Healthcare Engagement Research Articles

Exploring the Impact of Private Companies’ Participation in Health-Related Programs through Corporate Sustainable Reporting

Background: Sustainability reporting has evolved into a widespread method for leading corporations, not only due to its value as a means of tracking one’s company’s performance, but also as a tool for communicating performance to all involved stakeholders in any corporation. There has been little research into how private companies participate in various health programs while maintaining effective reporting. Aim: The study seeks to investigate the impact of private companies’ participation in health-related programs via corporate sustainable reporting (or corporate social responsibility disclosures; CSRD). Methods: Descriptive–correlational analysis, a balanced panel data of 117 Saudi listed businesses. Results: Corporate engagement in healthcare necessitates the identification of various hazards. As a result of the implementation of Saudi Arabia’s Vision 2030, in 2016, the reporting of health-related CSRD (HCSRD) increased from 36% in 2015, to 48% in 2018. Conclusions: Corporate sustainable participation in healthcare can vary among firms, indicating the different levels of influence in this regard. The healthcare sector, having the lowest average amount of disclosures, shows a lack of responsibility and control, as well as an inability to follow developments in the industry. The findings have practical implications for a range of stakeholders (e.g., regulators, investors, accounting professionals, and other institutions) of health-related CSRD in Saudi Arabia.

Associations Between Cognitive Impairment Severity and Barriers to Healthcare Engagement Among Older Adults.

Objectives: To assess whether older adults with a cognitive impairment were more likely to report challenges interacting with medical providers, or to avoid needed medical care. Methods: Data for this exploratory, cross-sectional analysis were from older adults (N = 493) ages 60-82 participating in the "LitCog" cohort study. Multivariable generalized linear models compared cognitive impairment (none, mild, moderate, severe) with validated measures of healthcare engagement. Results: A moderate cognitive impairment was associated with delays in medical care due to embarrassment (RR 5.34.95% CI 1.30-22.0) and discomfort asking the doctor questions (RR 4.07, 95% CI 1.00-16.5). Conclusions: Intermediate cognitive deficits, such as with mild cognitive impairment (MCI) or mild dementias, may impact meaningful engagement with healthcare systems, potentially affecting timely detection and appropriate management of cognitive concerns and other chronic medical conditions. More research is needed to understand mechanisms underlying this relationship.

The impact of educational whiteboard videos on healthcare providers' self-efficacy to deprescribe.

The impact of educational whiteboard videos on healthcare providers' self-efficacy to deprescribe.

Investigating Reliability, Validity, and Measurement Invariance of the Eight-Item Vocational Rehabilitation Engagement Scale With a Sample of Multilingual Clients

Background: Vocational rehabilitation (VR) engagement is a vital component for successful rehabilitation outcomes. Purpose: The purpose of this study is threefold: First, we investigated the item clarity of the Vocational Rehabilitation Engagement Scale (VRES); second, we explored the factorial structure; third, we examined the measurement invariance of the VRES across gender and education level for culturally diverse and bilingual clients in public VR program (i.e., clients speak English as a second language). Given the positive effects of client engagement in health and rehabilitative care on outcomes, it is important to validate this brief instrument to measure VR engagement for culturally diverse and bilingual clients. Method: Data, collected from 16 VR clients who completed the original VRES in the focus group, were subjected to content analysis, and data, collected from 264 clients who completed the eight-item VRES and Working Alliance Inventory Short Form (WAI-S), were subjected to confirmatory and multigroup confirmatory factor analysis (MGCFA). Results: Based on the feedback from the focus group, the first item was revised to increase clarity. However, the preliminary results indicated that the revised item had very low community value, and therefore, we removed the item from the subsequent analysis. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) results provided support for a unidimensional structure for the eight-item VRES. Measurement invariance across gender and education level was achieved after correlating error terms. The scale had strong reliability, and scores from the VRES were significantly moderately correlated with working alliance. Conclusion: The eight-item VRES is a reliable and valid measurement tool to use with culturally diverse and multilingual participants.

Innovative Research Framework for Strengthening Health Care and Public Health Engagement in Neighborhood Change as a Social Determinant of Health

Neighborhood change is a social determinant of health (SDOH) that has been associated with adverse health and increased health care utilization. The number of cities and neighborhoods undergoing intense gentrification, defined as an influx of wealthy populations into a working-class neighborhood, is not highly numerous. Public health and health systems are increasingly engaged with SDOH in community-level interventions. Pathways to study and affect NC-related health impacts are limited. This unfunded study provides a research framework to address concerns about financial investment, identifying population health needs, and community stakeholder engagement.

