School of Medicine, Oregon Health & Science University, Portland, OR, USA.
Department of Psychiatry, University of Pittsburgh, Pittsburg, PA, USA.
Subst Abus. 2022;43(1):1150-1157. doi: 10.1080/08897077.2022.2060447.
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. 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 dual-coded and analyzed using directed content analysis. 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. 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 face-to-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.
在 COVID-19 大流行期间，与药物相关的过量用药危机恶化。最近，为了在 COVID-19 期间增加阿片类药物使用障碍（MOUD）药物的可及性，药物政策发生了变化，将一些门诊 MOUD 治疗转移到虚拟环境中，以减少对面对面护理的需求。本研究的目的是定性探讨在一家提供丁丙诺啡和减少伤害服务的低门槛成瘾治疗诊所中，虚拟患者就诊对患有阿片类药物使用障碍的患者有何获益和损失。如果患者在 2019 年 11 月至 2021 年 3 月期间在减少伤害和 BRidges to Care（HRBR）诊所接受治疗并使用虚拟就诊，那么他们将被纳入本研究。该研究使用医疗保健获取框架和先前的远程医疗可接受性研究进行概念化。在 2021 年 3 月至 4 月期间完成了半结构化访谈。访谈采用双编码，并使用定向内容分析进行分析。共进行了 19 次访谈。样本主要是白人（84%），稳定住房（79%），性别相似（男性，53%），就业状况相似（就业，42%）。大多数（63%）患者更喜欢虚拟就诊，而不是面对面就诊（16%）或同时选择两种就诊方式（21%）。出现了两个并列的主要领域：可用性-适应性和可接受性-适当性。可用性-适应性反映了参与者对即时服务的渴望，以及减少交通和工作或照顾安排障碍的愿望，虚拟就诊促进了这一点。可接受性-适当性领域阐明了参与者如何与提供者建立联系，无论是通过面对面互动还是虚拟就诊期间体验到的相互信任。虚拟就诊被参与者视为获得阿片类药物使用障碍治疗的有价值和关键选择。虽然许多参与者更喜欢虚拟就诊，但由于与提供者的关系和身体互动，一些人更喜欢面对面就诊。参与者希望根据自己的需求灵活选择治疗方式。
