The Use of Telemedicine To Provide or Enhance Substance Abuse Services in Underserved Areas - Essay Sample

Introduction

Telemedicine refers to the sending of electronic health care information such as data, audio, or images over a long distance between two or more sites or individuals. The scope of telemedicine is somewhat narrower than telehealth because telehealth includes areas like self-help activities where individuals search for health-related material that may affect their health or health behavior. Numerous conventional interventions in substance abuse addiction have been shown to be effective.Nevertheless, the widespread use of these interventions has occasionally been restricted because of the limited number of personal services providedby professionals and the stigma linked to seeking and accessing the available services. Telemedicine can potentially overcome many of these challenges by offering substance abuse services over distances and availing these services to populations living in underserved areas. Although face-to-face, skilled, practitioner-provided care could be more effective than telemedicine modalities, validated telemedicine applications made freely available could significantly increase the available services for underserved populations suffering from substance abuse disorders.

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This review examines key telemedicine technologies used in underserved areas, such as rural areas, and among underserved populations, like individuals on parole. In these application areas, technologies could be mixed; for instance, addiction problems could be treated using telemedicine services as the only form of treatment or as part of a larger service package that includes both the telemedicine services and face-to-face programs. The purpose of this paper is to conducta systematic review of telemedicine studies in substance abuse and study the effectiveness of the different telemedicine modalities in providing or enhancing substance abuse services in underserved areas.

Literature Review

I searchedfor peer-reviewed literature that analyzed the effectiveness of various forms of telemedicine applications compared to either no treatment or to existing non-telemedicine substance abusetreatment. I also analyzed the acceptability or feasibility of telemedicine for this study area. The target groups were underserved populations suffering from substance abuse disorders. Such populations included people living in rural areas, individuals on parole or probation, minority groups, rural offenders, and persons with a history of multiple addiction treatment episodes. All ages, genders, and ethnic groups were included.

A comprehensive literature search was completed using a broad variety of terms related to different forms of telemedicine applications and diverse types of addictive behaviors and underserved populations. The keywords used for the search included telepsychiatry, health, telecare, telemedicine, e-health, video conferencing, effectiveness, efficacy, access, outcomes, satisfaction, quality of care, rural, web-based behavioral treatment, and e-delivered therapy. The search encompassed the following significant health and medicine-focused databases: PsycINFO, Medline, ResearchGate, PubMed Central, and Elsevier. Due toa relatively large number of studies found in the search and the speedy change in telemedicine modalities, the search was restricted to include articles from 2013 to 2018 only. In total, 12 references were identified in the searches. However, only 10 studies included both telemedicine and addiction specialties in their study area.

First, the articles that were selected included one or more of the following substance abuse areas: alcohol, cocaine, opioids, or illicit drugs. Second, the articles discussed some type of telemedicine or telehealth modality in the treatment process for substance abuse. Third, the review includes studies that compared telemedicine with another treatment, non-treatment, or combination of treatments. Telemedicine could have been part of a more extensive study protocol, but the telemedicine modality must have been measurable in the study. Articles without any comparisons were excluded because such studies could only avail limited information, such as technical acceptability of the telemedicine applications. Fourth, articles that assessed the efficacy, effectiveness, or access-effectiveness of the intervention were reviewed. Acceptability and patient satisfaction studies of telemedicine in addiction were excluded because they do not show any clear health care system or patient outcomes or benefits. Finally, studies that reviewed the effectiveness of telemedicine in substance abuse or addiction were also included.

Studies were grouped by the telemedicine modality used, the underserved population or area, and the type of substance use disorder. If various disorders were treated, the article was included in all addiction groups. Consequently, it was possible for a single study to be represented in various categories. Once all of the studies had been grouped, they were read and evaluated to determineif they fulfilled the inclusion criteria of the final review. All of the included studies' summaries were included in the attached literature review matrix (Appendix). In this paper, I report all of the study areas identified in the review. Nevertheless, the quality of the articles was not evaluated using a quality index, as utilized in numerous other systematic reviews. Instead, I report if the study was a randomized controlled trial (RCT), or if some other research design was used.

Predominantly, the quality of the studies was good. The majority of the studies were RCTs, and most of them had large sample sizes. Nevertheless, the use of RCTs as an index of study quality is somewhatrestrictive, but considering that aproportionately large number of the reviewed articles were based on RCTs, it is reasonable to state that the comprehensive study quality was excellent. Similarly, considerations for underserved populations and areas were found across the body of literature and highlight certain points for the successful use and application of telemedicine services.

