“Sign Me Up”: a qualitative study of video observed therapy (VOT) for patients receiving expedited methadone take-homes during the COVID-19 pandemic
Abstract Background Federal and state regulations require frequent direct observation of methadone ingestion at an Opioid Treatment Program (OTP)—a requirement that creates barriers to patient access. Video observed therapy (VOT) may help to address public health and safety concerns of providing tak...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-03-01
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| Series: | Addiction Science & Clinical Practice |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13722-023-00372-3 |
| _version_ | 1797853684501053440 |
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| author | James B. Darnton Elenore P. Bhatraju Kristin Beima-Sofie Alyssa Michaels Kevin A. Hallgren Sean Soth Paul Grekin Steve Woolworth Judith I. Tsui |
| author_facet | James B. Darnton Elenore P. Bhatraju Kristin Beima-Sofie Alyssa Michaels Kevin A. Hallgren Sean Soth Paul Grekin Steve Woolworth Judith I. Tsui |
| author_sort | James B. Darnton |
| collection | DOAJ |
| description | Abstract Background Federal and state regulations require frequent direct observation of methadone ingestion at an Opioid Treatment Program (OTP)—a requirement that creates barriers to patient access. Video observed therapy (VOT) may help to address public health and safety concerns of providing take-home medications while simultaneously reducing barriers to treatment access and long-term retention. Evaluating user experiences with VOT is important for understanding the acceptability of this strategy. Methods We conducted a qualitative evaluation of a clinical pilot program of VOT via smartphone that was rapidly implemented between April and August 2020 during the COVID-19 pandemic within three opioid treatment programs. In the program, selected patients submitted video recordings of themselves ingesting methadone take-home doses, which were asynchronously reviewed by their counselor. We recruited participating patients and counselors for semi-structured, individual interviews to explore their VOT experiences after program completion. Interviews were audio recorded and transcribed. Transcripts were analyzed using thematic analysis to identify key factors influencing acceptability and the effect of VOT on the treatment experience. Results We interviewed 12 of the 60 patients who participated in the clinical pilot and 3 of the 5 counselors. Overall, patients were enthusiastic about VOT, noting multiple benefits over traditional treatment experiences, including avoiding frequent travel to the clinic. Some noted how this allowed them to better meet recovery goals by avoiding a potentially triggering environment. Most appreciated having increased time to devote to other life priorities, including maintaining consistent employment. Participants described how VOT increased their autonomy, allowed them to keep treatment private, and normalized treatment to align with other medications that do not require in-person dosing. Participants did not describe major usability issues or privacy concerns with submitting videos. Some participants reported feeling disconnected from counselors while others felt more connected. Counselors felt some discomfort in their new role confirming medication ingestion but saw VOT as a useful tool for select patients. Conclusions VOT may be an acceptable tool to achieve equipoise between lowering barriers to treatment with methadone and protecting the health and safety of patients and their communities. |
| first_indexed | 2024-04-09T19:54:41Z |
| format | Article |
| id | doaj.art-e17fda8f46b74aacbc9d4022c504b4ca |
| institution | Directory Open Access Journal |
| issn | 1940-0640 |
| language | English |
| last_indexed | 2024-04-09T19:54:41Z |
| publishDate | 2023-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Addiction Science & Clinical Practice |
