Driving Access to Care: Use of Mobile Units for Urine Specimen Collection During the Coronavirus Disease-19 (COVID-19) Pandemic

Warrington, Jill; Brett, Alexa; Foster, Heather; Brandon, Jamie; Francis-Fath, Samuel; Joseph, Michael A.; Fung, Mark

doi:10.1177/2374289520953557

Cited by 9 publications

(14 citation statements)

References 18 publications

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“…Efforts to remove barriers to access to care for SUD patients resonated with patients. As previously demonstrated through provision of mobile van services ( 26 ) and supported in other studies ( 14 , 16 – 18 , 20 – 24 , 27 – 31 ), providing an experience that applies stigma prevention, empathy and compassion care delivery, excellent provider–patient communication, and trauma-informed care results in high patient satisfaction scores.…”

Section: Discussionsupporting

confidence: 62%

“…The survey was designed to identify patients’ needs and preferences in urine collection practices including an evaluation of perceived pain points or barriers to participation in observed UA protocols prior to COVID-19 and to explore the patients’ interest in an at-home telehealth urine collection solution. Survey results pertaining to the mobile unit have been previously published ( 26 ).…”

Section: Methodsmentioning

confidence: 99%

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Patient-Centered Telehealth Solution for Observed Urine Collections in Substance Use Disorder Care Delivery During COVID-19 and Beyond

Brett¹,

Foster²,

Joseph³

et al. 2021

Journal of Patient Experience

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Patients with substance use disorder (SUD) rely upon urine drug testing to support treatment adherence and to mitigate relapse. Before the onset of coronavirus 2019 (COVID-19), the logistical challenges of randomized observed collections for urine drug testing for the patient were significant. During COVID-19, these barriers were often insurmountable. Since SUD patients represent a population at a higher risk for complications from COVID-19, an alternative strategy to support COVID-19 testing was urgently needed. We designed and deployed a telehealth-based solution in which patients could use mobile devices to connect with trained collection professionals to perform observed urine collections, often referred to a UA (urinalysis). The solution was designed with patient-centered best practices for telehealth, stigma prevention, trauma-informed, empathy and compassion, and to remove barriers to access to care. This approach demonstrated high patient satisfaction scores thereby proving that it is possible to provide urine collection services in the patient’s home via a telehealth technology, while still upholding SUD testing integrity best practices. This study lays the path for a more patient-centered way to support this population.

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Section: Discussionsupporting

confidence: 62%

Section: Methodsmentioning

confidence: 99%

Patient-Centered Telehealth Solution for Observed Urine Collections in Substance Use Disorder Care Delivery During COVID-19 and Beyond

Brett¹,

Foster²,

Joseph³

et al. 2021

Journal of Patient Experience

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“…In Ohio, some programs mailed out naloxone kits directly to persons’ residences or arranged for their pick-up at drive-through centers (Courser et al [ 42 ]). Another article described a mobile van service that collected urine drug samples from patients enrolled in OUD treatment by driving directly to their residence (Warrington et al [ 52 ]).…”

Section: Resultsmentioning

confidence: 99%

Early innovations in opioid use disorder treatment and harm reduction during the COVID-19 pandemic: a scoping review

