Telehealth for opioid use disorder treatment in low-barrier clinic settings: an exploration of clinician and staff perspectives

Abstract Background The majority of individuals with opioid use disorder (OUD) face access barriers to evidence-based treatment, and the COVID-19 pandemic has exacerbated the United States (US) opioid overdose crisis. However, the pandemic has also ushered in rapid transitions to telehealth in the U...

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Autores principales:	Shoshana V. Aronowitz, Eden Engel-Rebitzer, Abby Dolan, Kehinde Oyekanmi, David Mandell, Zachary Meisel, Eugenia South, Margaret Lowenstein
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/ba23710e49064ce08956bfc5f116a214
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spelling	oai:doaj.org-article:ba23710e49064ce08956bfc5f116a2142021-11-28T12:23:50ZTelehealth for opioid use disorder treatment in low-barrier clinic settings: an exploration of clinician and staff perspectives10.1186/s12954-021-00572-71477-7517https://doaj.org/article/ba23710e49064ce08956bfc5f116a2142021-11-01T00:00:00Zhttps://doi.org/10.1186/s12954-021-00572-7https://doaj.org/toc/1477-7517Abstract Background The majority of individuals with opioid use disorder (OUD) face access barriers to evidence-based treatment, and the COVID-19 pandemic has exacerbated the United States (US) opioid overdose crisis. However, the pandemic has also ushered in rapid transitions to telehealth in the USA, including for substance use disorder treatment with buprenorphine. These changes have the potential to mitigate barriers to care or to exacerbate pre-existing treatment inequities. The objective of this study was to qualitatively explore Philadelphia-based low-barrier, harm-reduction oriented, opioid use disorder (OUD) treatment provider perspectives about and experiences with telehealth during the COVID-19 pandemic, and to assess their desire to offer telehealth to patients at their programs in the future. Methods We interviewed 22 OUD treatment prescribers and staff working outpatient programs offering OUD treatment with buprenorphine in Philadelphia during July and August 2020. All participants worked at low-barrier treatment programs that provide buprenorphine using a harm reduction-oriented approach and without mandating counseling or other requirements as a condition of treatment. We analyzed the data using thematic content analysis. Results Our analysis yielded three themes: 1/ Easier access for some: telehealth facilitates care for many patients who have difficulty attending in-person appointments due to logistical and psychological barriers; 2/ A layered digital divide: engagement with telehealth can be seriously limited by patients’ access to and comfort with technology; and 3/ Clinician control: despite some clinic staff beliefs that patients should have the freedom to choose their treatment modality, patients’ access to treatment via telehealth may hinge on clinician perceptions of patient “stability” rather than patient preferences. Conclusions Telehealth may address many access issues, however, barriers to implementation remain, including patient ability and desire to attend healthcare appointments virtually. In addition, the potential for telehealth models to extend OUD care to patients currently underserved by in-person models may partially depend on clinician comfort treating patients deemed “unstable” via this modality. The ability of telehealth to expand access to OUD care for individuals who have previously struggled to engage with in-person care will likely be limited if these patients are not given the opportunity to receive treatment via telehealth.Shoshana V. AronowitzEden Engel-RebitzerAbby DolanKehinde OyekanmiDavid MandellZachary MeiselEugenia SouthMargaret LowensteinBMCarticlePublic aspects of medicineRA1-1270ENHarm Reduction Journal, Vol 18, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Public aspects of medicine RA1-1270
spellingShingle	Public aspects of medicine RA1-1270 Shoshana V. Aronowitz Eden Engel-Rebitzer Abby Dolan Kehinde Oyekanmi David Mandell Zachary Meisel Eugenia South Margaret Lowenstein Telehealth for opioid use disorder treatment in low-barrier clinic settings: an exploration of clinician and staff perspectives
description	Abstract Background The majority of individuals with opioid use disorder (OUD) face access barriers to evidence-based treatment, and the COVID-19 pandemic has exacerbated the United States (US) opioid overdose crisis. However, the pandemic has also ushered in rapid transitions to telehealth in the USA, including for substance use disorder treatment with buprenorphine. These changes have the potential to mitigate barriers to care or to exacerbate pre-existing treatment inequities. The objective of this study was to qualitatively explore Philadelphia-based low-barrier, harm-reduction oriented, opioid use disorder (OUD) treatment provider perspectives about and experiences with telehealth during the COVID-19 pandemic, and to assess their desire to offer telehealth to patients at their programs in the future. Methods We interviewed 22 OUD treatment prescribers and staff working outpatient programs offering OUD treatment with buprenorphine in Philadelphia during July and August 2020. All participants worked at low-barrier treatment programs that provide buprenorphine using a harm reduction-oriented approach and without mandating counseling or other requirements as a condition of treatment. We analyzed the data using thematic content analysis. Results Our analysis yielded three themes: 1/ Easier access for some: telehealth facilitates care for many patients who have difficulty attending in-person appointments due to logistical and psychological barriers; 2/ A layered digital divide: engagement with telehealth can be seriously limited by patients’ access to and comfort with technology; and 3/ Clinician control: despite some clinic staff beliefs that patients should have the freedom to choose their treatment modality, patients’ access to treatment via telehealth may hinge on clinician perceptions of patient “stability” rather than patient preferences. Conclusions Telehealth may address many access issues, however, barriers to implementation remain, including patient ability and desire to attend healthcare appointments virtually. In addition, the potential for telehealth models to extend OUD care to patients currently underserved by in-person models may partially depend on clinician comfort treating patients deemed “unstable” via this modality. The ability of telehealth to expand access to OUD care for individuals who have previously struggled to engage with in-person care will likely be limited if these patients are not given the opportunity to receive treatment via telehealth.
format	article
author	Shoshana V. Aronowitz Eden Engel-Rebitzer Abby Dolan Kehinde Oyekanmi David Mandell Zachary Meisel Eugenia South Margaret Lowenstein
author_facet	Shoshana V. Aronowitz Eden Engel-Rebitzer Abby Dolan Kehinde Oyekanmi David Mandell Zachary Meisel Eugenia South Margaret Lowenstein
author_sort	Shoshana V. Aronowitz
title	Telehealth for opioid use disorder treatment in low-barrier clinic settings: an exploration of clinician and staff perspectives
title_short	Telehealth for opioid use disorder treatment in low-barrier clinic settings: an exploration of clinician and staff perspectives
title_full	Telehealth for opioid use disorder treatment in low-barrier clinic settings: an exploration of clinician and staff perspectives
title_fullStr	Telehealth for opioid use disorder treatment in low-barrier clinic settings: an exploration of clinician and staff perspectives
title_full_unstemmed	Telehealth for opioid use disorder treatment in low-barrier clinic settings: an exploration of clinician and staff perspectives
title_sort	telehealth for opioid use disorder treatment in low-barrier clinic settings: an exploration of clinician and staff perspectives
publisher	BMC
publishDate	2021
url	https://doaj.org/article/ba23710e49064ce08956bfc5f116a214
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Telehealth for opioid use disorder treatment in low-barrier clinic settings: an exploration of clinician and staff perspectives

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