| spelling | doaj.art-e17fda8f46b74aacbc9d4022c504b4ca2023-04-03T05:35:32ZengBMCAddiction Science & Clinical Practice1940-06402023-03-0118111210.1186/s13722-023-00372-3“Sign Me Up”: a qualitative study of video observed therapy (VOT) for patients receiving expedited methadone take-homes during the COVID-19 pandemicJames B. Darnton0Elenore P. Bhatraju1Kristin Beima-Sofie2Alyssa Michaels3Kevin A. Hallgren4Sean Soth5Paul Grekin6Steve Woolworth7Judith I. Tsui8Division of General Internal Medicine, University of WashingtonDivision of General Internal Medicine, University of WashingtonDepartment of Global Health, University of WashingtonDivision of HIV, ID, and Global Medicine, Department of Medicine, University of California, San FranciscoDepartment of Psychiatry and Behavioral Sciences, University of Washington School of MedicineEvergreen Treatment ServicesEvergreen Treatment ServicesEvergreen Treatment ServicesDivision of General Internal Medicine, University of WashingtonAbstract Background Federal and state regulations require frequent direct observation of methadone ingestion at an Opioid Treatment Program (OTP)—a requirement that creates barriers to patient access. Video observed therapy (VOT) may help to address public health and safety concerns of providing take-home medications while simultaneously reducing barriers to treatment access and long-term retention. Evaluating user experiences with VOT is important for understanding the acceptability of this strategy. Methods We conducted a qualitative evaluation of a clinical pilot program of VOT via smartphone that was rapidly implemented between April and August 2020 during the COVID-19 pandemic within three opioid treatment programs. In the program, selected patients submitted video recordings of themselves ingesting methadone take-home doses, which were asynchronously reviewed by their counselor. We recruited participating patients and counselors for semi-structured, individual interviews to explore their VOT experiences after program completion. Interviews were audio recorded and transcribed. Transcripts were analyzed using thematic analysis to identify key factors influencing acceptability and the effect of VOT on the treatment experience. Results We interviewed 12 of the 60 patients who participated in the clinical pilot and 3 of the 5 counselors. Overall, patients were enthusiastic about VOT, noting multiple benefits over traditional treatment experiences, including avoiding frequent travel to the clinic. Some noted how this allowed them to better meet recovery goals by avoiding a potentially triggering environment. Most appreciated having increased time to devote to other life priorities, including maintaining consistent employment. Participants described how VOT increased their autonomy, allowed them to keep treatment private, and normalized treatment to align with other medications that do not require in-person dosing. Participants did not describe major usability issues or privacy concerns with submitting videos. Some participants reported feeling disconnected from counselors while others felt more connected. Counselors felt some discomfort in their new role confirming medication ingestion but saw VOT as a useful tool for select patients. Conclusions VOT may be an acceptable tool to achieve equipoise between lowering barriers to treatment with methadone and protecting the health and safety of patients and their communities.https://doi.org/10.1186/s13722-023-00372-3Opioid use disorderOpioid treatment programPeople who use drugsVideo observed therapy |
| spellingShingle | James B. Darnton Elenore P. Bhatraju Kristin Beima-Sofie Alyssa Michaels Kevin A. Hallgren Sean Soth Paul Grekin Steve Woolworth Judith I. Tsui “Sign Me Up”: a qualitative study of video observed therapy (VOT) for patients receiving expedited methadone take-homes during the COVID-19 pandemic Addiction Science & Clinical Practice Opioid use disorder Opioid treatment program People who use drugs Video observed therapy |
| title | “Sign Me Up”: a qualitative study of video observed therapy (VOT) for patients receiving expedited methadone take-homes during the COVID-19 pandemic |
| title_full | “Sign Me Up”: a qualitative study of video observed therapy (VOT) for patients receiving expedited methadone take-homes during the COVID-19 pandemic |
| title_fullStr | “Sign Me Up”: a qualitative study of video observed therapy (VOT) for patients receiving expedited methadone take-homes during the COVID-19 pandemic |
| title_full_unstemmed | “Sign Me Up”: a qualitative study of video observed therapy (VOT) for patients receiving expedited methadone take-homes during the COVID-19 pandemic |
| title_short | “Sign Me Up”: a qualitative study of video observed therapy (VOT) for patients receiving expedited methadone take-homes during the COVID-19 pandemic |
| title_sort | sign me up a qualitative study of video observed therapy vot for patients receiving expedited methadone take homes during the covid 19 pandemic |
| topic | Opioid use disorder Opioid treatment program People who use drugs Video observed therapy |
| url | https://doi.org/10.1186/s13722-023-00372-3 |
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