Patient and Clinician Experiences with the Implementation of Telemedicine and Related Adaptations in Office-Based Buprenorphine Treatment During the COVID-19 Pandemic: A Qualitative Study

Research Square (Research Square), Journal Year: 2024, Volume and Issue: unknown

Published: April 22, 2024

Abstract Background: Deaths from opioid overdose have increased dramatically in the past decade, representing an epidemic United States. For individuals with use disorder (OUD), agonist medications such as methadone and buprenorphine reduce opioid-related morbidity mortality. Historically, provision of treatment office-based settings has relied on frequent in-person contact, likely influencing patients’ access to retention care. In response COVID-19 pandemic, providers rapidly adapted their care processes, increasingly relying telemedicine visits. To date, relatively few prior studies combined patient clinician perspectives examine implementation related adaptations, particularly safety-net settings. Methods: Qualitative methods were used explore experiences clinic affiliated urban hospital. From this clinic, we interviewed 25 patients 16 clinicians (including prescribers non-prescribers) understand how impacted quality engagement care, well preferences for using moving forward. Results: Five themes regarding other COVID-19-related adaptations arose perspectives: 1) integration precipitated openness more flexibility practices, 2) concerns telemedicine-related centered around safety accountability, 3) encounters required rapport trust between facilitate open communication, 4) populations experienced unique challenges when telemedicine, terms technology need privacy, 5) there is important role forward, primarily through its hybrid models Conclusions: Telemedicine within potential improve care; however, our findings emphasize tailored approaches implementing treatment, Overall, study supports maintenance changes policy practice that beyond public health emergency.

Language: Английский

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Do video or telephone consultations impact attendance rates in an addiction medicine specialist outpatient clinic?

Internal Medicine Journal, Journal Year: 2024, Volume and Issue: 54(9), P. 1490 - 1496

Published: June 27, 2024

Abstract Background Effective alcohol and other drugs (AODs) treatment has been proven to increase productivity reduce costs the community. Telehealth previously effective at delivering AOD in right settings. Yet, Australia's current Medicare funding restricts telephone consultations. Aim We hypothesise that modality influences attendance rates. Specifically, consultations can remove barriers accessing and, therefore, attendance. Methods conducted a retrospective audit on our addiction medicine specialist outpatient service from 1 July 2022 30 June 2023. A mixed‐effects logistic regression model was used analyse factors associated with Results There were 576 participants study, 3354 appointments booked over 12‐month study period. Of these, 2695 face‐to‐face, 541 118 video. The unadjusted raw rate highest group (87.24%), followed by face‐to‐face (73.02%) video (44.92%). After adjusting for covariates, consultation significantly increased odds of attending compared (odds ratio (OR) = 2.60, 95% confidence interval (CI) 1.90–3.54, P < 0.001). Video 69% reduction (OR 0.31, CI 0.019–0.49, Conclusions While physical may be required specific clinical care, are form an important adjunct treatment. Given substantial substance use disorders, this could inform government policies priorities further improve access outcomes.

Language: Английский

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Patient perceptions of and experiences with stigma using telehealth for opioid use disorder treatment: a qualitative analysis

Harm Reduction Journal, Journal Year: 2024, Volume and Issue: 21(1)

Published: June 27, 2024

Abstract Background Patients with opioid use disorder (OUD) experience various forms of stigma at the individual, public, and structural levels that can affect how they access engage healthcare, particularly medications for OUD treatment. Telehealth is a relatively new form care delivery As reducing surrounding treatment critical to address ongoing gaps in care, aim this study was explore telehealth impacts patient experiences stigma. Methods In qualitative study, we interviewed patients single urban academic medical center consisting multiple primary addiction clinics Oregon, USA. Participants were eligible if had (1) least one virtual visit between March 2020 December 2021, (2) prescription buprenorphine not exclusively used chronic pain. We conducted phone interviews October 2022, then recorded, transcribed, dual-coded, analyzed using reflexive thematic analysis. Results The mean age participants ( n = 30) 40.5 years (range 20–63); 14 women, 15 men, two transgender, non-binary, or gender-diverse. 77% white, 33% experienced homelessness prior six months. identified four themes regarding shaped perceptions individual (1), public (2–3), (4): offers wanted space improved control over setting; Public privacy concerns impact both in-person encounters, depending on clinical personal circumstances; (3) social distance could mitigate exacerbate clinician stigma, expectations; (4) increased flexibility translated trust respect. Conclusions by individuals are complex multifaceted, as ways which those interact telehealth-based care. mixed results support policies allowing more individualized, patient-centered approach allows choice receive services.

