In the current epidemic of opiate addiction, one of the challenges in providing treatment to people who need it has been a matter of geography: many people in rural areas and small towns do not have proximity to treatment programs.
One high tech solution to this problem is telemedicine, using online video apps such as Skype to enable care providers and patients to communicate face-to-face.
Telemedicine can increase patients’ access to addiction treatment resources, with more scheduling flexibility so treatment doesn’t have to conflict with family, work and school responsibilities.
It can also help alleviate a shortage of qualified treatment providers, especially the under-supply of physicians who have been trained and certified to deliver medication-assisted treatment. Telemedicine also makes it possible for the limited number of qualified addiction care providers to manage more cases and help more patients without diminishing the quality of care.
Reimbursement is a key issue in expanding the use of telemedicine. Many state Medicaid programs and a growing number of private insurers provide reimbursement for virtual visits on a level with in-office visits. Each state has different rules covering which providers can make video visits, whether an in-person session must precede a remote visit, and which medications, if any, can be prescribed during an online session.
Can addiction treatment provided via telemedicine be as effective as in-person help? Several studies of behavioral health care provided through the net indicate that treatment results can be as good, or even better than in-person treatment.
One of those is a Veterans Administration Telehealth Efficacy Study that included almost 100,000 patients, who received treatment for a number of conditions, including affective disorders, post-traumatic stress, psychotic disorders, and substance abuse.
National Public Radio recently reported on a family physician in Indiana who uses telemedicine for opioid addiction treatment, which became legal earlier this year – Jay Joshi, M.D., a family physician in Munster, Ind.
At Joshi’s practice, Prestige Clinics in Munster, Ind., telemedicine consultations are held in an exam room equipped with a computer. On Tuesdays, Joshi’s patients video-chat with a psychologist located 140 miles away.
Joshi still requires patients to make in-person visits, to begin and maintain his patients’ Suboxone prescriptions. He prefers to see these patients every two weeks and, if necessary, will arrange transportion to make that happen.
He will sometimes prescribe Suboxone remotely, but usually only for one or two refills once or twice during a patient’s course of treatment. Seeing the patient in-person is critical to their treatment, he says. “You’re not going to get a good system of health care for primary care in these high-risk areas unless you invest time and energy into these patients,” he told NPR.
According to NPR, Joshi has a number of telemedicine conversations with addiction treatment patients that aren’t billable.
That’s partly why there is a shortage of addiction treatment doctors, says Dr. Emily Zarse. She runs the addiction treatment program at Eskenazi Health in Indianapolis. “Telemedicine is a great idea in theory, but it doesn’t fix the workforce shortage problem,” she told NPR,
But telemedicine could be an effective way to train providers, Zarse says. “That takes one expert’s time for a couple of hours a week, maybe, and you can reach 10, 15, 20 people all at one time.” Zarse is planning to start a course to train Indiana doctors to treat addiction.
A study reported in the journal Addiction Science and Clinical Practice in 2015 identified some challenges to implementing telemedicine, including reimbursement problems at the system level, and resistance to using targeted telemedicine at the provider and patient levels.
“Telemedicine will inevitably play a greater role in addiction treatment and recovery services,” the researchers wrote. “Yet, technologies that become part of standard practice will likely be a result of considerations of the technology’s costs, perceived benefits, and ease or difficulty of implementation,” the researchers concluded.