Telehealth for Substance Abuse Care

Clinical Problem Identification

Substance abuse is concerned with the “harmful or hazardous use” of illegal and legal substances, including alcohol (World Health Organization, n.d., para. 1). With the increasing prevalence of substance use (Kandel & Kandel, 2014; Mayes & Suchman, 2015), substance abuse has become a challenge for modern healthcare (Turner & Mathias, 2017). It has multiple negative outcomes, including increased morbidity and mortality (Turner & Mathias, 2017), suicide, homicide (Mayes & Suchman, 2015), greater risk of recidivism (Batastini, King, Morgan, & McDaniel, 2016), and other major issues. The treatments involve a variety of practices, including medication- and psychotherapy-focused ones, depending on the specifics of the problem (Batastini et al., 2016; Turner & Mathias, 2017). The access to treatment remains lacking, especially in remote areas (Turner & Mathias, 2017).

Telehealth substance abuse screening and interventions are a form of service that is covered by Medicare (Medicare Learning Network [MLN], 2018). Some of the examples include remote brief interventions (Boudreaux, Haskins, Harralson, & Bernstein, 2015), programs devised to resolve specific issues (for instance, decrease risk practices) (Valente, Moreira, Ferigolo, & Barros, 2018), and various message-delivering programs and devices (Santa Ana, Martino, & Gebregziabher, 2015). Activities like screening, counseling, education, and medical management can be done with the help of telehealth; additionally, staff can be educated this way (Faragher, Zhang, Low, Folds, & Johnson, 2018). Also, the interventions can be customized for specific groups of patients, for instance, veterans (Santa Ana et al., 2015), parents, (Valente et al., 2018), and so on. The present paper will consider the application of telehealth to substance abuse care.

Use of Telehealth

A major benefit of telehealth is the fact that it eliminates significant barriers to seeking treatment (Faragher et al., 2018). It should be noted that for substance abuse, the access to related services is very poor while paired with high demand, especially in remote and rural areas (Turner & Mathias, 2017). Telehealth, among other things, presupposes the use of “interactive audio and video telecommunications systems” to enable real-time interaction between a provider and their patient (MLN, 2018, p. 4). Thus, telehealth resolves the problem of the lack of access to healthcare from several perspectives (distance, disability, the lack of transportation, and so on) (Faragher et al., 2018). Telehealth can decrease the costs and time required for treatment (Boudreaux et al., 2015; Faragher et al., 2018), and it keeps visits confidential, which is important because of the stigmatization of the clinical problem (Faragher et al., 2018). However, it is also important to consider the effectiveness of telehealth in addressing substance abuse.

Research on the topic suggests that the telehealth services meant for substance abuse treatment are sufficiently effective. This statement is supported by not very recent articles, as well as more modern ones (Faragher et al., 2018). For instance, Batastini et al. (2016) conducted a systematic review and meta-analysis on the use of telehealth for the treatment of people with substance issues, as well as those who were involved in criminal justice. The results indicated that the research on the topic is not very extensive, but with the total of 342 participants, Batastini et al. (2016) concluded that telehealth services were comparable to face-to-face ones from the perspective of outcomes.

Boudreaux et al. (2015) studied the telehealth approach to screening, brief intervention, and referral to treatment (which is a preventative measure), demonstrating that it was a feasible and effective alternative to its face-to-face version in encouraging people to contact relevant services. Santa Ana et al. (2015) studied a messaging device meant to assist veterans with “assessment and self-management education” (p. e197) which proved to be more effective than four one-hour group sessions with the same goals. Thus, telehealth is generally shown to be effective in reducing or preventing substance abuse; sometimes, it can be more effective than face-to-face alternatives.

Based on this information, it is apparent that the implementation of telehealth substance abuse screening and intervention approaches is feasible within the researcher’s organization. Currently, it does not offer this kind of telehealth services, which is not uncommon since the practice is not very widely spread (Faragher et al., 2018). Therefore, the implementation would require the development of a specific project meant for the process. Some of the key stages would include planning, drafting a budget, gaining the approval of the management, and engaging the stakeholders; also, provisions would be required for the training of the providers, and their contribution would be necessary to determine the types of services that they would provide. However, given the benefits of telehealth in addressing the studied clinical program, the change can assist the organization’s providers in ensuring the access to substance abuse treatment services.

Barriers and Solutions

Despite the limited research on the topic, a few barriers to the implementation of substance abuse telehealth have been documented. They are multiple and can be related to the change in the reimbursement processes, credentialing, associated costs, including those of training and equipment, and so on (Faragher et al., 2018). Two major issues that need to be resolved within the organization include provider acceptance and their training.