Language: Английский

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Regulation and Compliance in Telemedicine: A Viewpoint (Preprint)

Journal of Medical Internet Research, Journal Year: 2024, Volume and Issue: 27, P. e53558 - e53558

Published: Sept. 27, 2024

The US COVID-19 Public Health Emergency ended on May 11, 2023. Lawmakers and regulators extended some flexibilities while they deliberate effective long-term telemedicine policy. Here, we discuss critical challenges in compliance regulation grounded scholarly literature current events. We specifically consider obstacles progress toward solutions law regarding privacy security issues, care across state borders, prescribing over the United States. conclude that simplified policies are needed to keep accessible providers patients measures need refinement protect appropriately.

Language: Английский

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Mental Health Providers’ Comfort in Prescribing Over Telemedicine: Content Analysis of Challenges and Solutions (Preprint)

JMIR Human Factors, Journal Year: 2024, Volume and Issue: 12, P. e65419 - e65419

Published: Dec. 20, 2024

Background In response to the COVID-19 pandemic, United States extended regulatory flexibilities make telemedicine more accessible providers and patients. Some of these allowed intake patients over prescribe certain scheduled medications without an in-person visit. Objective We aim understand providers’ parameters for their comfort in prescribing report on solutions have adopted potential barriers challenges via telemedicine. Methods As part a larger mixed methods study between February April 2024, we conducted 16 semistructured interviews with mental health who within States. used results web-based, cross-sectional survey develop codebook support recruitment. analyzed subsection using content analysis capture comfort, barriers, workarounds prescribing. reported codes by frequency provider. Results Participants were typically male (11/16, 69%), provided care mostly or completely psychiatrists (8/16, 50%) other physician (3/16, 19%). Providers’ primary states (10/16, 62%) practice included Oregon, Texas, New York, California. The yielded total 234 codes, three main codes—comfort (98/234, 41.9%), (85/234, 36.3%), (27/234, 11.5%)—and two subcodes—uncomfortable (30/98, 31%) comfortable (68/98, 69%) being as long they could meet working expertise, having access needed patient information, compliant rules regulations. frustrations e-prescription workflows miscommunications pharmacies. Solutions ease alleviate discomforts developing help complete laboratory tests physical examinations directly communicating Conclusions By applying provider interviews, found that physicians are when feel practicing personal safety. While many experience such miscommunication pharmacies, appear not prevent them from With expected changes 2024 2025 US laws regulations prescribing, may see

Language: Английский

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Transitions of care between jail-based medications for opioid use disorder and ongoing treatment in the community: A retrospective cohort study

medRxiv (Cold Spring Harbor Laboratory), Journal Year: 2023, Volume and Issue: unknown

Published: Nov. 11, 2023

Abstract Background and Aims Offering medications for opioid use disorder (MOUD) in carceral settings can significantly reduce overdose risk. However, it is unknown whether to what extent individuals U.S. jail continue MOUD once they leave incarceration, factors influence treatment continuity. Design Retrospective cohort study of linked jail-based electronic health records community OUD claims. Setting New York City Jail Participants Incarcerations with discharged from the between May 1, 2011 December 31, 2017 Comparators Receiving vs. not receiving (methadone or buprenorphine) at time release Measurements We measured continuity community-based within one month release, among those without during jail. tested effect modification based on receipt prior incarceration assessed associated discontinuation upon re-entry. Findings Of 28,298 eligible incarcerations, 52.8% received release. 30% incarcerations had a claim 30 days compared 7% (Risk Ratio: 2.62 (2.44-2.82)). Most (69%) claims who in-jail continued community, only 9% MOUD. Among were younger, Non-Hispanic Black no history less likely following Conclusions maintenance strongly Still, findings highlight gap upon-reentry, especially initiate In wake worsening deaths troubling disparities, improving continuty evidence-based care this population must be an urgent policy priority.

Language: Английский

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