Three-fourths of physicians said they believe telemedicine visits limit their ability to determine whether patients are at risk for or are currently misusing prescription drugs, according to a new study.
Providers are concerned that substance abuse issues are slipping through the cracks in virtual care, as patients experience more stress and mental illness, according to the 2021 Quest Diagnostics Health Trends report released in November.
"Telemedicine is important," said Dr. Harvey Kaufman, senior medical director and head of the health trends research program at Quest Diagnostics. "It drives engagement that can't otherwise occur when offices are closed, and it also has a role in terms of allowing easy exchange between a physician and a patient. But it can't substitute for everything that occurs in an in-person visit."
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This led to the Government Accountability Office and others urging the federal government to focus on addressing drug misuse in addition to COVID-19 measures.
In a survey of more than 500 prescribing state-licensed physicians commissioned by Quest Diagnostics, 71% said the pandemic made the prescription drug crisis worse and 76% anticipate that drug overdose deaths will continue to rise even as the pandemic subsides.
Virtually all, 94%, of primary care physicians surveyed reported witnessing more patients who were experiencing stress, anxiety or other mental health issues due to the pandemic.
Only half of physicians feel confident that they can recognize the signs of prescription drug misuse based on telehealth interactions, compared with 91% who feel confident that they can detect misuse based on in-office interactions with patients.
Because of the lack of in-person visits, 67% of physicians reported being afraid that they missed signs of drug misuse or use disorders in one or more of their patients during the pandemic.
Even before the pandemic, telehealth has contributed enormous value and benefit to the treatment of mental health and substance abuse disorders, said Krista Drobac, executive director of the Alliance for Connected Care.
In 2018, Congress first passed legislation allowing Medicare members with substance use disorders to be treated using telehealth.
While physically going to a lab is necessary to officially confirm someone is misusing drugs, Drobac said physicians can ask patients the same questions about their history and current activities via telehealth that they do in-person to detect possible substance abuse. They can also provide essential counseling and support services virtually to patients dealing with drug misuse as well.
"The preconceptions of telehealth are that you can't get as much out of a telehealth visit as you would in person," she said. "But then once people conduct a telehealth visit, their perception changes, and they like it more and believe that they can get more out of a virtual visit."
Quest Diagnostics experienced a 70% decline in clinical drug testing volumes during the early months of the pandemic, which it said contradicted most physicians responding that they believe clinical drug testing is critical to preventing substance abuse.
Doctors and patients need to engage with one another to decide when to use telemedicine and when to turn to in-person visits, particularly for detecting and testing for drug misuse, Kaufman said.
"There's a difference in the visualization between people on screen versus in person," he said. "And to do a drug test, one needs assessment, generally of a urine drug specimen. It can't be virtual."
Data from more than 475,000 de-identified 2020 test results, shows that nearly half of all patients tested by Quest Diagnostics showed signs of drug misuse, and a quarter showed signs of drug combining.
Doctors want guidance in finding the balance between remote and in-office care to deliver compassionate care to their patients, Kaufman said. Around 80% of survey respondents said they want more information on how to monitor prescription drug addiction in general.
"They're looking for educational support in understanding how best to use the different resources they have available, whether it's telehealth, in-person visits or urine drug testing, to better get a handle on this epidemic within the pandemic," Kaufman said.