(54) Pre-Paid Phone Distribution to People With Substance Use Disorder

Introduction: People with substance use disorders (SUD) face significant phone insecurity and high rates of phone turnover. As U.S. healthcare delivery models expanded towards telehealth due to the COVID-19 pandemic, consistent access to a working phone became a critical tool for healthcare engagement. As part of the COVID-19 response, our institution distributed free pre-paid phones to patients with SUD who did not own a phone starting April 2020 from multiple addiction specialty access points (inpatient addiction consult service, low-barrier bridge clinic, infectious disease drop-in center and integrated psychiatry and SUD program). We sought to evaluate the real-world implications of this intervention for patients with SUD who received these pre-paid phones by assessing their change in 30-day healthcare utilization pre- vs post-phone receipt and conducting an exploratory analysis to assess self-reported attitudes towards phone ownership.

Methods: We conducted a retrospective cohort study of 181 adult patients with SUD who received a pre-paid phone between April 2020 and February 2021 from our institution. Our primary outcomes were the change in healthcare utilization of in-person outpatient visits, telemedicine visits, and telephone encounters (incoming or outgoing phone calls answered by the patient) 30 days before and after receiving the pre-paid phone. To assess self-reported phone utilization and attitudes to phone ownership we did an exploratory analysis from a subset of patients (n=141) using a telephone survey post-phone receipt. We used descriptive statistics where appropriate and paired t-tests to assess the change in healthcare utilization measures.

Results: 181 adult patients with SUD received pre-paid phones, 64.6% male, 66.3% 30-49 years old, 62.4% white, 81% were experiencing homelessness, 90% had opioid use disorder and 60% had stimulant use disorders. We found substantial and statistically significant increases in change in 30-day pre-post telemedicine (mean change=0.38, SD=0.99; p < 0.0001) and telephone encounters (mean change=0.31, standard deviation (SD)=1.13, p=0.0003), while there was a small increase though non-significant change in outpatient visits (mean change=0.09, SD=1.50, p=0.45). For our exploratory analysis using patient telephone surveys, 141 patients were contacted a mean of 2.7 months after phone distribution; 16.3% (23/141) answered the phone on a single attempt and 48% (11/23) completed the survey. Survey results showed that 6-months preceding pre-paid phone receipt, patients had a mean of 2.73 phones and 2.55 unique phone numbers and the majority perceived phone ownership as extremely important and it contributed to a general sense of safety. Pre-paid phones also facilitated medical appointment attendance.

Conclusions: Pre-paid phone distribution to patients with SUD during the COVID-19 pandemic was associated with an increase in healthcare utilization including telemedicine encounters. Further studies are needed to understand and optimize the impact of pre-paid phone distribution as tools for healthcare engagement among people with SUD

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