A Telemedicine Bridge Clinic Successfully Engages Patients in Buprenorphine Treatment

The benefits of medication treatment of opioid use disorder (MOUD) are well established. However, a variety of barriers, including geographical and socioeconomic inequities, exist making access to evidence-based MOUD challenging. Patients evaluated on the day that they initially present for treatment are 7x more likely to engage than those who are required to wait 2+ days to be. Telehealth has been proposed as a means of resolving at least some of those barriers and limited evidence has supported its feasibility and effectiveness. The Covid-19 public health emergency has prompted waivers that have liberalized the ability to use both audiovisual and audio-only telehealth for the management of OUD, including temporary exemption from requiring an initial in-person exam before prescribing controlled substances such as buprenorphine. A novel telemedicine bridge clinic model was developed by the UPMC Division of Medical Toxicology that has served more than 325 patients on 550 visits to date. The purpose of this presentation will be to describe the implementation of this program, discuss process challenges and solutions that can be employed elsewhere, and present outcomes associated with this cohort of patients. Additionally, the presentation will provide an overview of existing legislation, temporary regulatory waivers and their applications, as well as draft legislation that is being considered to provide further guidance for telehealth addiction services after the Covid-19 public health emergency eventually expires. Preliminary analysis of the first 200 patients with OUD evaluated at the UPMC Medical Toxicology Telemedicine Bridge Clinic has demonstrated that 79% required audio-only service and 62% or patients were covered by Medicaid while 19% were identified as “self-pay”. Nearly half of patients were referred by addiction treatment providers and a third were referred by harm reduction organizations. Seven percent of patients were seen following release from jail. Engagement rate was 95%. Using an intention to treat analysis that included patients who scheduled but did not arrive, 95% of patients filled at least one prescription for buprenorphine within 30 days and 76% filled 2 or more prescriptions for buprenorphine following the initial telehealth visit. There was no statistical difference in patients initially evaluated by audio only vs. audiovisual technology. The presentation will include a didactic portion to present background data as well as bridge clinic mechanisms, outcomes, and potential broad application and integration within existing addiction treatment programs that may struggle to provide initial, urgent medical engagement. It is anticipated that there will be a variety of questions related to process, implementation and outcomes. Therefore, ~20-25 minutes will be left to allow audience participation and Q&A with the speaker.Learner takeaways should include expanded understanding of telehealth and its application to addiction care as well as specific understanding of how to establish or collaborate with a telemedicine bridge program based upon the outcomes demonstrated in this single state sample. Learners should understand the utilization of both audiovisual and audio-only methods of patient evaluation and outcomes associated with each. Learners will also be informed regarding pending legislation and their potential role in advocacy.