A Qualitative Study of Patient Experiences with Telemedicine Opioid use Disorder Treatment during COVID-19

Abstract

Background: The drug-related overdose crisis worsened during the COVID-19 pandemic. Recent drug policy changes to increase access to medications for opioid use disorder (MOUD) during COVID-19 shifted some outpatient MOUD treatment into virtual settings to reduce the demand for in-person care. The objective of this study was to qualitatively explore what is gained and lost in virtual patient encounters for patients with opioid use disorder at a low-threshold, addiction treatment clinic that offers buprenorphine and harm reduction services. Methods: Patients were included in this study if they received care at the Harm Reduction and BRidges to Care (HRBR) clinic and utilized virtual visits between November 2019 and March 2021. The study was conceptualized using a health care access framework and prior studies of telemedicine acceptability. Semi-structured interviews were completed between March and April 2021. Interviews were dualcoded and analyzed using directed content analysis. Results: Nineteen interviews were conducted. The sample was predominantly White (84%) and stably housed (79%) with comparable gender (male, 53%) and employment status (employed, 42%). The majority (63%) of patients preferred virtual visits compared to in-person visits (16%) or a combination of access to both (21%). Two overarching tandem domains emerged: availability-accommodation and acceptability-appropriateness. Availability-accommodation reflected participants' desires for immediate services and reduced transportation and work or caregiving scheduling barriers, which was facilitated by virtual visits. The acceptable-appropriate domain articulated how participants felt connected to their providers, whether through in-person interactions or the mutual trust experienced during virtual visits. Conclusions: Virtual visits were perceived by participants as a valuable and critical option for accessing treatment for OUD. While many participants preferred virtual visits, some favored faceto-face visits due to relational and physical interactions with providers. Participants desired flexibility and the ability to have a choice of treatment modality depending on their needs.

Flexible delivery of opioid agonist treatment during COVID-19 in Norway: A cross-sectional survey of provider experiences

“…Implications for policy and clinical practice ndings suggest that telemedicine can be useful as adjunct to face-to-face treatment and provide greater exibility for patients, who should be offered the choice between modalities, where possible. Lockard et al [30] emphasize the importance of having the exibility to choose in their study of patient experiences with telemedicine. Telemedicine may be particularly suitable for rural regions.…”

Use of and Retention on Video, Telephone, and In-Person Buprenorphine Treatment for Opioid Use Disorder During the COVID-19 Pandemic

“…[49][50][51][52][53] Additional studies with clinicians providing buprenorphine beyond the COVID-19 context are needed to identify and address barriers to continuing telehealth. Research should also continue to examine patient experiences and preferences related to buprenorphine treatment modality [54][55][56].…”

Patient and provider perspectives of the implementation of remote consultations for community-dwelling people with mental health conditions: A systematic mixed studies review

“…In fact, during the pandemic, providers in one study reported that they could still see patients face-to-face if they were concerned for their wellbeing ( Ashcroft et al, 2021 ). Many providers and patients expressed a preference for in-person care ( Lockard et al, 2022 ), acknowledging that remote consultations were not suitable for every patient. Patients and providers across studies endorsed using remote consultations after the pandemic ( Frye et al, 2022a ), with a hybrid model of remote and in-person care being commonly endorsed ( Benudis et al, 2022 ).…”

“…The time-saving benefits of remote consultations were also reported as facilitating factors, primarily in relation to reducing time spent travelling to appointments ( Goetter et al, 2022 ; Moo et al, 2020 ; Schubert et al, 2019 ). In addition, patients also reported that remote consultations improved their access to care by removing some of the logistical barriers, including requiring less time off work ( Aronowitz et al, 2021 ), reducing expenses ( Das et al, 2020 ), removing childcare barriers ( Lockard et al, 2022 ), and reducing waiting times ( Tuijt et al, 2021 ). In the context of the COVID-19 pandemic, patients also remarked that remote consultations reduced their likelihood of contracting COVID-19 ( Severe et al, 2020 ).…”