Evaluation of urine drug screen falsification of results among patients with opioid use disorder receiving treatment in a telehealth model of care.

INTRODUCTION: As telehealth models for treatment of opioid use disorder (OUD) are expanding, the field does not know the reliability of urine drug screening (UDS) in this setting. The objective of this study is to determine the rate of falsification of UDS testing among patients with OUD in active treatment with buprenorphine via a telehealth provider. METHODS: This is a prospective cohort study of 899 randomly selected eligible patients, of which 392 participated in the final cohort that the study team used for analysis. The study mailed patients a UDS cup and asked them to return the sample by mail. After the UDS sample was received, a buccal swab was mailed, and the study asked patients to schedule a virtual meeting in which consent was sought and an observed buccal swab was obtained. We evaluated urine for evidence of falsification, and used buccal swabs to genetically match individuals to urine samples. RESULTS: After exclusion criteria, 395 (52.3 %) of 755 patients who received a UDS kit returned it for analysis prior to knowledge of the study. Of that, 392 samples had sufficient quantity for testing. We determined 383 (97.7 %) to be human urine containing buprenorphine without indication of exogenous buprenorphine addition and with evidence of compliance. A total of 374 patients received a buccal swab kit and 139 (37.2 %) attended the consent/observed buccal swab session. One hundred and thirty-two patients consented and completed the swab under video observation, and 120 successfully sent the swab back to the external laboratory. Of the 120 buccal swabs received, 109 (90.8 %) were a genetic match, 10 (8.3 %) were indeterminate, and 1 (0.8 %) was a genetic mismatch. CONCLUSIONS: This study of patients treated by a telehealth OUD provider demonstrated a low rate of urine test falsification.

Implementation of a Novel Telehealth Patient Advisory Council.

Patient engagement in healthcare delivery processes has been increasingly emphasized in recent years, which can be accomplished in part by Patient Advisory Councils (PACs). Although well-established in brick-and-mortar facilities, the use of PACs in pure telehealth settings is limited. Bicycle Health, a digital health organization that provides biopsychosocial treatment of opioid use disorder (OUD) via telehealth, sought to increase patient engagement regarding care delivery and innovation, ultimately launching a telehealth Patient Advisory Council. Herein we discuss implementation challenges and iterative changes to address each challenge. Key learnings include the following: Patients with OUD are often subject to significant stigma, including by healthcare professionals. This is a key factor to consider when recruiting and engaging patients; trust building is key and can help to overcome both perceived and actual stigma.Inclusion of core staff persons who have lived experience with the respective health condition-in this case, OUD-is beneficial.Utilizing a formal framework, such as the Model for Improvement (utilized widely by the Institute for Healthcare Improvement), to guide improvement work is helpful for providing structure to feedback conversations, though this framework should be presented to patients in accessible language.