Women over 50 who use alcohol and their engagement with primary and preventative health services: a narrative review using a systematic approach

Background Women who are over 50 years are drinking alcohol in higher quantities and more frequently than in previous decades. Good engagement with primary care is crucial for women’s physical and psychological health, particularly if they use alcohol. However, there is little known about the alcohol use of women over 50 and their use of primary care. Methods A systematic search was conducted on six databases; CINAHL, Medline, PsycINFO, Academic Search Complete, EMBASE and Web of Science to identify literature on primary health care engagement of women 50 years and older (50+) who use alcohol. Titles and abstracts were reviewed and full texts were independently reviewed by two researchers. A narrative review, critical appraisal and synthesis of the eligible studies produced common themes and key findings. Results After excluding 3822 articles, 13 articles were deemed eligible for the review. For this age group (50+), findings were: 1) women who drink heavily were less likely than men to attend General Practitioners (GPs), moderate drinkers were more likely than abstainers to attend mammogram screening, 2) GPs were less likely to ask questions or discuss alcohol with women than with men, 3) GPs offered less advice on alcohol to women than to men, and 4) less women than men received alcohol screening from their GP. Discussion While women 50+ are drinking more, their alcohol use is underreported and insufficiently provided for in primary health. As women’s life expectancy increases, improved GP engagement will benefit women’s health and reduce future healthcare costs.

Making (female) health care work matter

Over the last two years, digital media have contributed significantly to increasing the visibility of those who are outstandingly challenged by the pandemic. In Germany, the Twitter hashtag #systemrelevant [systemically relevant] initiated a public debate on values and working conditions. Applying the practice-theory-based concept of performative publics, we analyze the formation of this specific public with a special focus on its gendered structure. Results of our mixed-methods approach show how health care work has become the dominant issue of #systemrelevant. Civil society actors and engaged health care workers set the agenda, and journalism primarily responds to these voices. Although care work is performed predominantly by women, most of the attention online is given to men. However, on the level of tweets and linked content, the discourse in #systemrelevant counteracts stereotypical images of women in health care. Overall, the ethnographic data on the most significant collective actor show a continuous tension between symbolic recognition and their struggle for improving working conditions.

Effect of health-care professionals' weight status on patient satisfaction and recalled advice: a prospective cohort study.

Research has demonstrated that healthcare professionals are not immune to weight stigma attitudes, with evidence showing that people living with overweight or obesity may experience direct and indirect stigma and discrimination. This can impact the quality of care provided and impact patients' engagement in healthcare. Despite this, there is a paucity of research examining patient attitudes towards healthcare professionals living with overweight or obesity, which can also hold implications for the patient-practitioner relationship. Thus, this study examined whether healthcare professionals' weight status impacts patient satisfaction and recalled advice. In this prospective cohort study, using an experimental design, 237 participants (113 women, 125 men) aged 32±8.92 with a body mass index of 25.87±6.79kgm2 were recruited through a participant pooling service (ProlificTM), word of mouth, and social media. The majority of participants were from the UK: 119, followed by participants from the USA: 65, Czechia: 16, Canada: 11, and other countries (N=26). Participants completed an online experiment consisting of questionnaires assessing satisfaction with healthcare professionals and recalled advice after exposure to one of eight conditions assessing the impact of healthcare professional weight status (lower weight or obesity), gender (woman or man) and profession (psychologist or dietitian). A novel approach to creating the stimuli was used to exposure participants to healthcare professionals of different weight status. All of the participants responded to the experiment hosted on Qualtrics™ in the period from June 8, 2016 to July 5, 2017. Study hypotheses were examined using linear regression with dummy variables and follow up post-hoc analysis to estimate marginal means with adjustment for planned comparisons. The only statistically significant result was a difference with a small effect in patient satisfaction, where satisfaction was significantly higher in healthcare professional who was a women living with obesity compared to healthcare professional who was a man living with obesity (estimate=-0.30; SE=0.08; df=229; ωₚ2=0.05; CI=-0.49 to-0.11; p<0.001), and healthcare professional who was a women living with lower weight compared to healthcare professional who was a man living with lower weight (estimate=-0.21; SE=0.08; df=229; CI=-0.39 to-0.02; ωₚ2=0.02; p=0.02). There were no statistically significant differences in satisfaction of healthcare professionals and recall of advice in the lower weight compared to obesity conditions. This study has used novel experimental stimuli to examine weight stigma towards healthcare professionals which is vastly under-researched and holds implications for the patient-practitioner relationship. Our findings showed statistically significant differences and a small effect where satisfaction with healthcare professionals both living with obesity and with a lower weight were higher when the healthcare professional was a woman compared to man. This research should act as a stimulus for further research that aims to examine the impact of healthcare professional gender on patient responses, satisfaction and engagement, and weight stigma from patients towards healthcare professionals. Sheffield Hallam University.

