ABSTRACT
Background: Alcohol use disorders (AUD) account for considerable illness, disability, and mortality. Since the onset of COVID-19, heavy and problematic alcohol use increased. Overall healthcare visits dropped in the US and telemedicine use surged. No prior work has assessed the impact of the pandemic on receipt of AUD care and the role of telemedicine. Aims of the Study: Compare outpatient AUD utilization in the U.S. in 2019 and 2020 among a national commercially insured population of adults ages 18-64. Methods: Using OptumLabs Data Warehouse claims, we developed two AUD cohorts. Individuals were identified as having AUD in the first year and AUD outpatient visit utilization was tracked in the second year. The 2019 cohort (N=23,204) covered the period 2018- 2019 and the 2019 cohort (N=24,445) 2019-2020. In unadjusted analyses we compared the weekly percent of individuals who had an outpatient AUD visit, comparing 2019 and 2020 with a focus on weeks 12-52 (aligning with the start of the 2020 US COVID-19 emergency declaration). We also examined in 2020 what fraction of outpatient visits were conducted via telemedicine (phone or video). We fit logistic regression models examining the association between at least one outpatient AUD visit weeks 12-52 in 2019 vs. 2020, with patient characteristics-demographic (age, sex, US region) and clinical (AUD severity, alcohol related medical condition, co-occurring substance use disorder, prior year mental health outpatient visit, prior year mental health/substance use disorder emergency department visit/hospitalization). Results: Following an initial drop of ∼20%, by week 16 (one month after the US pandemic start), the weekly AUD outpatient visit rate was similar to pre-pandemic. Telemedicine for AUD care quickly increased: from <2% of AUD outpatient visits pre-pandemic in 2020, to 29.8% within the first week (week 12), peaking week 19 (59.2%), and remaining 45.5%-55.6% through 2020. There was no change in receiving at least one AUD outpatient visit weeks 12-52 in 2019 vs. 2020;nor an association between patient demographic and clinical characteristics and receiving at least one outpatient AUD visit. Discussion (with limitations of the study): Initial US pandemic disruptions in AUD outpatient visits resolved within weeks, largely aided by telemedicine. Demographic and clinical characteristics were not associated with differential changes in receipt of AUD care. Limitations include: (i) an inability to evaluate whether utilization reflects patient needs;(ii) individuals with new onset AUD during the pandemic were not included in the study;(iii) AUD is under-diagnosed in clinical care and claims data;(iv) the data are limited to individuals commercially insured-results may differ among Medicaid and Medicare populations. Implications for Health Care Provision and Use: Telemedicine quickly diffused into AUD care during the pandemic and minimized care disruptions. Implications for Health Policies: Telemedicine can be a valuable tool to facilitate access to AUD care. Federal, state and health plan policies that enable the continued use of telemedicine should be considered. Implications for Further Research: Additional research is needed to better understand which models of AUD care that incorporate telemedicine improve patient access, equity, and AUD care quality.