Monico Laura B, Eastlick Megan, Michero Darcy, Pielsticker Peyton, Glasner Suzette
Department of Clinical Affairs Pelago, 350 7th Avenue, Suite #1100, New York, NY, 10001, USA.
Subst Abuse Treat Prev Policy. 2025 Feb 18;20(1):8. doi: 10.1186/s13011-024-00631-9.
The opioid epidemic contributes to increasing morbidity and mortality due to drug overdoses in the US, but barriers to traditional opioid use disorder (OUD) treatment prevent a vast majority of patients from accessing quality care and medications for opioid use disorder (MOUDs). Public Health Emergency (PHE) provisions during the COVID-19 pandemic relaxed in-person evaluation requirements for buprenorphine inductions, allowing for the expansion of telehealth care to OUD populations. This qualitative study explores patients' experiences with a novel digital therapeutic telehealth program with buprenorphine for OUD.
Semi-structured qualitative interviews were conducted with a sub-sample (n = 15) of participants from a larger feasibility and acceptability pilot. Interviews explored participants' opioid use, OUD treatment history, previous MOUD experience, barriers to previous treatment attempts, medication adherence, counseling experience, treatment satisfaction, and comparisons between current and previous treatments.
Barriers to care in previous OUD treatment episodes included logistical and program related inconveniences (program attendance requirements, commute distances, transportation, appointment wait times, and clinic patient volumes), financial strain, unreliable access to prescribers, residential program experiences, and the availability of detox-only based treatments. Participants with previous treatment experiences contrasted these barriers with the virtual delivery study setting and reported that the characteristics of telehealth OUD care facilitated improved engagement and retention by overcoming many of these barriers through: no transportation requirements, open and flexible appointment scheduling, appointment times confined to care team meetings only, absence of provider availability concerns, and the ability to receive buprenorphine maintenance care from home. The primary barrier noted for virtual care delivery was the fulfillment of buprenorphine prescriptions from local pharmacies.
A novel digital therapeutic telehealth program was reported to overcome almost all of the barriers encountered by participants during previous traditional OUD treatment episodes, contributing to a growing body of evidence supporting the permanency of current PHE expansions for OUD telehealth care. Findings also emphasize the importance of coming to workable policy solutions for buprenorphine supply threshold constraints on local pharmacies that unintentionally constrict access for telehealth and other OUD patients.
在美国，阿片类药物流行导致药物过量造成的发病率和死亡率不断上升，但传统阿片类药物使用障碍（OUD）治疗存在的障碍使绝大多数患者无法获得优质护理和用于阿片类药物使用障碍的药物（MOUDs）。新冠疫情期间的公共卫生紧急状态（PHE）规定放宽了丁丙诺啡诱导治疗的面对面评估要求，使得远程医疗服务能够扩展到患有阿片类药物使用障碍的人群。这项定性研究探讨了患者参与一项使用丁丙诺啡治疗阿片类药物使用障碍的新型数字治疗远程医疗项目的体验。
对来自一项更大规模的可行性和可接受性试点研究的部分参与者（n = 15）进行了半结构化定性访谈。访谈探讨了参与者的阿片类药物使用情况、阿片类药物使用障碍治疗史、以往使用MOUDs的经历、以往治疗尝试的障碍、药物依从性、咨询体验、治疗满意度以及当前治疗与以往治疗的比较。
以往阿片类药物使用障碍治疗过程中的护理障碍包括后勤和项目相关的不便之处（项目出勤要求、通勤距离、交通、预约等待时间和诊所患者数量）、经济压力、难以联系到处方医生、住院项目体验以及仅提供戒毒治疗的情况。有过以往治疗经历的参与者将这些障碍与虚拟治疗研究环境进行了对比，并表示远程医疗阿片类药物使用障碍护理的特点通过以下方式克服了许多此类障碍，从而促进了更好的参与度和留存率：无需交通、开放灵活的预约安排、预约时间仅限制在护理团队会议期间、无需担心医生是否有空以及能够在家中接受丁丙诺啡维持治疗。虚拟护理提供过程中指出的主要障碍是当地药房丁丙诺啡处方的配药问题。
据报道，一项新型数字治疗远程医疗项目克服了参与者在以往传统阿片类药物使用障碍治疗过程中遇到的几乎所有障碍，这为越来越多支持当前将公共卫生紧急状态下阿片类药物使用障碍远程医疗服务扩展永久化的证据增添了内容。研究结果还强调了针对当地药房丁丙诺啡供应阈值限制制定可行政策解决方案的重要性，这些限制无意中限制了远程医疗和其他阿片类药物使用障碍患者的获取途径。