Krawczyk

Fawole

Yang

et al. 2021

Addict Sci Clin Pract

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Background The COVID-19 pandemic has exerted a significant toll on the lives of people who use opioids (PWUOs). At the same time, more flexible regulations around provision of opioid use disorder (OUD) services have led to new opportunities for facilitating access to services for PWUOs. In the current scoping review, we describe new services and service modifications implemented by treatment and harm reduction programs serving PWUO, and discuss implications for policy and practice. Methods Literature searches were conducted within PubMed, LitCovid, Embase, and PsycInfo for English-language studies published in 2020 that describe a particular program, service, or intervention aimed at facilitating access to OUD treatment and/or harm reduction services during the COVID-19 pandemic. Abstracts were independently screened by two reviewers. Relevant studies were reviewed in full and those that met inclusion criteria underwent final data extraction and synthesis (n = 25). We used a narrative synthesis approach to identify major themes around key service modifications and innovations implemented across programs serving PWUO. Results Reviewed OUD treatment and harm reduction services spanned five continents and a range of settings from substance use treatment to street outreach programs. Innovative service modifications to adapt to COVID-19 circumstances primarily involved expanded use of telehealth services (e.g., telemedicine visits for buprenorphine, virtual individual or group therapy sessions, provision of donated or publicly available phones), increased take-home medication allowances for methadone and buprenorphine, expanded uptake of long-acting opioid medications (e.g. extended-release buprenorphine and naltrexone), home delivery of services (e.g. MOUD, naloxone and urine drug screening), outreach and makeshift services for delivering MOUD and naloxone, and provision of a safe supply of opioids. Conclusions The COVID-19 pandemic has posed multiple challenges for PWUOs, while simultaneously accelerating innovations in policies, care models, and technologies to lower thresholds for life-saving treatment and harm reduction services. Such innovations highlight novel patient-centered and feasible approaches to mitigating OUD related harms. Further studies are needed to assess the long-term impact of these approaches and inform policies that improve access to care for PWUOs.

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“…HaRePo and NEXT Distro can therefore be considered as mail-based HR service and is part of a broader category called home-delivery services [22][23][24]. Home-delivery services are generallydesigned to help di cult-to-reach populations to access HR services like women [25] or populations living in rural areas [26].…”

Section: Discussionmentioning

confidence: 99%

Mail-based harm reduction services are key solutions to reduce the impact of COVID-19-like crises on people who use drugs: evidence from two independent structures in France and in the USA

Torres-Leguizamon¹,

Favaro

Coello

et al. 2022

Preprint

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Background: Harm Reduction (HR) policies for People Who Use Drugs (PWUD) have a significant positive impact on their health. Such approaches limit the spread of infections and reduce opioid overdose mortality. These policies have led to the opening of specialized centers located mainly in big cities and urbanized zones. The COVID-19 pandemic reduced access to HR centers in locations undergoing lockdown. Before the pandemic, HR services in France and in the USA were complemented by the development of remote HR programs: HaRePo (Harm Reduction by Post) for France, implemented in 2011, and NEXT Distro for the USA founded in 2017. These programs are free and specifically designed for people who have difficulties accessing HR tools and counseling in-person. PWUD can access HaRePo program by phone and/or email. NEXT Distro users can access the program through its dedicated website. The COVID-19 pandemic and the associated lockdowns have drastically impacted the HR services in both countries and many HR centers were forced to adapt their activities. Methods: Here, we analyzed how lockdowns impacted the number of new users entering the programs, the numbers of parcels sent and naloxone distributed using the records of both structures. With the ability to reach PWUD remotely, HaRePo and NEXT Distro were particularly effective at maintaining service continuity and scaling up services to meet the needs of PWUD during the COVID-19 pandemic.Results: By comparing previous year’s data average with a 95% confidence interval, we showed that the activity of both programs were significantly impacted by the pandemic. Both show an increase in new users joining the programs as well as the number of parcels sent per month. It shows that remote HR was able to partially compensate for the reduced HR activities due to COVID-19. We also observed that the distribution of naloxone per parcel tends to increase for both structures. Conclusion: By studying two independent structures in France and in the USA sharing similar objectives (remote HR), we showed that this approach can be a key solution to crises that impact classical HR structures despite various differences in operating procedures between countries.

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Driving Access to Care: Use of Mobile Units for Urine Specimen Collection During the Coronavirus Disease-19 (COVID-19) Pandemic

Cited by 9 publications

References 18 publications

Patient-Centered Telehealth Solution for Observed Urine Collections in Substance Use Disorder Care Delivery During COVID-19 and Beyond

Patient-Centered Telehealth Solution for Observed Urine Collections in Substance Use Disorder Care Delivery During COVID-19 and Beyond

Early innovations in opioid use disorder treatment and harm reduction during the COVID-19 pandemic: a scoping review

Mail-based harm reduction services are key solutions to reduce the impact of COVID-19-like crises on people who use drugs: evidence from two independent structures in France and in the USA

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