Leadership Behavior Associations with Domains of Safety Culture, Engagement, and Health Care Worker Well-Being.

Leadership is a key driver of health care worker well-being and engagement, and feedback is an essential leadership behavior. Methods for evaluating interaction norms of local leaders are not well developed. Moreover, associations between local leadership and related domains are poorly understood. This study sought to evaluate health care worker leadership behaviors in relation to burnout, safety culture, and engagement using the Local Leadership scale of the Safety, Communication, Operational Reliability, and Engagement (SCORE) survey. The SCORE survey was administered to 31 Midwestern hospitals as part of a broad effort to measure care context, with domains including Local Leadership, Emotional Exhaustion/Burnout, Safety Climate, and Engagement. Mixed-effects hierarchical logistic regression was used to evaluate the relationships between local leadership scores and related domains, adjusted for role and work-setting characteristics. Of the 23,853 distributed surveys, 16,797 (70.4%) were returned. Local leadership scores averaged 68.8 ± 29.1, with 7,338 (44.2%) reporting emotional exhaustion, 9,147 (55.9%) reporting concerning safety climate, 10,974 (68.4%) reporting concerning teamwork climate, 7,857 (47.5%) reporting high workload, and 3,436 (20.7%) reporting intentions to leave. Each 10-point increase in local leadership score was associated with odds ratios of 0.72 (95% confidence interval [CI] 0.71-0.73) for burnout, 0.48 (95% CI 0.47-0.49) for concerning safety climate, 0.64 (95% CI 0.63-0.66) for concerning teamwork climate, 0.90 (95% CI 0.89-0.92) for high workload, and 0.80 (95% CI 0.78-0.81) for intentions to leave, after adjustment for unit and provider characteristics. Local leadership behaviors are readily measurable using a five-item scale and strongly associate with established domains of health care worker well-being, safety culture, and engagement.

Management of orofacial clefts in Africa, insufficient management centers, and workforce.

Management of orofacial clefts in Africa, insufficient management centers, and workforce.

Lessons learned about policymaking: Moving an emergency department-initiated screening protocol to systemwide input in the development and implementation process.

Lessons learned about policymaking: Moving an emergency department-initiated screening protocol to systemwide input in the development and implementation process.

Group citizenship behaviour in healthcare organization, doctor-patient relationship, work engagement and turnover intention: A moderated mediation model.

The effective functioning of health care organisations depends on the inter-professional collaboration among healthcare professionals from diverse backgrounds, representing different work units, to provide quality services. This study aims to understand how group citizenship behaviour (GCB) that supports other work groups may moderate the relationship between doctor-patient relationship (DPR), Work Engagement (WE) and Turnover Intention (TI). The data for this study were collected through two waves of questionnaire survey at a tertiary public hospital in China. The hypothesised model was tested by Hayes' PROCESS macro. There were significant differences of perceived GCB across different professional units with work units practicing a multidisciplinary working approach and working in the high-stake working environment reported higher levels of GCB. The results show that WE mediates the relationships between DPR and TI and GCB accentuates the positive relationship between DPR and WE. Specifically, the path between DPR and WE was stronger for individuals with high perceived GCB than those with low perceived GCB. The study contributes to the development of Job Demands-Resources model with integrating GCB into the model and enriching the challenge job demand conceptualisation by focussing on DPR in Chinese health care setting. In practice, the hospital administrators should encourage GCB to improve organizational effectiveness and doctors' attitudes.

