An Assessment of the One-Month Effectiveness of Telehealth Treatment for Opioid Use Disorder Using the Brief Addiction Monitor.

OBJECTIVES: Telehealth treatment with medication for opioid use disorder (teleMOUD) was made possible with regulations following the COVID-19 pandemic that permitted prescribing buprenorphine without an in-person visit. This study evaluates the self-reported outcomes of patients treated by teleMOUD using the Brief Addiction Monitor (BAM), a 17-question tool that assesses drug use, cravings, physical and psychological health, and psychosocial factors to produce 3 subset scores: substance use, risk factors, and protective factors. METHODS: Patients treated by a teleMOUD provider group operating in >30 states were asked to complete an app-based version of BAM at enrollment and at 1 month. Patients who completed both assessments between June 2022 and March 2023 were included. RESULTS: A total of 2556 patients completed an enrollment BAM and 1447 completed both assessments. Mean number of days from baseline BAM to follow-up was 26.7 days. Changes were significantly different across most questions. The substance use subscale decreased from mean 2.6 to 0.8 (P < .001), the risk factors subscale decreased from mean 10.3 to 7.5 (P < .001), and the protective factors subscale increased from mean 14.3 to 15.0. (P < .001). Substance use and risk factor subscale changes were significant across all sex and age groups, while protective factors subscale did not improve for those <25 and >54 years. Patient reports of at least 1 day of illegal use or misuse decreased, including marijuana (28.1% vs 9.0%), cocaine/crack (3.9% vs 2.6%), and opioids (49.8% vs 10.5%). CONCLUSIONS: Among patients treated by teleMOUD who completed assessments at enrollment and 1 month, there was improvement in drug use, risk factor, and protective factor scores.

Implementation of a Novel Telehealth Patient Advisory Council.

Patient engagement in healthcare delivery processes has been increasingly emphasized in recent years, which can be accomplished in part by Patient Advisory Councils (PACs). Although well-established in brick-and-mortar facilities, the use of PACs in pure telehealth settings is limited. Bicycle Health, a digital health organization that provides biopsychosocial treatment of opioid use disorder (OUD) via telehealth, sought to increase patient engagement regarding care delivery and innovation, ultimately launching a telehealth Patient Advisory Council. Herein we discuss implementation challenges and iterative changes to address each challenge. Key learnings include the following: Patients with OUD are often subject to significant stigma, including by healthcare professionals. This is a key factor to consider when recruiting and engaging patients; trust building is key and can help to overcome both perceived and actual stigma.Inclusion of core staff persons who have lived experience with the respective health condition-in this case, OUD-is beneficial.Utilizing a formal framework, such as the Model for Improvement (utilized widely by the Institute for Healthcare Improvement), to guide improvement work is helpful for providing structure to feedback conversations, though this framework should be presented to patients in accessible language.