{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T16:28:45Z","timestamp":1787243325317,"version":"build-2736575974"},"reference-count":36,"publisher":"SAGE Publications","issue":"11","license":[{"start":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T00:00:00Z","timestamp":1752105600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Telemedicine and e-Health"],"published-print":{"date-parts":[[2025,11,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To determine whether buprenorphine initiation among American Indian and Alaska Native (AI\/AN) Veterans increased with expanded telehealth-prescribing abilities during the COVID-19 pandemic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This cohort study used the Veterans Health Administration medical record system, including 1,761 AI\/AN Veterans with a new opioid use disorder (OUD) diagnosis. Exclusion criteria included buprenorphine receipt in the 3 months before diagnosis and methadone use. Primary exposures included time of diagnosis (3 years before vs. during COVID-19 pandemic, April 1, 2020\u2013March 31, 2023), rurality, and telehealth-only versus in-person encounters. Covariates included age, gender, marital status, Deyo\u2013Charlson Comorbidity Index, and psychiatric comorbidities. The primary outcome was buprenorphine initiation, defined by prescription at\/after OUD diagnosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Of 1,761 AI\/AN Veterans with OUD, the mean age was 53.8, 58.5% urban residing, and 37.5% married. Depressive (62.8%) and alcohol use disorders (38.9%) were common. The pre-COVID-19 cohort had more in-person opioid encounters (59.8% vs. 35.7%). Buprenorphine was more frequently prescribed in the pre-COVID-19 cohort (18.5% vs. 12.9%). In the adjusted main-effects model, neither time nor rurality was associated with initiation, but in-person encounters were (odds ratio [OR] = 6.09; 95% confidence interval [CI]: 4.24\u20138.76). Rurality \u00d7 time effect modification revealed rural Veterans were more likely to initiate buprenorphine than urban Veterans during the pandemic (OR = 1.81, 95% CI: 1.10\u20132.99).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Unadjusted buprenorphine initiation rates decreased during COVID-19 but were ultimately unexplained by time, with only in-person encounters associated with initiation, compared with telehealth alone. Urban Veterans saw a decline, while rural rates remained stable, likely due to less reliance on in-person care. AI\/AN Veteran OUD disparities necessitate telehealth optimization and provider education.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/tmj.2025.0038","type":"journal-article","created":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T14:01:12Z","timestamp":1752156072000},"page":"1333-1341","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Telehealth Buprenorphine Initiation for Opioid Use Disorder Among American Indian and Alaska Native Veterans, April 2017\u2013March 2023"],"prefix":"10.1177","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3760-8557","authenticated-orcid":false,"given":"Cole","family":"Haskins","sequence":"first","affiliation":[{"name":"Department of Behavioral Health Services, Denver Health Medical Center, Denver, Colorado, USA."},{"name":"Department of Psychiatry, University of Colorado, Aurora, Colorado, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amber B.","family":"Amspoker","sequence":"additional","affiliation":[{"name":"Michael E. DeBakey VA Medical Center, VA HSR&amp;D Houston Center of Innovations in Quality, Effectiveness and Safety, Houston, Texas, USA."},{"name":"Department of Medicine, Baylor College of Medicine, Houston, Texas, USA."},{"name":"Education and Clinical Center, VA South Central Mental Illness Research, Houston, Texas, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annette","family":"Walder","sequence":"additional","affiliation":[{"name":"Michael E. DeBakey VA Medical Center, VA HSR&amp;D Houston Center of Innovations in Quality, Effectiveness and Safety, Houston, Texas, USA."},{"name":"Department of Medicine, Baylor College of Medicine, Houston, Texas, USA."},{"name":"Education and Clinical Center, VA South Central Mental Illness Research, Houston, Texas, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julianna","family":"Hogan","sequence":"additional","affiliation":[{"name":"Michael E. DeBakey VA Medical Center, VA HSR&amp;D Houston Center of Innovations in Quality, Effectiveness and Safety, Houston, Texas, USA."},{"name":"Department of Medicine, Baylor College of Medicine, Houston, Texas, USA."},{"name":"Education and Clinical Center, VA South Central Mental Illness Research, Houston, Texas, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Ecker","sequence":"additional","affiliation":[{"name":"Michael E. DeBakey VA Medical Center, VA HSR&amp;D Houston Center of Innovations in Quality, Effectiveness and Safety, Houston, Texas, USA."},{"name":"Department of Medicine, Baylor College of Medicine, Houston, Texas, USA."},{"name":"Education and Clinical Center, VA South Central Mental Illness Research, Houston, Texas, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2853-0113","authenticated-orcid":false,"given":"Jan","family":"Lindsay","sequence":"additional","affiliation":[{"name":"Michael E. DeBakey VA Medical Center, VA HSR&amp;D Houston Center of Innovations in Quality, Effectiveness and Safety, Houston, Texas, USA."},{"name":"Department of Medicine, Baylor College of Medicine, Houston, Texas, USA."},{"name":"Education and Clinical Center, VA South Central Mental Illness Research, Houston, Texas, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay","family":"Shore","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of Colorado, Aurora, Colorado, USA."},{"name":"VHA Office of Rural Health, Veterans Rural Health Resource Center, Salt Lake City, Utah, USA."},{"name":"Colorado School of Public Health, Centers for American Indian and Alaska Native Health, Anschutz Medical Campus, Aurora, Colorado, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,7,10]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.addbeh.2020.106743"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.1111\/papr.12097"},{"issue":"6","key":"e_1_3_6_4_2","first-page":"4","article-title":"Veterans\u2019 health and opioid safety\u2014Contexts, risks, and outreach implications","volume":"32","author":"Bennett AS","year":"2015","unstructured":"Bennett AS, , Elliott L, , Golub A. 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