Structural violence and the uncertainty of viral undetectability for African, Caribbean and Black people living with HIV in Canada: an institutional ethnography

Biomedical advances in healthcare and antiretroviral treatment or therapy (ART) have transformed HIV/AIDS from a death sentence to a manageable chronic disease. Studies demonstrate that people living with HIV who adhere to antiretroviral therapy can achieve viral suppression or undetectability, which is fundamental for optimizing health outcomes, decreasing HIV-related mortality and morbidity, and preventing HIV transmission. African, Caribbean, and Black (ACB) communities in Canada remain structurally disadvantaged and bear a disproportionate burden of HIV despite biomedical advancements in HIV treatment and prevention. This institutional ethnography orients to the concept of ‘structural violence’ to illuminate how inequities shape the daily experiences of ACB people living with HIV across the HIV care cascade. We conducted textual analysis and in-depth interviews with ACB people living with HIV (n = 20) and health professionals including healthcare providers, social workers, frontline workers, and health policy actors (n = 15). Study findings produce a cumulative understanding that biomedical HIV discourses and practices ignore structural violence embedded in Canada’s social fabric, including legislation, policies and institutional practices that produce inequities and shape the social world of Black communities. Findings show that inequities in structural and social determinants of health such as food insecurity, financial and housing instability, homelessness, precarious immigration status, stigma, racial discrimination, anti-Black racism, criminalization of HIV non-disclosure, health systems barriers and privacy concerns intersect to constrain engagement and retention in HIV healthcare and ART adherence, contributing to the uncertainty of achieving and maintaining undetectability and violating their right to health. Biomedical discourses and practices, and inequities reduce Black people to a stigmatized, pathologized, and impoverished detectable viral underclass. Black people perceived as nonadherent to ART and maintain detectable viral loads are considered “bad” patients while privileged individuals who achieve undetectability are considered “good” patients. An effective response to ending HIV/AIDS requires implementing policies and institutional practices that address inequities in structural and social determinants of health among ACB people.

Future Directions in Youth and Family Treatment Engagement: Finishing the Bridge Between Science and Service

ABSTRACT The field has spent more than 50 years investing in the quality of youth mental healthcare, with intervention science yielding roughly 1,300 efficacious treatments. In the latter half of this period, concurrent efforts in implementation science have developed effective methods for supporting front-line service organizations and therapists to begin to bridge the science to service gap. However, many youths and families still do not benefit fully from these strategic investments due to low treatment engagement: nearly half of youths in need of services pursue them, and among those who do, roughly another half terminate prematurely. The negative impact of low engagement is substantial, and is disproportionally and inequitably so for many. We contend that to build a robust and “finished” bridge connecting science and service, the field must go beyond its two historical foci of designing interventions and preparing therapists to deliver them, to include an intentional focus on the youths and families who participate in these interventions and who work with those therapists. In this paper, we highlight the significance of treatment engagement in youth mental healthcare and discuss the current state of the literature related to four priorities: conceptualization, theory, measurement, and interventions. Next, we offer an example from our own program of research as one illustration for advancing these priorities. Finally, we propose recommendations to act on these priorities.

Tough Talks COVID-19 Digital Health Intervention for Vaccine Hesitancy Among Black Young Adults: Protocol for a Hybrid Type 1 Effectiveness Implementation Randomized Controlled Trial.

Interventions for increasing the uptake of COVID-19 vaccination among Black young adults are central to ending the pandemic. Black young adults experience harms from structural forces, such as racism and stigma, that reduce receptivity to traditional public health messaging due to skepticism and distrust. As such, Black young adults continue to represent a priority population on which to focus efforts for promoting COVID-19 vaccine uptake. In aims 1 and 2, the Tough Talks digital health intervention for HIV disclosure will be adapted to address COVID-19 vaccine hesitancy and tailored to the experiences of Black young adults in the southern United States (Tough Talks for COVID-19). In aim 3, the newly adapted Tough Talks for COVID-19 digital health intervention will be tested across the following three southern states: Alabama, Georgia, and North Carolina. Our innovative digital health intervention study will include qualitative and quantitative assessments. A unique combination of methodological techniques, including web-based surveys, choose-your-own-adventures, digital storytelling, user acceptability testing, and community-based participatory approaches, will culminate in a 2-arm hybrid type 1 effectiveness implementation randomized controlled trial, wherein participants will be randomized to the Tough Talks for COVID-19 intervention arm or a standard-of-care control condition (N=360). Logistic regression will be used to determine the effect of the treatment arm on the probability of vaccination uptake (primary COVID-19 vaccine series or recommended boosters). Concurrently, the inner and outer contexts of implementation will be ascertained and catalogued to inform future scale-up. Florida State University's institutional review board approved the study (STUDY00003617). Our study was funded at the end of April 2021. Aim 1 data collection concluded in early 2022. The entire study is expected to conclude in January 2025. If effective, our digital health intervention will be poised for broad, rapid dissemination to reduce COVID-19 mortality among unvaccinated Black young adults in the southern United States. Our findings will have the potential to inform efforts that seek to address medical mistrust through participatory approaches. The lessons learned from the conduct of our study could be instrumental in improving health care engagement among Black young adults for several critical areas that disproportionately harm this community, such as tobacco control and diabetes prevention. ClinicalTrials.gov NCT05490329; https://clinicaltrials.gov/ct2/show/NCT05490329. DERR1-10.2196/41240.

