Research shows potential for increased patient engagement and limited support for improved retention rates.
A new study on the efficacy of telehealth services in addiction treatment during the COVID-19 pandemic found that telehealth may increase patient engagement. Investigators also found limited evidence of improved retention rates in telehealth compared with in-person treatment.
The study, conducted by researchers from RTI International and the University of California, Los Angeles, drew on existing research and provider experiences to explore the continued use of telehealth in substance-use disorder treatment after the pandemic. It was published online in Psychiatric Services.
“Telehealth health may allow patients to more easily begin and stay in addiction treatment, which has been a longstanding challenge,” said Tami L. Mark, PhD, MBA, in a press release. Mark is lead author of the study and senior fellow, Behavioral Health Financing and Quality Measurement at RTI International. “However, research is needed to confirm this benefit. As providers pivot to hybrid telehealth models—offering both telehealth and in-person treatment—they need information to help target telehealth to the most appropriate services and patients.”1
Mark et al used data collected from a number of sources: a review of the literature, an online survey of 100 California addiction treatment providers, and interviews with 30 California treatment providers and additional stakeholders.2 Although they found potential for patients to be more engaged in treatment due to the easier access and convenience of telehealth, they also explored some of the circumstances in which telehealth may be most appropriate.
In most of the studies included in the literature review, compared with in-person addiction treatment, telehealth was found equally effective in terms of patient retention, treatment satisfaction, substance use, and therapeutic alliance. Three of the studies also found that telehealth can be effective in opioid use disorder medication management. In these studies, patients who received medication management via telehealth also received regular in-person treatment for counseling, drug testing, and other services as needed. In addition, the largest study (N = 3733) reported increased retention for telehealth methadone medication management.2
The survey released that most providers reported the most comfort with using telehealth for one-on-one counseling, with 46% saying telehealth was overall equally or more effective than in-person treatment. For medication management, however, 51% of providers reported that telehealth was less effective than in-person treatment, with 33% reporting that telehealth was equally or more effective. The services reported most likely to be provided via telehealth were intensive outpatient (61% of patients), individual counseling (58%), group counseling, and intake assessment (both 52%). The services reported least likely to be provided via telehealth were withdrawal management, methadone intake assessments (both 39% of patients), and drug testing (17%).2
In the interviews, participants reported that the relative benefits of telehealth are dependent on the individual patient’s circumstances. They emphasized advantages of telehealth such as the reduced time and cost to patients—particularly those with young children or who have difficulty taking time off or traveling to appointments—and opportunities to observe the patient’s home environments and families. However, participants also acknowledged that in-person treatment may still be preferable for some patients, such as those who are homeless or isolated, those with attention challenges, and those uncomfortable with technology. Similarly, they noted that there may be more challenges in gauging patient progress and providing personal connectedness needed by patients with substance abuse disorders.
“This research underscores the importance of offering telehealth for addiction treatment and the dramatic need to conduct more empirical work to test out the concerns regarding telehealth articulated by agency staff and on surveys,” said Lisa Dixon, MD, MPH, in a press release. 1 Dixon is editor of Psychiatric Services, professor of Psychiatry at the Columbia University Medical Center, director of the Division of Behavioral Health Services and Policy Research within the Department of Psychiatry, and director of the Center for Practice Innovations at New York State Psychiatric Institute.
1. Addiction treatment rose rapidly during pandemic; but potential benefits still unclear. newsrelease. American Psychiatric Association. October 13, 2021. Accessed October 13, 2021.https://www.psychiatry.org/newsroom/news-releases/telehealth-addiction-treatment-rose-rapidly-during-pandemic-but-potential-benefits-still-unclear
2. Mark TL, Treiman K, Padwa H, et al. Addiction treatment and telehealth: Review of efficacy and provider insights during the COVID-19 pandemic. Psychiatric Services. October 13, 2021. Accessed October 13, 2021. https://ps.psychiatryonline.org/doi/10.1176/appi.ps.202100088