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