Background: Patients with opioid use disorder (OUD) represent a high-risk population due to increased rates of adverse health outcomes and death. To evaluate whether telehealth utilization during OUD treatment compared with in-person encounters alone was associated with emergency department (ED) utilization, inpatient admissions, and mortality within three years of initiating buprenorphine. Methods: We conducted a retrospective cohort study within the Veterans Health Administration among Veterans treated for OUD between 2012 and -2022. The primary exposure was modality of care, characterized as telehealth encounters (with or without an in-person visit) compared with in-person visits only. Outcomes included an ED visit, inpatient admission, or mortality within three years of the index buprenorphine prescription. We measured the association between each type of treatment modality and outcomes through Cox proportional hazards regression modeling, adjusting for demographic and clinical covariates and confounders. Findings: Of the 57,021 Veterans diagnosed with OUD and who initiated buprenorphine, 38,072 Veterans met study eligibility criteria. The majority of Veterans were male, non-Hispanic White, 25-44 years of age, and lived in urban areas. Approximately 60% of this entire cohort experienced at least one ED visit, 40% experienced an inpatient admission, and 8% died during follow-up. Telehealth use compared with in-person visits only was associated with reduced ED visits (adjusted hazard ratio [aHR] 0.81; 95% confidence interval [CI] 0.77-0.85), inpatient admissions (aHR: 0.71; 95% CI: 0.67-0.76), and mortality (aHR: 0.80; 95% CI: 0.67-0.94). Conclusions: Telehealth may help overcome barriers to in-person care. During buprenorphine treatment for OUD, telehealth as a point of contact with providers and the health care system may reduce more adverse health outcomes, potentially through improving treatment retention. Qualitative studies may help shed light on the mechanisms through which telehealth directly impacts clinical outcomes.
Keywords: buprenorphine; compliance; mental health; military medicine; pharmacy; telepsychiatry; treatment adherence.