Care Integration for Hepatitis C Virus Treatment Through Facilitated Telemedicine Within Opioid Treatment Programs: Qualitative Study

Abstract

Background: Telemedicine has the potential to remove geographic and temporal obstacles to healthcare access. Whether and how telemedicine can increase healthcare access for underserved populations remains an open question. To address this issue, we situated facilitated telemedicine encounters for management of hepatitis C virus (HCV), a highly prevalent condition among people with opioid use disorder (OUD), into opioid treatment programs (OTPs). OTPs are routine clinical care providers for people with OUD. We investigated the integration and impact of facilitated telemedicine into normal clinical practice.Objective: To understand OTP staff experiences of integrating facilitated telemedicine for HCV treatment into OTPs, including best practices and lessons learned. Methods:We conducted semi-structured interviews with 45 OTP staff (16 clinical, 15 administrative, and 14 patient engagement staff) at least one year after the implementation of facilitated telemedicine for HCV management. We utilized hermeneutic phenomenological analysis to understand OTP staff experiences. Results:We identified four overarching themes illustrating successful integration of facilitated telemedicine for HCV care into OTPs. First, integration requires understanding of the challenges, goals, and values of the OTP. As OTP staff learned about new, highly effective HCV therapies, they valued an HCV cure as a "win" for their patients and were excited about the potential to eliminate a highly prevalent infectious disease. Second, integration of facilitated telemedicine into OTPs fosters social support and reinforces relationships between patients and OTP staff. OTP staff appreciated the ability to have "eyes on" patients during telemedicine encounters to assess body language, a necessary component in addiction psychiatry. Third, participants described high levels of interprofessional collaboration as a care team that included blurring of lines between disciplines working toward a common goal of improving patient care. Study case managers were integrated into OTP workflows and established communication channels to improve patient outcomes. Fourth, administrators endorsed sustaining and future expansion of facilitated telemedicine to address comorbidities.Conclusions: OTP staff were highly enthusiastic about facilitated telemedicine for an underserved population. They described high levels of collaboration and integration, comparable with relevant integrative frameworks. When situated within OTPs, facilitated telemedicine is a high value application of telemedicine that provides support for underserved populations necessary for high quality healthcare. These experiences support sustaining and scaling facilitated telemedicine in comparable settings and evaluating its ability to address other comorbidities. Clinical Trial: ClinicalTrials.gov Identifier: NCT02933970