Demographic differences in services utilization across in-person (2019), telehealth (2020), and hybrid (2021) outpatient substance use services in New York.

OBJECTIVES: Many outpatient substance use programs have experienced in-person, remote/telehealth, and hybrid models of care since the 2020 Covid-19 Pandemic. Changes in treatment models naturally affect service utilization and may affect treatment trajectories. Currently, limited research examines the implications of different health care models on service utilization and patient outcomes in substance use treatment. Here, we reflect on the implications of each model from a patient-centered care approach and review the implications on service utilization and outcomes. METHODS: We employed a retrospective, observational, longitudinal, cohort design to explore differences in demographic characteristics and service utilization among patients receiving in-person, remote, or hybrid services across four substance use clinics in New York. We reviewed admission (N = 2238) and discharge (N = 2044) data from four outpatient SUD clinics within the same health care system across three cohorts (2019, in-person; 2020, remote; 2021, hybrid). RESULTS: Patients discharged in 2021 (hybrid) had significantly more median total treatment visits (M = 26, p ≤ 0.0005), a longer course of treatment (M = 154.5 days, p ≤ 0.0001), and more individual counseling sessions (M = 9, p ≤ 0.0001) compared to the other two cohorts. Demographic analyses indicate more ethnoracial diversity (p = 0.0006) among patients admitted in 2021, compared to the other two cohorts. Over time, the proportion of individuals being admitted with a co-existing psychiatric disorder (2019, 49 %; 2020; 55.4 %, 2021, 54.9 %) and no prior mental health treatment (2019, 49.4 %; 2020, 46.0 %; 2021, 69.3 %) increased (p = 0.0001). Admissions in 2021 were more likely to be self-referred (32.5 %, p < 0.0001), employed full-time (39.5 %, p = 0.01), and have higher educational attainment (p = 0.0008). CONCLUSION: During hybrid treatment in 2021, patients from a wider range of ethnoracial backgrounds were admitted and retained in care, patients with higher socioeconomic status (who were previously less likely to enter treatment) were admitted, and fewer individuals left against clinical advice (compared to the remote 2020 cohort). More patients successfully completed treatment in 2021. Service utilization, demographic, and outcome trends support a hybrid model of care.

A pilot study comparing in-person and remote outpatient substance use treatment services on quality-of-life outcomes.

Background: The widespread shift from in-person to Telehealth services during the Covid-19 pandemic irreversibly shifted the landscape of outpatient substance use treatment. This shift was necessitated by health, rather than data-driven, reasons. As we reflect on whether to continue providing Telehealth services moving forward, we require empirical support on the effectiveness of Telehealth services (compared to in-person services) in terms of patient outcomes, such as Quality of Life (QOL), to support this decision. Objective: To present data from a pilot project comparing changes in QOL across patients receiving outpatient in-person versus Telehealth substance use treatment in five clinics across New York State. Method: To retrospectively compare total self-reported QOL scores from admission to 3-months later utilizing the Quality-of-Life Enjoyment and Satisfaction scale during in-person (pre-pandemic, n = 298) and Telehealth (pandemic, n = 316) services with a mixed repeated measures ANOVA. Results: Self-reported QOL scores significantly improved across the first three months, regardless of treatment modality. Conclusion: Telehealth and in-person treatment appear comparable on QOL outcomes over the first 3 months of outpatient treatment. Both modalities are associated with improved QOL scores. Scientific significance: These preliminary findings provide evidence that Telehealth services are associated with positive patient outcomes and appear comparable to QOL outcomes among patients receiving in-person services. Future directions include further assessment of additional clinical outcomes and investigation into causal mechanisms.