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Health Services Research & Development

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HSR&D In Progress

September 2020

In This Issue: How Research Helps Combat COVID-19
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Telemental Healthcare for Veterans with Opioid Use Disorder During the COVID-19 Pandemic

Feature Article


Takeaway: Study results will be of immediate relevance and impact for VA operations partners, including VA Analytics and Business Intelligence (RAPID), Pharmacy Benefits Management (PBM), VA’s Center for Medication Safety VA MedSAFE, and the Office of Connected Care.  


The United States saw a 4-fold increase in opioid-related deaths between 2002 and 2017, and Veterans experience opioid overdose at twice the rate of non-Veterans. Fortunately, evidence-based medications for opioid use disorder (OUD) exist (i.e., buprenorphine). However, due to the potential for misuse and per the Ryan Haight Act, there are additional training requirements for providers to be certified to prescribe these types of medications, including in-person requirements, resulting in inadequate numbers of providers in some areas, particularly rural ones. Due to the public health emergency caused by COVID-19, the in-person requirement for OUD prescriptions has been temporarily waived. This waiver presents a unique opportunity to understand the impact of VA's pre-existing telehealth structure for the treatment of OUD. Will telehealth allow for prescription maintenance, or will prescriptions drop? Relatedly, will relaxing this requirement lead to a dramatic increase in prescriptions for controlled substances? What are the barriers and facilitators associated with this recent change in policy for substance use providers, and how can this information inform VA's response to future natural and/or public health disasters, particularly for high-risk Veterans?

This ongoing HSR&D-funded study (May 2020 – March 2021) will develop methods required to conduct robust analyses assessing the impact of COVID-19 and related changes in policy and service design on access to care and medication management for Veterans with OUD. Study investigators will conduct:

  • Interviews with providers and key local stakeholders to understand modes of patient interaction, documentation patterns for patient visits, and perceived facilitators and barriers to the rapid expansion of telehealth for OUD; and
  • Preliminary analyses of temporal trends in schedule II-IV narcotic prescription rates for Veterans who would normally fall under the parameters of the Ryan Haight Act.

Investigators also will examine and compare the rate of prescriptions for buprenorphine, as well as other schedule II-IV narcotics, such as methadone, oxycodone, fentanyl, morphine, and hydrocodone.

Methods

Investigators will conduct qualitative interviews with providers and key local stakeholders in the Substance Treatment and Recovery (STAR) and telehealth clinics. Additionally, investigators will extract data from VA’s Corporate Data Warehouse and pharmacy databases – and will use segmented regression interrupted time series (SR-ITS) to assess changes in prescribing behavior potentially attributable to the waiver of the Ryan Haight Act to access narcotic prescriptions via telehealth. SR-ITS allows for the assessment of long-term effects on an outcome attributable to a specific event (policy intervention) in time, i.e., the implementation of legislative mandates. Study investigators will determine if there are differences in the effect of the intervention by the patient’s rurality, age, gender, and/or race/ethnicity, and utilize information gathered in the qualitative interviews to help explain potential differences seen in prescriptions.

Findings

None at this time.

Anticipated Impact

Findings will be of immediate relevance and impact for VA operations partners who include VA Analytics and Business Intelligence (RAPID), Pharmacy Benefits Management, Center for Medication Safety, and Office of Connected Care.

Principal Investigator: Ursula Myers, PhD, is a clinical psychologist affiliated with HSR&D’s Charleston Health Equity and Rural Outreach Innovation Center (HEROIC) in Charleston, SC.

Publications

Myers U, Birks A, Grubaugh A, and Axon R. Flattening the curve by getting ahead of it: How the VA Healthcare System is leveraging telehealth to provide continued access to care for rural Veterans. The Journal of Rural Health. 2020; Epub ahead of print.

View study abstract

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