Clinician and Patient Experiences with COVID-19 Induced Rapid Transitions to Telehealth for Opioid Use Disorder Treatment

摘要 COVID-19大流行导致医疗保健服务从面对面到远程医疗的快速变化 服务，包括治疗阿片类药物使用障碍患者。远程保健服务（例如， 电话和视频到家，或VTH）已被有效地用于精神病学，但我们有非常 关于初级保健临床医生或患者使用远程医疗就诊的经验的信息很少 与阿片类药物使用障碍（MOUD）相关的药物（例如，丁丙诺啡）。了解这些 在COVID-19大流行期间，农村OUD患者的问题势在必行，因为他们处于高水平， 吸毒复吸、孤立和孤独的风险以及心理健康下降。 我们建议对农村初级保健临床医生和患者进行混合方法研究， MOUD。我们将对30名农村初级保健临床医生进行定性访谈， 评估他们使用远程医疗（电话和VTH）诊断和 治疗OUD患者，感知或经验丰富的促进者和实施远程医疗的障碍，以及 观察OUD患者的治疗依从性。与此同时，我们将进行量化 在接受MOUD的250名患者的样本中进行调查。定量调查将评估 OUD患者对远程医疗服务可接受性的看法，使用远程医疗的经验 服务、治疗连续性和药物使用结果。具体目标是：1。描述（使用 质的方法）农村初级保健医生的能力和实际经验过渡到 接受MOUD的患者的远程医疗，他们对患者的药物使用和心理健康的评估 在过渡到远程医疗时发生了变化，以及适应/不适应远程医疗的患者特征 远程保健; 2.确定（使用定量方法）农村MOUD患者治疗的预测因素 连续性，对远程医疗服务的满意度，以及对面对面与远程医疗服务的偏好;以及 3.确定（使用定量方法）农村MOUD患者药物使用复发的预测因素，实际 过量和过量风险。 这项研究是非常时间敏感的时间内迅速变化的基本提供远程保健 COVID-19危机导致的服务，可能对接受者产生长期影响 治疗OUD。

Abstract The COVID-19 pandemic has caused rapid changes in health care delivery from in-person to telehealth services, including the treatment of persons with opioid use disorder (OUD). Telehealth services (e.g., telephone calls and video-to-home, or VTH) have been effectively used in psychiatry, but we have very little information about primary care clinicians’ or patients’ experiences using telehealth for visits associated with medication for opioid use disorder (MOUD) (e.g., buprenorphine). Understanding these issues among rural OUD patients during the COVID-19 pandemic is imperative because they are at high risk of drug use relapse, isolation and loneliness, and mental health declines. We propose to conduct a mixed-methods study of rural primary care clinicians and patients receiving MOUD. We will conduct qualitative interviews among a sample of 30 rural primary care clinicians to evaluate their practices’ abilities and experiences using telehealth (telephone and VTH) to diagnose and treat patients with OUD, perceived or experienced facilitators and barriers to implementing telehealth, and observations about OUD patients’ treatment adherence. Simultaneously, we will conduct quantitative surveys among a sample of 250 patients who are receiving MOUD. The quantitative surveys will evaluate OUD patients’ perspectives of the acceptability of telehealth services, experiences using telehealth services, treatment continuity, and drug use outcomes. Specific Aims are to: 1. Describe (using qualitative methods) rural primary care clinicians’ abilities and actual experiences transitioning to telehealth for patients receiving MOUD, their evaluations of how patients’ drug use and mental health changed when transitioning to telehealth, and characteristics of patients’ who did/did not adjust well to telehealth; 2. Identify (using quantitative methods) rural MOUD patients’ predictors of treatment continuity, satisfaction with telehealth services, and preferences for in-person vs. telehealth services; and 3. Identify (using quantitative methods) rural MOUD patients’ predictors of drug use relapse, actual overdose, and overdose risk. This study is very time-sensitive during a time of rapid changes in the essential delivery of telehealth services caused by the COVID-19 crisis that may have long-lasting implications for persons receiving treatment for OUD.