Training is among the significant concerns that are reported by telehealth users (Faragher et al., 2018), and the apparent solution consists of ensuring their training, although it will involve a couple of concerns. According to the article by Faragher et al. (2018), to enable a successful implementation of telehealth services, the providers’ training should incorporate the information about confidentiality and security, reimbursement specifics, and the details of working with the technology involved. Thus, the content of the course needs to be carefully considered. Furthermore, training is an issue because it is bound to require resources, including funding and time. This difficulty needs to be resolved by engaging the management and justifying the project’s budget appropriately. Finally, the training concern hinges on the other identified barrier: the providers of the organization need to be engaged in the project, and, as shown by Faragher et al. (2018), provider acceptance of telehealth may be lacking.

It is possible to view the latter issue as another form of change resistance and address it accordingly. Nowadays, there exist multiple approaches to change management which often include the topic of working with change resistance or ensuring its absence (Spear, 2016). They have been applied to healthcare settings as well, and they can be used in conjunction for improved outcomes. Two examples include Rogers’ innovation theory and Kotter’s change model. The former suggests considering the dimensions of innovation that can affect its adoption, for instance, its perceived difficulty or advantage (Pashaeypoor, Ashktorab, Rassouli, & Alavi-Majd, 2016). Thus, to manage the resistance to telehealth implementation, a leader who uses Rogers’ ideas would demonstrate the benefits of telehealth and provide the training that would help providers to work with it without difficulties.

Kotter’s change model also incorporates multiple steps that can help to prevent or combat resistance, including the creation of the sense of urgency, the development of a vision, and the celebration of wins (Small et al., 2016). Thus, a leader can demonstrate the significance of the problem of the access to substance use to create the sense of urgency. This information will also help to develop a relevant vision of ensuring this access. The celebration of the positive outcomes related to the use of the service would also be helpful. Overall, healthcare leaders are well-equipped to combat the issue of provider resistance to innovation, and appropriate change management is the obvious solution to the second barrier. In summary, the adoption of telehealth is likely to encounter barriers, the solutions to which may require substantial resources. However, given the ability of telehealth to improve access to care, which is particularly important for the widespread disorders associated with substance abuse, telehealth implementation is a feasible choice.

References

Batastini, A., King, C., Morgan, R., & McDaniel, B. (2016). Telepsychological services with criminal justice and substance abuse clients: A systematic review and meta-analysis. Psychological Services, 13(1), 20-30. doi:10.1037/ser0000042

Boudreaux, E., Haskins, B., Harralson, T., & Bernstein, E. (2015). The remote brief intervention and referral to treatment model: Development, functionality, acceptability, and feasibility. Drug and Alcohol Dependence, 155, 236-242. doi:10.1016/j.drugalcdep.2015.07.014

Faragher, J., Zhang, Y., Low, V., Folds, D., & Johnson, M. (2018). Utilization of telehealth technology in addiction treatment in Colorado. Journal of Technology in Behavioral Science, 1-21. doi:10.1007/s41347-018-0057-3

Kandel, D., & Kandel, E. (2014). The Gateway Hypothesis of substance abuse: developmental, biological and societal perspectives. Acta Paediatrica, 104(2), 130-137. doi:10.1111/apa.12851

Mayes, L., & Suchman, N. (2015). Developmental pathways to substance abuse. Developmental Psychopathology, 599-619. doi:10.1002/9780470939406.ch16

Medicare Learning Network. (2018). Telehealth services. Web.

Pashaeypoor, S., Ashktorab, T., Rassouli, M., & Alavi-Majd, H. (2016). Predicting the adoption of evidence-based practice using “Rogers diffusion of innovation model.” Contemporary Nurse, 52(1), 85-94. doi:10.1080/10376178.2016.1188019

Santa Ana, E., Martino, S., & Gebregziabher, M. (2015). Impact of telehealth in-home-messaging devices on alcohol use in dually diagnosed veterans. Drug and Alcohol Dependence, 156, e197. doi:10.1016/j.drugalcdep.2015.07.531

Small, A., Gist, D., Souza, D., Dalton, J., Magny-Normilus, C., & David, D. (2016). Using Kotterʼs change model for implementing bedside handoff. Journal of Nursing Care Quality, 31(4), 304-309. doi:10.1097/ncq.0000000000000212

Spear, M. (2016). How to facilitate change. Plastic Surgical Nursing, 36(2), 58-61. Web.

Turner, B., & Mathias, C. (2017). Increasing prevalence of alcohol use disorders: Meeting the challenge in primary care. Journal of General Internal Medicine, 33(3), 236-237. doi:10.1007/s11606-017-4226-4

Valente, J., Moreira, T., Ferigolo, M., & Barros, H. (2018). Randomized clinical trial to change parental practices for drug use in a telehealth prevention program: A pilot study. Jornal de Pediatria, 1-8. doi:10.1016/j.jped.2018.02.004

World Health Organization. (n.d.). Substance abuse. Web.