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...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2021-11-01
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| Series: | Harm Reduction Journal |
| Online Access: | https://doi.org/10.1186/s12954-021-00572-7 |
| _version_ | 1818857943543578624 |
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| 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 |
| collection | DOAJ |
| 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. |
| first_indexed | 2024-12-19T08:48:25Z |
| format | Article |
| id | doaj.art-ba23710e49064ce08956bfc5f116a214 |
| institution | Directory Open Access Journal |
| issn | 1477-7517 |
| language | English |
| last_indexed | 2024-12-19T08:48:25Z |
| publishDate | 2021-11-01 |
| publisher | BMC |
| record_format | Article |
| series | Harm Reduction Journal |
| spelling | doaj.art-ba23710e49064ce08956bfc5f116a2142022-12-21T20:28:46ZengBMCHarm Reduction Journal1477-75172021-11-011811910.1186/s12954-021-00572-7Telehealth for opioid use disorder treatment in low-barrier clinic settings: an exploration of clinician and staff perspectivesShoshana V. Aronowitz0Eden Engel-Rebitzer1Abby Dolan2Kehinde Oyekanmi3David Mandell4Zachary Meisel5Eugenia South6Margaret Lowenstein7University of Pennsylvania School of NursingUniversity of Pennsylvania Perelman School of MedicineUniversity of Pennsylvania Center for Emergency Care Policy and ResearchUniversity of Pennsylvania Center for Emergency Care Policy and ResearchPenn Center for Mental Health, University of PennsylvaniaUniversity of Pennsylvania Perelman School of MedicineUniversity of Pennsylvania Perelman School of MedicineUniversity of Pennsylvania Perelman School of MedicineAbstract 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.https://doi.org/10.1186/s12954-021-00572-7 |
| spellingShingle | 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 Harm Reduction Journal |
| title | 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_short | 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 |
| url | https://doi.org/10.1186/s12954-021-00572-7 |
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