Development of a brief support and education intervention for loved ones of veterans with posttraumatic stress disorder.

Clinical practice guidelines for managing posttraumatic stress disorder (PTSD) encourage incorporating loved ones into treatment, and supportive relationships can increase engagement in mental health care for veterans with PTSD. This study describes the iterative refinement, feasibility/acceptability testing, and national dissemination of a brief support and psychoeducation intervention for loved ones of veterans with PTSD. Loved ones (n = 181; range:1-11 per group) attended and qualitatively rated "PTSD 101 for Family and Friends: A Support and Education Workshop." Open-ended questions were used to gather data on suggestions for improvement and descriptions of helpful content, and the workshop was refined following participant and operational partner feedback using a quality improvement framework. Rating quantitative items on a 1-5 scale, participants found the overall quality (M = 4.76) and relevance (M = 4.82) to be excellent, noting they learned substantial new information (M = 4.45). Sense of support (M = 4.95), intentions to use the material (M = 4.87), PTSD self-efficacy (M = 4.41), and understanding of PTSD (M = 4.76) were rated favorably. Common themes among helpful elements were a sense of shared experience and optimism and increased knowledge of treatments/resources. Suggestions for improvement referenced logistics. Following continual stakeholder feedback and refinement, the workshop represents a novel method for providing loved ones with empirically supported psychoeducation, coping skills, and community. It is being disseminated by the Family Services Section of the Veterans Health Administration Office of Mental Health and Suicide Prevention.

Experience delivering an integrated service model to people with criminal justice system involvement and housing insecurity

BackgroundPeople returning to communities from prison or jail face stressors related to securing housing, including discrimination, restrictions based on prior felony convictions, and limited economic and social resources. Existing housing programs can effectively reduce housing instability but often do not fully address the needs of people involved in the criminal justice system experiencing homelessness who often have co-occurring chronic medical issues, and psychiatric and substance use disorders.MethodsProject CHANGE is an ongoing program to deliver person-centered, integrated care and services to individuals involved with the criminal justice system and experiencing homelessness. Applying a Screening, Brief Intervention, (Referral to) Treatment framework, a comprehensive needs assessment is followed by delivery of intensive housing and vocational case management; and psychiatric, substance use, and medical services in a single location by an interdisciplinary team. Participants are followed with study interviews for 12 months. The current analysis was designed to assess the baseline characteristics and needs of the sample population, and the intensity of contact required for integrated service delivery.ResultsBetween November 2019 and September 2021, 86 participants were enrolled, of whom 64% had been released from prison/jail in the past 6 months; the remainder were on parole, probation, or intensive pretrial supervision. Participants were unstably housed (64%) or residing outdoors (26.7%) or in a shelter (24.4%). Most participants had high medical need and frequent healthcare engagement through outpatient and emergency department visits. Most participants were at-risk for clinical depression, and half were diagnosed with anxiety, dissociative, stress-related, somatoform, and other non-psychotic psychiatric disorders. Over 12-month follow-up, the interdisciplinary team made over 500 contact encounters, over half of which resulted in direct services provided, including obtaining vital documents for homelessness verification, housing applications, and employment coaching.ConclusionNavigation of services can be particularly challenging for individuals experiencing criminal justice involvement, homelessness, and co-occurring medical, psychiatric, and substance use issues, which can be addressed holistically in an integrated service model. Integrated service delivery was time-, resource-, and staffing-intensive, and challenged by the COVID-19 pandemic, requiring innovative solutions to sustain participant engagement.

