Treatment of opioid use disorder during COVID-19: Experiences of clinicians transitioning to telemedicine
Treatment of opioid use disorder during COVID-19: Experiences of clinicians transitioning to telemedicine
复制标题
DOI：
10.1016/j.jsat.2020.108124
复制
发表时间：
2020-11-01
影响因子：
3.9
通讯作者：
Huskamp, Haiden A.
中科院分区：
文献类型：
--
作者：
Uscher-Pines, Lori;Sousa, Jessica;Huskamp, Haiden A.
目的：COVID-19大流行改变了阿片类药物使用障碍（OUD）患者的护理方式;然而，人们对一线临床医生在向远程医疗过渡过程中的经验知之甚少。这项研究描述了如何，在大流行的早期阶段的背景下，临床医生使用远程医疗OUD结合在人的护理，遇到的障碍，以及对护理quality of care.Methods的影响：在2020年4月，我们进行了半结构化的采访与放弃开丁丙诺啡的临床医生。我们使用最大变异抽样。我们使用标准的定性分析技术，包括归纳和演绎的方法，以确定和表征themes.Results：18名临床医生代表10个国家参加。几乎所有的受访者都在做一些远程医疗，超过一半的人只做远程医疗访问。大多数参与者报告说，他们改变了典型的临床护理模式，以帮助患者留在家中，并尽量减少对COVID-19的暴露。这些变化包括免除尿液毒理学筛查，让患者带着更多的OUD药物回家，以及减少就诊次数。虽然在大流行的最初几周，一些参与者通过远程医疗为新病人提供服务，但其他人没有。一些临床医生确定了远程医疗对其患者互动质量的积极影响，包括增加患者的访问。其他人指出了负面影响，包括结构和责任减少，临床决策信息减少，建立联系的挑战，技术挑战和缩短访问时间。尽管如此，仍有许多未知数，包括广泛使用远程医疗治疗OUD的质量和安全性。
Objective: The COVID-19 pandemic has transformed care delivery for patients with opioid use disorder (OUD); however, little is known about the experiences of front-line clinicians in the transition to telemedicine. This study described how, in the context of the early stages of the pandemic, clinicians used telemedicine for OUD in conjunction with in-person care, barriers encountered, and implications for quality of care.Methods: In April 2020, we conducted semistructured interviews with clinicians waivered to prescribe buprenorphine. We used maximum variation sampling. We used standard qualitative analysis techniques, consisting of both inductive and deductive approaches, to identify and characterize themes.Results: Eighteen clinicians representing 10 states participated. Nearly all interview participants were doing some telemedicine, and more than half were only doing telemedicine visits. Most participants reported changing their typical clinical care patterns to help patients remain at home and minimize exposure to COVID-19. Changes included waiving urine toxicology screening, sending patients home with a larger supply of OUD medications, and requiring fewer visits. Although several participants were serving new patients via telemedicine during the early weeks of the pandemic, others were not. Some clinicians identified positive impacts of telemedicine on the quality of their patient interactions, including increased access for patients. Others noted negative impacts including less structure and accountability, less information to inform clinical decision-making, challenges in establishing a connection, technological challenges, and shorter visits.Conclusions: In the context of the pandemic, buprenorphine prescribers quickly transitioned to providing telemedicine visits in high volume; nonetheless, there are still many unknowns, including the quality and safety of widespread use of telemedicine for OUD treatment.