RAND Corporation, Arlington, VA, United States of America.
RAND Corporation, Boston, MA, United States of America.
J Subst Abuse Treat. 2020 Nov;118:108124. doi: 10.1016/j.jsat.2020.108124. Epub 2020 Aug 30.
The COVID-19 pandemic has transformed care delivery for patients with opioid use disorder (OUD); however, little is known about the experiences of front-line clinicians in the transition to telemedicine. This study described how, in the context of the early stages of the pandemic, clinicians used telemedicine for OUD in conjunction with in-person care, barriers encountered, and implications for quality of care.
In April 2020, we conducted semistructured interviews with clinicians waivered to prescribe buprenorphine. We used maximum variation sampling. We used standard qualitative analysis techniques, consisting of both inductive and deductive approaches, to identify and characterize themes.
Eighteen clinicians representing 10 states participated. Nearly all interview participants were doing some telemedicine, and more than half were only doing telemedicine visits. Most participants reported changing their typical clinical care patterns to help patients remain at home and minimize exposure to COVID-19. Changes included waiving urine toxicology screening, sending patients home with a larger supply of OUD medications, and requiring fewer visits. Although several participants were serving new patients via telemedicine during the early weeks of the pandemic, others were not. Some clinicians identified positive impacts of telemedicine on the quality of their patient interactions, including increased access for patients. Others noted negative impacts including less structure and accountability, less information to inform clinical decision-making, challenges in establishing a connection, technological challenges, and shorter visits.
In the context of the pandemic, buprenorphine prescribers quickly transitioned to providing telemedicine visits in high volume; nonetheless, there are still many unknowns, including the quality and safety of widespread use of telemedicine for OUD treatment.
新冠疫情改变了阿片类药物使用障碍（OUD）患者的医疗服务模式；然而，人们对临床医生在向远程医疗过渡过程中的经验知之甚少。本研究描述了在疫情早期阶段，临床医生如何将远程医疗与面对面护理相结合用于 OUD 治疗，以及所遇到的障碍和对护理质量的影响。
2020 年 4 月，我们对被豁免开处丁丙诺啡的临床医生进行了半结构式访谈。我们采用最大差异抽样。我们使用标准的定性分析技术，包括归纳和演绎方法，来识别和描述主题。
18 名代表 10 个州的临床医生参与了研究。几乎所有的访谈参与者都在进行某种程度的远程医疗，超过一半的参与者只进行远程医疗访问。大多数参与者报告改变了他们典型的临床护理模式，以帮助患者留在家里并最大程度减少新冠病毒暴露。这些变化包括豁免尿液毒理学检测，给患者开更大剂量的 OUD 药物，并减少就诊次数。尽管在疫情早期的几周内，一些临床医生通过远程医疗为新患者提供服务，但其他临床医生则没有。一些临床医生认为远程医疗对他们的医患互动质量有积极影响，包括增加了患者的就诊机会。其他临床医生则注意到一些负面影响，包括结构和责任减少、信息不足影响临床决策、建立联系困难、技术挑战以及就诊时间缩短。
在疫情背景下，丁丙诺啡处方医生迅速过渡到大量提供远程医疗服务；尽管如此，仍有许多未知因素，包括广泛使用远程医疗治疗 OUD 的质量和安全性。