P260 Care pathway modelling and economic analysis of a single NHS IBD Service following introduction of Small bowel ultrasound.

Abstract Background Small bowel ultrasound (SBUS) is an accurate, inexpensive and non-invasive method of diagnosing and monitoring IBD. The service delivery and economic implications of SBUS implementation on NHS IBD services have not previously been explored. Methods This study took the form of a service evaluation. Analysis of patient care episodes and flow through the established imaging (MRE and SBUS) and IBD care pathways was undertaken, data relating to patient flow, waiting times, resource use and healthcare engagement of patients were collected from care episodes between 01/01/2021 – 30/03/2022. Costs were calculated per care episode. Results Data from a service evaluation relating to 192 imaging referrals from IBD clinics for patients with Small bowel Crohn's disease (SBCD), and patient flow through the pathway were collected. Per scan, MRE was almost 5 times more costly than SBUS examinations (£305 versus £51 respectively). Patients from the SBUS pathway had fewer healthcare interactions across all three categories (Helpline, IBD Nurse or IBD Consultant appointments). Patients from the MRE pathway. Estimated costs per patient in the SBUS pathway were £81.72, and £379.58 per patient in the MRE pathway. Further to this the waiting times for MRE were significantly longer than those for SBUS. Conclusion The use of SBUS is a potential cost saving option when compared to MRE for adult patients with SBCD. There was a difference between the SBUS and MRE pathways in the waiting times for both the medical imaging scans, the reports of the scans and the initiation of an appropriate treatment plan. SBUS waiting times were shorter in all aspects except for the time between scanning report and the treatment initiation, indicating that it is the waiting times for the scans and the respective reporting that cause delays in treatment initiation. Future research in this area should attempt to consider the wider impact on cost effectiveness of the use of SBUS through investigation of costs including treatment costs, including the timing and use of biologic and immunomodulator treatments, impact of delays on service use and healthcare interactions of patients, work productivity and quality adjusted life years.

Climate mitigation and adaptation is cancer prevention and control

Climate change contributes to adverse outcomes and disruptions in cancer care with disproportionate impacts on specific populations. As the health effects of fossil fuel air pollution and planetary warming increase, transdisciplinary stakeholders across communities will be crucial to developing and implementing climate solutions as health solutions for patients affected by cancer. We provide a narrative review of four key themes at the intersection of climate change and cancer then describe potential opportunities to engage health care and community organizations, government agencies, public health entities, and clinicians dedicated to ensuring high quality cancer care for all. Through the review, we highlight that an expansion of climate-focused research funding and educational offerings for health professionals provides the foundation for ongoing action that can reduce health disparities, care disruptions, and health service demands while diminishing the carbon footprint of cancer care and improving patient-centered health outcomes. Lastly, we discuss lessons from the past that emphasize the importance of preparedness and swift action through scalable institutional, national, and international policies rooted in health, equity, and justice. We posit that through systematic and deliberate choice by those with decision making capabilities, climate mitigation and adaptation becomes cancer prevention and control.

Pre-Paid Phone Distribution: A Tool for Improving Healthcare Engagement for People with Substance Use Disorder

Background The COVID-19 pandemic drove significant disruptions in access to substance use disorder (SUD) treatment and harm reduction services. Healthcare delivery via telemedicine has increasingly become the norm, rendering access to a phone essential for engagement in care. Methods Adult patients with SUD who lacked phones (n = 181) received a free, pre-paid phone during encounters with inpatient and outpatient SUD programs. We evaluated changes in healthcare engagement including completed in-person and telemedicine outpatient visits and telephone encounters 30 days before and after phone receipt. We used descriptive statistics, where appropriate, and paired t-tests to assess the change in healthcare engagement measures. Results Patients were predominantly male (64%) and white (62%) with high rates of homelessness (81%) and opioid use disorder (89%). When comparing 30 days before to 30 days after phone receipt, there was a significant increased change in number of telemedicine visits by 0.3 (95% CL [0.1,0.4], p < 0.001) and telephone encounters by 0.2 (95% CL [0.1,0.3], p = 0.004). There was no statistically significant change in in-person outpatient visits observed. Conclusions Pre-paid phone distribution to patients with SUD was associated with an increased healthcare engagement including telemedicine visits and encounters.