VA Central Western Massachusetts Healthcare System, Leeds, MA, United States of America; University of Massachusetts Medical School, Worcester, MA, United States of America.
Yale University School of Medicine, New Haven, CT, United States of America; VA Connecticut Healthcare System, West Haven, CT, United States of America.
J Subst Abuse Treat. 2022 Aug;139:108777. doi: 10.1016/j.jsat.2022.108777. Epub 2022 Mar 25.
Opioid use disorder (OUD) is a debilitating illness that remains a serious public health issue in the United States. Use of telemedicine to deliver medications for the treatment of OUD (MOUD) was limited until the confluence of the COVID-19 and opioid addiction epidemics in spring 2020. Starting in spring 2020, the Department of Veterans Health Affairs (VHA) transitioned from in-person to mostly telemedicine-delivered OUD care to reduce COVID-19 transmission among veterans and providers. To gain a nuanced understanding of provider perspectives on MOUD care delivery using telemedicine, we conducted semi-structured interviews with VHA providers who were using telehealth to deliver MOUD care.
We conducted semi-structed Zoom interviews with VA clinicians at nine VA Medical Centers (VAMCs) in eight states. Potential study participants were identified as providers who were involved in referrals and provision of buprenorphine treatment for chronic pain and opioid addiction. Audio-recordings of all interviews were transcribed and entered into Atlas. Ti qualitative analysis software. The study team analyzed the transcripts for major themes related to tele-prescribing practices for buprenorphine.
Twenty-three VA providers participated in the study, representing 32% of all providers invited to participate in the study. The research team identified the following four themes: (1) COVID-19 spurred a seismic shift in OUD treatment; (2) Video calls provided a rare window into veterans' lives; (3) Providers experienced numerous challenges to virtual visits; and (4) Providers wrestled with paternalism and trust.
The pandemic accelerated the movement toward harm reduction approaches. Prior to the pandemic, stringent requirements existed for patients receiving MOUD care. Providers in this study reflected on the need for these requirements (e.g., in-person visits, toxicology screens) and how reducing this monitoring implied more trust in patients' autonomous decisions. Providers' observation that videoconferencing offered them a window into patients' lives may offer some ways to improve rapport, and research should explore how best to incorporate the additional information conveyed in virtual visits.
阿片类药物使用障碍（OUD）是一种使人衰弱的疾病，在美国仍然是一个严重的公共卫生问题。直到 2020 年春季 COVID-19 和阿片类药物成瘾流行，远程医疗在提供治疗 OUD 的药物（MOUD）方面的应用才受到限制。从 2020 年春季开始，退伍军人事务部（VA）将 OUD 护理从面对面治疗转变为主要通过远程医疗进行，以减少退伍军人和医务人员之间 COVID-19 的传播。为了更深入地了解提供者对使用远程医疗进行 MOUD 护理的看法，我们对使用远程医疗提供 MOUD 护理的 VA 提供者进行了半结构化访谈。
我们在八个州的九个退伍军人医疗中心（VAMC）与 VA 临床医生进行了 Zoom 半结构化访谈。潜在的研究参与者是那些参与转介和提供丁丙诺啡治疗慢性疼痛和阿片类药物成瘾的提供者。所有访谈的音频记录都被转录并输入到 Atlas. Ti 定性分析软件中。研究小组分析了转录本，以确定与丁丙诺啡远程处方实践相关的主要主题。
23 名 VA 提供者参与了这项研究，占所有受邀参与研究的提供者的 32%。研究团队确定了以下四个主题：（1）COVID-19 推动了 OUD 治疗的重大转变；（2）视频通话为退伍军人的生活提供了一个难得的窗口；（3）提供者在虚拟访问中遇到了许多挑战；（4）提供者在家长式作风和信任方面存在争议。
大流行加速了向减少伤害方法的转变。在大流行之前，接受 MOUD 护理的患者有严格的要求。本研究中的提供者反思了这些要求的必要性（例如，面对面访问、毒理学筛查），以及减少这种监测意味着对患者自主决策的更多信任。提供者观察到视频会议为他们提供了一个了解患者生活的窗口，这可能为改善融洽关系提供了一些方法，研究应探讨如何最好地将虚拟访问中传达的额外信息纳入其中。