Critical Appraisal of the Studies

The reviewed literature showed that promising results have been found for synchronous and asynchronous telemedicine health interventions that involve interaction with a professional (Eiblet al., 2017). The growth in technology and outreach creates new opportunities for service delivery. Nevertheless, it also generates new responsibilities for ensuring effective, evidence-based psychological treatments across rural and underserved settings and for additional professional training in the skills and styles of practice needed for active development and delivery of e-substance abuse services (Obikunle, 2015). In their non-randomized retrospective study,Eibl et al. (2017) suggested that the strength of telemedicine is derived, partly, from the combination of technological applications with more traditional face-to-face techniques that can help mitigate the limitations of both modalities.

The review revealedthat the recent studies on synchronous telemedicine modalities in substance abuse have been dominated by computerized screening and assessment tools, smartphone mobile devices, and video conferencing (Carroll et al., 2014; Molfenter,Boyle, Holloway,& Zwick, 2015; Molfenter, Brown, O'Neill, Kopetsky, & Toy, 2018). The review also revealed a preference for telephone-based applications, such as for texting appointment reminders. Mobile technologies and text messaging can be used as a convenient client assessment and monitoring method, for self-management, and to keep continuous communication between in-person sessions. In their cross-sectional survey, Molfenter et al. (2018) established that computerized screenings and texting appointment reminders were the telemedicine technologies that generated the most interest, at 69.97% and 68.49%, respectively. Similarly, Molfenter et al. (2015) discovered that video conferencing generated interest in four of the five states studied. Smartphone mobile devices and video conferencing can enhance the quality and quantity of substance abuse services, extending access to underserved populations in rural, remote, and isolated areas. Diagnosis, treatment, and follow-up for various substance abuse areas can be improved, alongside timeliness and reduction of transportation costs for assessment.

Similarly, three studies in the review referred exclusively to web- or internet-based behavioral treatment (Marschet al., 2014; Campbell et al., 2014; Campbell et al., 2015). Internet- or web-based programs can includewebsites that provideinformation concerning treatment resources, anonymous counseling services, and self-help and resources for helping others. The primary form of web-based modality found in the literature was the therapeutic education system (TES).

Some approaches included more than one form of technology for substance abuse treatment delivery. This report refers to them as mixed modalities. Examples of mixed techniques include applications that enable patients to complete assessments or therapeutic exercises through the internet, and then the information generated can inform initial and ongoing consultation (Carroll et al., 2014). A primary benefit of this approach is that it allows clinicians, particularly those who conduct brief motivational interventions, to focus more efficiently on the sessions based on the patient's personalized feedback (Obikunle, 2015). Moreover, Eibl et al. (2017) and Marsch et al. (2014) asserted that mixed modalities that combine telemedicine applications with in-person therapy can have a positive effect on therapeutic relationships and patient outcomes.

While specific frameworks of collaborative programs varied, the primary goal behind the mixed modalities model is to develop primary care providers' capacities to identify and respond to substance use clients through partnerships with specialists. Notably, this approach has been particularly essential in rural areas where primary care practitioners typically have access to few local resources for support and referral. Obikunle (2015) argued that the opportunity to observe the process of a substance abuse interview through telemedicine applications may enhance practical and case-based education for primary care clinicians. Similarly, a community needs assessment service model considers and responds to the needs of all users. Since it is inclusive and engaging, this model leads to high patient and community satisfaction and is useful in rural programs. In particular, Campbell et al. (2015) used a community reinforcement approach to identify and adequately address the acceptability of an efficacious, web-based psychosocial intervention among an underrepresented population of American Indians/Alaska Natives (AI/AN). Evaluation of the study established that core TES content was acceptable in a diverse AI/AN client population,which leads to further commitment to the service delivery model.

This review encompasses studies that referred explicitly to the use of telemedicine for substance abuse interventions. The study by Molfenter et al. (2018) of extended telemedicine interventions for substance abuse indicated a variety of telemedicine modalities. These modalities include computerized screening and assessment tools, texting appointment reminders, texting motivational messages, an organizational web portal for patients to use, video- and telephone-based therapy, and virtual worlds for treatment. According to Molfenter et al. (2018), these modalities have potential as clinically useful tools for substance abuse therapy. Various studies supported this through their research findings. For example, in a retrospective study that compared telepsychiatry and face...