment demand and engagement among patients receiving medications for opioid use disorder (MOUD) in the months after the declaration of the COVID-19 public health emergency in 2020.

Methods:

Data were collected through an online survey (June–November 2020) of outpatient MOUD prescribers. The survey obtained information on outpatient practices’ adaptations to MOUD treatment and urine drug screening (UDS) and elicited provider views on the effects of the COVID-19 pandemic on patient demand for, and engagement in, treatment. Multivariable regression analyses were used to examine associations among practice characteristics, patient engagement, and service adaptations.

Results:

Of 516 respondents, 74% reported adaptations to MOUD delivery during the pandemic. Most respondents implemented virtual visits for initial (67%) and follow-up (77%) contacts. Prescribers of buprenorphine were more likely than those who did not prescribe the medication to report MOUD adaptations. Among respondents reporting any MOUD adaptation, 77% made adaptations to their UDS practices. Among 513 respondents who answered COVID-19–related questions, 89% reported that the pandemic had affected the treatment and engagement of their patients. Of these respondents, 30% reported increased difficulty with patient engagement, and 45% reported that their patients preferred virtual visits during this period, whereas 18% endorsed patient preference for in-person visits.

Conclusions:

Telehealth and federal regulatory easements in response to the COVID-19 pandemic enabled providers to continue treating patients for opioid use disorder in 2020. The results suggest that care adaptations and changes in patient demand and engagement were common in the practices surveyed.

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Supplementary Material

File (appi.ps.202100507.ds001.pdf)

Information & Authors

Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services
Psychiatric Services
Volume 75 • Number 3 • March 01, 2024
Pages: 258 - 267
PubMed: 37855101

History

Received: 20 August 2021
Revision received: 20 July 2023
Accepted: 26 July 2023
Published online: 19 October 2023
Published in print: March 01, 2024

Keywords

  1. Opioid use disorders
  2. Buprenorphine treatment
  3. Telehealth
  4. Patient engagement
  5. Drug abuse
  6. Patient compliance

Authors

Affiliations

Xinzhe Zhou, M.Sc.
Division of Research, American Psychiatric Association, Washington, D.C. (Zhou, Thompson, Rahman, Patel, Gibson, Casanova, Clarke); Quality and Science Department, American Society of Addiction Medicine, Rockville, Maryland (Pagano); Friends Research Institute, Baltimore (Ibrahim, Schwartz, Vocci); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Clarke).
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Laura K. Thompson, M.S.
Division of Research, American Psychiatric Association, Washington, D.C. (Zhou, Thompson, Rahman, Patel, Gibson, Casanova, Clarke); Quality and Science Department, American Society of Addiction Medicine, Rockville, Maryland (Pagano); Friends Research Institute, Baltimore (Ibrahim, Schwartz, Vocci); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Clarke).
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Anna Pagano, Ph.D.
Division of Research, American Psychiatric Association, Washington, D.C. (Zhou, Thompson, Rahman, Patel, Gibson, Casanova, Clarke); Quality and Science Department, American Society of Addiction Medicine, Rockville, Maryland (Pagano); Friends Research Institute, Baltimore (Ibrahim, Schwartz, Vocci); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Clarke).
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Nusrat Rahman, Ph.D.
Division of Research, American Psychiatric Association, Washington, D.C. (Zhou, Thompson, Rahman, Patel, Gibson, Casanova, Clarke); Quality and Science Department, American Society of Addiction Medicine, Rockville, Maryland (Pagano); Friends Research Institute, Baltimore (Ibrahim, Schwartz, Vocci); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Clarke).
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Sejal Patel, M.P.H.
Division of Research, American Psychiatric Association, Washington, D.C. (Zhou, Thompson, Rahman, Patel, Gibson, Casanova, Clarke); Quality and Science Department, American Society of Addiction Medicine, Rockville, Maryland (Pagano); Friends Research Institute, Baltimore (Ibrahim, Schwartz, Vocci); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Clarke).
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Debbie Gibson, M.Sc.
Division of Research, American Psychiatric Association, Washington, D.C. (Zhou, Thompson, Rahman, Patel, Gibson, Casanova, Clarke); Quality and Science Department, American Society of Addiction Medicine, Rockville, Maryland (Pagano); Friends Research Institute, Baltimore (Ibrahim, Schwartz, Vocci); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Clarke).
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Adila Ibrahim, M.Sc.
Division of Research, American Psychiatric Association, Washington, D.C. (Zhou, Thompson, Rahman, Patel, Gibson, Casanova, Clarke); Quality and Science Department, American Society of Addiction Medicine, Rockville, Maryland (Pagano); Friends Research Institute, Baltimore (Ibrahim, Schwartz, Vocci); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Clarke).
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Barbara Casanova, B.A.
Division of Research, American Psychiatric Association, Washington, D.C. (Zhou, Thompson, Rahman, Patel, Gibson, Casanova, Clarke); Quality and Science Department, American Society of Addiction Medicine, Rockville, Maryland (Pagano); Friends Research Institute, Baltimore (Ibrahim, Schwartz, Vocci); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Clarke).
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Robert P. Schwartz, M.D.
Division of Research, American Psychiatric Association, Washington, D.C. (Zhou, Thompson, Rahman, Patel, Gibson, Casanova, Clarke); Quality and Science Department, American Society of Addiction Medicine, Rockville, Maryland (Pagano); Friends Research Institute, Baltimore (Ibrahim, Schwartz, Vocci); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Clarke).
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Frank J. Vocci, Ph.D.
Division of Research, American Psychiatric Association, Washington, D.C. (Zhou, Thompson, Rahman, Patel, Gibson, Casanova, Clarke); Quality and Science Department, American Society of Addiction Medicine, Rockville, Maryland (Pagano); Friends Research Institute, Baltimore (Ibrahim, Schwartz, Vocci); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Clarke).
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Diana E. Clarke, Ph.D. [email protected]
Division of Research, American Psychiatric Association, Washington, D.C. (Zhou, Thompson, Rahman, Patel, Gibson, Casanova, Clarke); Quality and Science Department, American Society of Addiction Medicine, Rockville, Maryland (Pagano); Friends Research Institute, Baltimore (Ibrahim, Schwartz, Vocci); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Clarke).
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Notes

Send correspondence to Dr. Clarke ([email protected]).

Competing Interests

Dr. Schwartz has served as a consultant for Verily Life Sciences and as one of multiple principal investigators for a National Institute on Drug Abuse cooperative study that received free medications from Alkermes and Indivior. Dr. Vocci has served as a consultant to Lyndra Therapeutics, Takeda Pharmaceuticals, and a group of generic buprenorphine manufacturers; he has received free medications from Alkermes and Braeburn for clinical studies, meals from Braeburn, and meals and travel reimbursements from IntraTab Labs, Lyndra Therapeutics, Takeda Pharmaceuticals, and a group of generic buprenorphine manufacturers. Dr. Clarke has served on the Mental Health Landscape Project Advisory Panel for RAND, a project funded by Otsuka. The other authors report no financial relationships with commercial interests.

Funding Information

This project was supported by grant 3U01 DA-046910-02S2 from the National Institute on Drug Abuse (NIDA), with additional funding from the Office of the Secretary, Patient-Centered Outcomes Research Trust Fund (interagency agreement number 750120PE080047).The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the NIH or the U.S. Department of Health and Human Services.

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