Davoust Melissa, Bazzi Angela R, Blakemore Samantha, Blodgett Juliana, Cheng Anna, Fielman Sarah, Magane Kara M, Theisen Jacqueline, Saitz Richard, Ventura Alicia S, Weinstein Zoe M
Department of Health Law, Policy, and Management, Boston University School of Public Health, 715 Albany St, Boston, MA, 02118, USA.
Department of Community Health Sciences, Boston University School of Public Health, 715 Albany St, Boston, MA, 02118, USA.
Addict Sci Clin Pract. 2025 Mar 4;20(1):21. doi: 10.1186/s13722-025-00536-3.
Deaths from opioid overdose have increased dramatically in the past decade. For individuals with opioid use disorder (OUD), agonist medications such as methadone and buprenorphine reduce opioid-related morbidity and mortality. Historically, the provision of buprenorphine treatment in office-based settings has relied on frequent in-person contact, likely influencing patients' access to and retention in care. In response to the COVID-19 pandemic, providers of office-based buprenorphine treatment rapidly adapted their care processes, increasingly relying on telemedicine visits. To date, relatively few prior studies have combined patient and clinician perspectives to examine the implementation of telemedicine and related care adaptations, particularly in safety-net settings.
Qualitative methods were used to explore clinician and patient experiences with telemedicine in an office-based buprenorphine treatment clinic affiliated with an urban safety-net hospital. From this clinic, we conducted semi-structured interviews with 25 patients and 16 clinicians (including prescribers and non-prescribers). We coded all interview data and used a thematic analysis approach to understand how telemedicine impacted treatment quality and engagement in care, as well as preferences for using telemedicine moving forward.
Five themes regarding the implementation of telemedicine and other COVID-19-related care adaptations arose from patient and clinician perspectives: (1) telemedicine integration precipitated openness to more flexibility in care practices, (2) concerns regarding telemedicine-related adaptations centered around safety and accountability, (3) telemedicine encounters required rapport and trust between patients and clinicians to facilitate open communication, (4) safety-net patient populations experienced unique challenges when using telemedicine, particularly in terms of the technology required and the need for privacy, and (5) there is an important role for telemedicine in office-based buprenorphine treatment moving forward, primarily through its use in hybrid models of care which integrate both in-person and virtual visits.
Telemedicine implementation within office-based buprenorphine treatment has the potential to improve patients' engagement in care; however, our findings emphasize the need for tailored approaches to implementing telemedicine in office-based buprenorphine treatment, particularly within safety-net settings. Overall, this study supports the maintenance of changes to policy and practice that facilitate the use of telemedicine in office-based buprenorphine treatment beyond the COVID-19 public health emergency.
在过去十年中，阿片类药物过量致死人数急剧增加。对于患有阿片类药物使用障碍（OUD）的个体，美沙酮和丁丙诺啡等激动剂药物可降低与阿片类药物相关的发病率和死亡率。从历史上看，在门诊环境中提供丁丙诺啡治疗依赖于频繁的面对面接触，这可能会影响患者获得治疗以及在治疗中的留存率。为应对新冠疫情，门诊丁丙诺啡治疗的提供者迅速调整了他们的护理流程，越来越依赖远程医疗就诊。迄今为止，相对较少的先前研究将患者和临床医生的观点结合起来，以研究远程医疗的实施以及相关护理调整，特别是在安全网环境中。
采用定性方法，探讨一家隶属于城市安全网医院的门诊丁丙诺啡治疗诊所中临床医生和患者对远程医疗的体验。我们从该诊所对25名患者和16名临床医生（包括开处方者和非开处方者）进行了半结构化访谈。我们对所有访谈数据进行编码，并采用主题分析方法来了解远程医疗如何影响治疗质量和护理参与度，以及对未来使用远程医疗的偏好。
从患者和临床医生的角度出现了关于远程医疗实施以及其他与新冠疫情相关的护理调整的五个主题：（1）远程医疗的整合促使人们对护理实践中更大的灵活性持开放态度；（2）对与远程医疗相关的调整的担忧主要围绕安全性和问责制；（3）远程医疗接触需要患者和临床医生之间建立融洽关系和信任，以促进开放沟通；（4）安全网患者群体在使用远程医疗时面临独特挑战，特别是在所需技术和隐私需求方面；（5）远程医疗在未来门诊丁丙诺啡治疗中具有重要作用，主要通过其在整合面对面和虚拟就诊的混合护理模式中的应用。
在门诊丁丙诺啡治疗中实施远程医疗有潜力提高患者的护理参与度；然而，我们的研究结果强调，在门诊丁丙诺啡治疗中，特别是在安全网环境中，需要采用量身定制的方法来实施远程医疗。总体而言，本研究支持维持政策和实践的变革，以促进在新冠疫情公共卫生紧急情况之外的门诊丁丙诺啡治疗中使用远程医疗。
