Perspectives of opioid use disorder treatment providers during COVID-19: Adapting to flexibilities and sustaining reforms.
Perspectives of opioid use disorder treatment providers during COVID-19: Adapting to flexibilities and sustaining reforms.
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DOI：
10.1016/j.jsat.2021.108514
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发表时间：
2022-01
影响因子：
3.9
通讯作者：
Crystal S
中科院分区：
文献类型：
--
作者：
Treitler PC;Bowden CF;Lloyd J;Enich M;Nyaku AN;Crystal S
COVID-19大流行导致前所未有的临时联邦和州监管灵活性，迅速改变了阿片类药物使用障碍（MOUD）治疗的药物提供。这项研究旨在了解COVID-19期间治疗提供者护理的变化，提供者的适应经验，以及对应长期维持哪些变化的看法。我们进行了深入的，半结构化的采访与20新泽西MOUD供应商，有目的地抽样，以反映多样性的供应商设置，专业，和其他特点。使用快速分析方法，我们总结了访谈领域内的内容，并分析了参与者的重复概念和主题。在COVID-19大流行期间，MOUD治疗实践发生了变化，包括从面对面护理迅速转变为远程医疗，减少毒理学测试和心理社会/咨询服务的频率，以及修改处方持续时间和带回家的美沙酮供应。对实践的修改得到了积极的接受，并加强了供应商的自主意识，以及提高提供以病人为中心的护理的能力。所有答复者都表示支持将临时性监管灵活性永久化，但在灵活性的实施以及计划长期修改自身做法的程度方面存在差异。调查结果支持维持MOUD实践的临时监管和支付变化，这可能改善了治疗的可及性，并允许更灵活，个性化的患者护理。提供者报告的负面、意外后果很少，但需要更多研究来评估患者在COVID-19大流行期间改变做法的经历。
The COVID-19 pandemic led to unprecedented temporary federal and state regulatory flexibilities that rapidly transformed medication for opioid use disorder (MOUD) treatment delivery. This study aimed to understand changes in treatment providers' care during COVID-19, provider experiences with the adaptations, and perceptions of which changes should be sustained long-term. We conducted in-depth, semi-structured interviews with 20 New Jersey MOUD providers, purposively sampled to reflect diversity in provider setting, specialty, and other characteristics. Using a rapid analysis approach, we summarized content within interview domains and analyzed domains across participants for recurring concepts and themes. MOUD treatment practice changes taking place during the COVID-19 pandemic included a rapid shift from in-person care to telehealth, reduction in frequency of toxicology testing and psychosocial/counseling services, and modifications to prescription durations and take-home methadone supplies. Modifications to practice were positively received and reinforced a sense of autonomy for providers as well as enhancing the ability to provide patient-centered care. All respondents expressed support for making temporary regulatory flexibilities permanent, but differed in their implementation of the flexibilities and the extent to which they planned to modify their own practices long-term. Findings support sustaining temporary regulatory and payment changes to MOUD practice, which may have improved treatment access and allowed for more flexible, individually tailored patient care. Few negative, unintended consequences were reported by providers, but more research is needed to evaluate the patient experience with changes to practice during the COVID-19 pandemic.
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