在 COVID-19 大流行期间,患者和临床医生在基于诊室的丁丙诺啡治疗中实施远程医疗和相关调整的经验:一项定性研究。

IF 3.2 2区 医学 Q1 SUBSTANCE ABUSE
Melissa Davoust, Angela R Bazzi, Samantha Blakemore, Juliana Blodgett, Anna Cheng, Sarah Fielman, Kara M Magane, Jacqueline Theisen, Richard Saitz, Alicia S Ventura, Zoe M Weinstein
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引用次数: 0

摘要

背景:在过去十年中,阿片类药物过量死亡人数急剧增加。对于阿片类药物使用障碍(OUD)患者,美沙酮和丁丙诺啡等激动剂药物可降低阿片类药物相关的发病率和死亡率。从历史上看,在办公室环境中提供丁丙诺啡治疗依赖于频繁的面对面接触,可能影响患者获得和保留护理。为应对COVID-19大流行,丁丙诺啡办公室治疗提供者迅速调整了其护理流程,越来越多地依赖远程医疗就诊。迄今为止,相对较少的先前研究结合患者和临床医生的观点来检查远程医疗和相关护理适应的实施,特别是在安全网设置中。方法:采用定性方法,对某城市社会保障医院丁丙诺啡门诊远程医疗的临床和患者体验进行分析。从该诊所,我们对25名患者和16名临床医生(包括开处方者和非开处方者)进行了半结构化访谈。我们对所有访谈数据进行编码,并使用主题分析方法来了解远程医疗如何影响治疗质量和参与护理,以及使用远程医疗的偏好。结果:从患者和临床医生的角度出发,提出了实施远程医疗和其他与covid -19相关的护理适应的五个主题:(1)远程医疗整合促进了医疗实践的开放性和灵活性;(2)对远程医疗相关适应性的关注以安全和问责制为中心;(3)远程医疗接触需要患者和临床医生之间的关系和信任,以促进开放式沟通;(4)安全网患者群体在使用远程医疗时遇到了独特的挑战,特别是在所需的技术和隐私需求方面。(5)远程医疗在以办公室为基础的丁丙诺啡治疗中发挥着重要作用,主要是通过在结合面对面和虚拟就诊的混合护理模式中使用远程医疗。结论:在办公室丁丙诺啡治疗中实施远程医疗有可能提高患者对护理的参与度;然而,我们的研究结果强调需要量身定制的方法来实施基于办公室的丁丙诺啡治疗的远程医疗,特别是在安全网设置中。总体而言,本研究支持维持政策和实践的变化,以促进在COVID-19突发公共卫生事件之后在办公室丁丙诺啡治疗中使用远程医疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Patient and clinician experiences with the implementation of telemedicine and related adaptations in office-based buprenorphine treatment during the COVID-19 pandemic: a qualitative study.

Patient and clinician experiences with the implementation of telemedicine and related adaptations in office-based buprenorphine treatment during the COVID-19 pandemic: a qualitative study.

Patient and clinician experiences with the implementation of telemedicine and related adaptations in office-based buprenorphine treatment during the COVID-19 pandemic: a qualitative study.

Background: Deaths from opioid overdose have increased dramatically in the past decade. For individuals with opioid use disorder (OUD), agonist medications such as methadone and buprenorphine reduce opioid-related morbidity and mortality. Historically, the provision of buprenorphine treatment in office-based settings has relied on frequent in-person contact, likely influencing patients' access to and retention in care. In response to the COVID-19 pandemic, providers of office-based buprenorphine treatment rapidly adapted their care processes, increasingly relying on telemedicine visits. To date, relatively few prior studies have combined patient and clinician perspectives to examine the implementation of telemedicine and related care adaptations, particularly in safety-net settings.

Methods: Qualitative methods were used to explore clinician and patient experiences with telemedicine in an office-based buprenorphine treatment clinic affiliated with an urban safety-net hospital. From this clinic, we conducted semi-structured interviews with 25 patients and 16 clinicians (including prescribers and non-prescribers). We coded all interview data and used a thematic analysis approach to understand how telemedicine impacted treatment quality and engagement in care, as well as preferences for using telemedicine moving forward.

Results: Five themes regarding the implementation of telemedicine and other COVID-19-related care adaptations arose from patient and clinician perspectives: (1) telemedicine integration precipitated openness to more flexibility in care practices, (2) concerns regarding telemedicine-related adaptations centered around safety and accountability, (3) telemedicine encounters required rapport and trust between patients and clinicians to facilitate open communication, (4) safety-net patient populations experienced unique challenges when using telemedicine, particularly in terms of the technology required and the need for privacy, and (5) there is an important role for telemedicine in office-based buprenorphine treatment moving forward, primarily through its use in hybrid models of care which integrate both in-person and virtual visits.

Conclusions: Telemedicine implementation within office-based buprenorphine treatment has the potential to improve patients' engagement in care; however, our findings emphasize the need for tailored approaches to implementing telemedicine in office-based buprenorphine treatment, particularly within safety-net settings. Overall, this study supports the maintenance of changes to policy and practice that facilitate the use of telemedicine in office-based buprenorphine treatment beyond the COVID-19 public health emergency.

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来源期刊
Addiction Science & Clinical Practice
Addiction Science & Clinical Practice Psychology-Clinical Psychology
CiteScore
3.90
自引率
10.80%
发文量
64
审稿时长
28 weeks
期刊介绍: Addiction Science & Clinical Practice provides a forum for clinically relevant research and perspectives that contribute to improving the quality of care for people with unhealthy alcohol, tobacco, or other drug use and addictive behaviours across a spectrum of clinical settings. Addiction Science & Clinical Practice accepts articles of clinical relevance related to the prevention and treatment of unhealthy alcohol, tobacco, and other drug use across the spectrum of clinical settings. Topics of interest address issues related to the following: the spectrum of unhealthy use of alcohol, tobacco, and other drugs among the range of affected persons (e.g., not limited by age, race/ethnicity, gender, or sexual orientation); the array of clinical prevention and treatment practices (from health messages, to identification and early intervention, to more extensive interventions including counseling and pharmacotherapy and other management strategies); and identification and management of medical, psychiatric, social, and other health consequences of substance use. Addiction Science & Clinical Practice is particularly interested in articles that address how to improve the quality of care for people with unhealthy substance use and related conditions as described in the (US) Institute of Medicine report, Improving the Quality of Healthcare for Mental Health and Substance Use Conditions (Washington, DC: National Academies Press, 2006). Such articles address the quality of care and of health services. Although the journal also welcomes submissions that address these conditions in addiction speciality-treatment settings, the journal is particularly interested in including articles that address unhealthy use outside these settings, including experience with novel models of care and outcomes, and outcomes of research-practice collaborations. Although Addiction Science & Clinical Practice is generally not an outlet for basic science research, we will accept basic science research manuscripts that have clearly described potential clinical relevance and are accessible to audiences outside a narrow laboratory research field.
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