Chen Sadie, Aldrich Alison, Andrews-Higgins Shaquita, Back-Haddix Sandra, Bartkus Mary, Brown Jennifer L, Davis Jill, Drainoni Mari-Lynn, Goddard-Eckrich Dawn, Goetz Michael, Gumudavelly Divya, Huerta Timothy R, McAlearney Ann Scheck, Roberts Sara, Walker Daniel M
Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Substance Use Priority Research Area, Center for Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA.
Telemed J E Health. 2025 Sep;31(9):1137-1146. doi: 10.1089/tmj.2024.0592. Epub 2025 May 5.
The rapid expansion of telehealth-delivered medication for opioid use disorder (MOUD) during the COVID-19 pandemic highlighted critical digital divide issues in communities. How community context influences the digital divide remains unclear, creating uncertainty about ameliorating the gaps in access to tele-MOUD. We qualitatively examined the perspectives of 315 opioid community coalition members who were part of the HEALing Communities Study (HCS) to understand how the digital divide created access barriers in urban and rural communities. Primary coding for all interviews used a deductive approach with codes derived from the Reach, Effectiveness, Adoption, Implementation, Maintenance/Practical Robust Implementation and Sustainability Model overarching HCS framework. Secondary coding used the nine determinants of Lythreatis's 2022 digital divide framework, and inductive thematic analysis was used to identify themes with each of the nine determinants. Shared issues across communities related to the digital divide, including trust, social support, technological infrastructure, digital literacy, policy changes, and pandemic-related disruptions, critically influenced telehealth expansion and effectiveness. Rural communities reported specific barriers around infrastructure and socioeconomics, whereas urban communities reported specific barriers around sociodemographic factors. To address these digital divide issues, policymakers should continue to invest in rural infrastructure and improve internet access for underserved populations. Clear guidelines are also needed for when tele-MOUD is appropriate versus in-person visits and when urine drug screening is necessary. Additionally, emphasizing patient choice and maintaining in-person care is important to support equitable access to these services.
在新冠疫情期间，远程医疗提供的阿片类药物使用障碍药物（MOUD）迅速扩张，凸显了社区中关键的数字鸿沟问题。社区环境如何影响数字鸿沟仍不清楚，这使得改善远程MOUD获取方面的差距存在不确定性。我们对参与“治愈社区研究”（HCS）的315名阿片类药物社区联盟成员的观点进行了定性研究，以了解数字鸿沟如何在城市和农村社区造成获取障碍。所有访谈的初级编码采用演绎法，编码源自HCS总体框架的“可及性、有效性、采用、实施、维持/实际稳健实施和可持续性”模型。二级编码使用了利蒂雷蒂斯2022年数字鸿沟框架的九个决定因素，并采用归纳主题分析来确定与这九个决定因素各自相关的主题。社区间与数字鸿沟相关的共同问题，包括信任、社会支持、技术基础设施、数字素养、政策变化和与疫情相关的干扰，严重影响了远程医疗的扩张和有效性。农村社区报告了围绕基础设施和社会经济方面的具体障碍，而城市社区报告了围绕社会人口因素的具体障碍。为解决这些数字鸿沟问题，政策制定者应继续投资农村基础设施，改善服务不足人群的互联网接入。对于何时适合远程MOUD而非面对面就诊以及何时需要进行尿液药物筛查，也需要明确的指导方针。此外，强调患者选择并维持面对面护理对于支持公平获取这些服务很重要。
