A qualitative study of patient experiences with telemedicine opioid use disorder treatment during COVID-19

Abstract

Background: The drug-related overdose crisis worsened during the COVID-19 pandemic. Recent drug policy changes to increase access to medications for opioid use disorder (MOUD) during COVID-19 shifted some outpatient MOUD treatment into virtual settings to reduce the demand for in-person care. The objective of this study was to qualitatively explore what is gained and lost in virtual patient encounters for patients with opioid use disorder at a low-threshold, addiction treatment clinic that offers buprenorphine and harm reduction services. Methods: Patients were included in this study if they received care at the Harm Reduction and BRidges to Care (HRBR) clinic and utilized virtual visits between November 2019 and March 2021. The study was conceptualized using a health care access framework and prior studies of telemedicine acceptability. Semi-structured interviews were completed between March and April 2021. Interviews were dual-coded and analyzed using directed content analysis. Results: Nineteen interviews were conducted. The sample was predominantly White (84%) and stably housed (79%) with comparable gender (male, 53%) and employment status (employed, 42%). The majority (63%) of patients preferred virtual visits compared to in-person visits (16%) or a combination of access to both (21%). Two overarching tandem domains emerged: availability-accommodation and acceptability-appropriateness. Availability-accommodation reflected participants’ desires for immediate services and reduced transportation and work or caregiving scheduling barriers, which was facilitated by virtual visits. The acceptable-appropriate domain articulated how participants felt connected to their providers, whether through in-person interactions or the mutual trust experienced during virtual visits. Conclusions: Virtual visits were perceived by participants as a valuable and critical option for accessing treatment for OUD. While many participants preferred virtual visits, some favored face-to-face visits due to relational and physical interactions with providers. Participants desired flexibility and the ability to have a choice of treatment modality depending on their needs.

Keywords:

• Telemedicine
• COVID-19
• buprenorphine
• opioid use disorder
• qualitative research
• substance use disorder

Acknowledgments

We respectfully acknowledge that this work took place on the traditional and unceded land of the Multnomah, Kathlamet, Clackamas, Chinook, Tualatin Kalapuya, Molalla, and many other Tribes who made their homes along the Columbia River. We would like to thank the participants that generously donated their time and expertise to this study and the staff of Harm Reduction and Bridges to Care Clinic. We also are grateful for the support and mentorship from Honora Englander, MD, and Ximena Levander, MD, MCR, FACP.

Author contributions

RL, KCP, and BB contributed to the conception of the study design. RL conducted interviews. RL and KCP analyzed the data. RL, KCP, JG, and BB interpreted data. RL took the lead in writing this manuscript and KCP, JG, and BB provided critical feedback and contributed to the writing and revising of the manuscript.

Disclosure statement

None of the authors report a conflict of interest.

Additional information

Funding

This work was supported by scholarships from the OHSU School of Medicine Robert L. Bacon Endowment Fund and the OHSU Department of Psychiatry Edward M. Scott and Jack E. Keener Endowed Education Scholarship. Funding sources did not have a role in the study design, analysis of data, or writing of this manuscript.