Telehealth referrals boost OUD treatment initiation, retention

Telehealth-based referrals can be more effective than referrals made during an in-person emergency department (ED) visit in ensuring that opioid use disorder (OUD) patients start and stay engaged in medication-assisted treatment, according to new research.

Published in the Journal of Substance Use and Addiction Treatment, the study examined outcomes following telehealth referrals for OUD medication-assisted treatment compared with ED-based referrals.

Medications for OUD, such as buprenorphine, are evidence-based treatments that can save lives. The study notes that in-person ED visits offer an opportunity to initiate and engage OUD patients in medication-assisted treatment. However, as telehealth proves a feasible alternative to in-person interventions, researchers from the University at Buffalo Jacobs School of Medicine and Biomedical Sciences and the New York State Department of Health investigated whether telehealth referrals for medication-assisted OUD treatment are more effective than referrals at the ED.

They conducted a retrospective review of data for patients referred from EDs or telehealth through the Medication for Addiction Treatment and Electronic Referrals (MATTERS) Network. They studied initial visit attendance and 30-day retention in medication-assisted treatment among OUD patients.

The MATTERS Network made 1,349 referrals between October 2020 and September 2022, 39.7 percent of which originated from an in-person ED visit and 47.8 percent from a telehealth visit.

The researchers found that those referred from a telehealth visit were 1.64 times more likely to attend their initial clinic appointment and 2.59 times more likely to be engaged in medication-assisted treatment at 30 days compared to those referred from an ED.

More specifically, of the 393 patients with available follow-up data, 65.1 percent of patients referred via a telehealth visit showed up at their first clinic appointment, compared with 32.3 percent referred via an in-person ED visit. Additionally, 53.2 percent of telehealth-based referral patients were still in treatment at the 30-day mark versus 22.2 percent of those referred from an ED visit.

“Our findings only emphasize the utility of telemedicine as a modality that works, especially for disease processes that are typically challenging for patients to link to and retain in treatment,” said Joshua J. Lynch, DO, study first author and associate professor in the emergency medicine department in the Jacobs School, in a press release.

Renoj Varughese, MD, study co-author and assistant professor of emergency medicine at the Jacobs School, noted that the complexity of OUD treatment initiation and retention may explain why ED-based referrals were less effective than telehealth ones.

“Trying to educate hundreds of emergency department providers on the approach to opioid use disorder, evaluation, initiating medication and linking to treatment is very challenging,” he said in the press release. “Emergency departments may have varying approaches and varying levels of interest in how they treat these patients.”

The study is the latest research to affirm the positive effects of telehealth on OUD patients.

A study published in March 2023 revealed that Medicare beneficiaries who received OUD-related care through telehealth during the COVID-19 pandemic experienced a lower risk of a fatal drug overdose.

The study assessed OUD care outcomes in two periods: pre-pandemic (September 1, 2018, to February 29, 2020) and pandemic (September 1, 2019, to February 28, 2021). The pre-pandemic cohort included 105,162 patients, and the pandemic group included 70,479 patients.

Following a multivariable analysis, researchers found that telehealth-based OUD treatment resulted in a 33 percent lower risk of fatal drug overdose.

In light of these positive associations, the Department of Health and Human Services (HHS) published a final rule in February that significantly expanded access to medications for OUD, including allowing treatment initiation through telehealth.