School of Medicine, Oregon Health & Science University, Portland, OR, USA.
Department of Medicine, Division of General Internal Medicine & Geriatrics, Section of Addiction Medicine, Oregon Health & Science University, Portland, OR, USA.
Harm Reduct J. 2024 Jun 27;21(1):125. doi: 10.1186/s12954-024-01043-5.
Patients with opioid use disorder (OUD) experience various forms of stigma at the individual, public, and structural levels that can affect how they access and engage with healthcare, particularly with medications for OUD treatment. Telehealth is a relatively new form of care delivery for OUD treatment. As reducing stigma surrounding OUD treatment is critical to address ongoing gaps in care, the aim of this study was to explore how telehealth impacts patient experiences of stigma.
In this qualitative study, we interviewed patients with OUD at a single urban academic medical center consisting of multiple primary care and addiction clinics in Oregon, USA. Participants were eligible if they had (1) at least one virtual visit for OUD between March 2020 and December 2021, and (2) a prescription for buprenorphine not exclusively used for chronic pain. We conducted phone interviews between October and December 2022, then recorded, transcribed, dual-coded, and analyzed using reflexive thematic analysis.
The mean age of participants (n = 30) was 40.5 years (range 20-63); 14 were women, 15 were men, and two were transgender, non-binary, or gender-diverse. Participants were 77% white, and 33% had experienced homelessness in the prior six months. We identified four themes regarding how telehealth for OUD treatment shaped patient perceptions of and experiences with stigma at the individual (1), public (2-3), and structural levels (4): (1) Telehealth offers wanted space and improved control over treatment setting; (2) Public stigma and privacy concerns can impact both telehealth and in-person encounters, depending on clinical and personal circumstances; (3) The social distance of telehealth could mitigate or exacerbate perceptions of clinician stigma, depending on both patient and clinician expectations; (4) The increased flexibility of telehealth translated to perceptions of increased clinician trust and respect.
The forms of stigma experienced by individuals with OUD are complex and multifaceted, as are the ways in which those experiences interact with telehealth-based care. The mixed results of this study support policies allowing for a more individualized, patient-centered approach to care delivery that allows patients a choice over how they receive OUD treatment services.
患有阿片类药物使用障碍（OUD）的患者在个人、公众和结构层面上经历各种形式的污名化，这可能会影响他们获得和参与医疗保健的方式，尤其是在接受 OUD 治疗的药物方面。远程医疗是 OUD 治疗的一种相对较新的护理提供方式。由于减少 OUD 治疗方面的污名化对于解决持续存在的护理差距至关重要，因此本研究旨在探讨远程医疗如何影响患者对污名化的体验。
在这项定性研究中，我们采访了美国俄勒冈州一家城市学术医疗中心的 OUD 患者，该中心由多个初级保健和成瘾诊所组成。参与者符合以下条件：（1）2020 年 3 月至 2021 年 12 月期间至少有一次 OUD 虚拟就诊，（2）开有丁丙诺啡处方，但并非仅用于治疗慢性疼痛。我们于 2022 年 10 月至 12 月期间进行了电话访谈，随后对访谈内容进行了记录、转录、双编码，并使用反思性主题分析进行了分析。
参与者（n=30）的平均年龄为 40.5 岁（范围 20-63 岁）；14 名女性，15 名男性，2 名跨性别、非二元或性别多样化。参与者中 77%为白人，33%在过去六个月内经历过无家可归。我们确定了四个主题，涉及远程医疗治疗 OUD 如何塑造患者对个人（1）、公众（2-3）和结构（4）层面污名化的看法和体验：（1）远程医疗提供了想要的空间，并改善了对治疗环境的控制；（2）公众污名化和隐私问题可能会影响远程医疗和面对面就诊，具体取决于临床和个人情况；（3）远程医疗的社交距离可以减轻或加剧临床医生污名化的看法，具体取决于患者和临床医生的期望；（4）远程医疗的灵活性转化为对临床医生信任和尊重的增加的看法。
OUD 患者经历的污名化形式复杂多样，这些体验与远程医疗为基础的护理相互作用的方式也复杂多样。本研究的混合结果支持允许采取更个体化、以患者为中心的护理提供方式的政策，让患者可以选择接受 OUD 治疗服务的方式。
