Health center implementation of telemedicine for opioid use disorders: A qualitative assessment of adopters and nonadopters
Health center implementation of telemedicine for opioid use disorders: A qualitative assessment of adopters and nonadopters
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DOI：
10.1016/j.jsat.2020.108037
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发表时间：
2020-08-01
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;Raja, Pushpa;Huskamp, Haiden A.
目的：虽然使用远程医疗治疗阿片类药物使用障碍（远程OUD）正在增长，但关于如何实际部署在治疗中的研究有限。我们探讨了美国各地的健康中心如何使用远程OUD进行治疗以及不采用的原因。方法：我们使用了2018年SAMHSA行为健康治疗服务中心数据库和文献综述，以创建一个社区精神卫生中心和联邦合格的健康中心与远程健康服务的样本。从这份健康中心的名单中，我们使用最大多样性抽样来确定和招募健康中心的领导人参加半结构化面试。我们使用归纳和演绎的方法来开发网站summarization.Results：二十二个健康中心从14个不同的国家参加。其中，有8家提供了远程OUD。在具有远程OUD的中心中，药物管理是通过视频提供的最常见的服务。通常情况下，健康中心在与豁免（处方）提供者进行首次面对面访问后提供远程医疗访问。一些项目只通过远程医疗提供咨询。远程OUD项目代表提到的主要治疗障碍包括关于丁丙诺啡等受控物质处方的规定，以及将实验室结果发送给远程（处方）提供者的困难。Nonadopters报告不提供远程OUD由于管制物质处方，复杂性和监管障碍，提供团体visits，并相信在人OUD服务满足病人need.Conclusions的规定：远程OUD正在部署在各种方式。描述当前的交付模式可以为促进和实施远程OUD以对抗阿片类药物流行病的战略提供信息。
Objective: Although use of telemedicine for the treatment of opioid use disorders (Tele-OUD) is growing, there is limited research on how it is actually being deployed in treatment. We explored how health centers across the U.S. are using tele-OUD in treatment as well as reasons for nonadoption.Methods: We used the 2018 SAMHSA Behavioral Health Treatment Services Locator database and literature review to create a sample of community mental health centers and federally qualified health centers with telemental health services. From this list of health centers, we ued maximum diversity sampling to identify and recruit health center leaders to participate in semistructured interviews. We used inductive and deductive approaches to develop site summaries.Results: Twenty-two health centers from 14 different states participated. Of these, 8 offered tele-OUD. Among centers with tele-OUD, medication management was the most common service provided via video. Typically, health centers offered telemedicine visits after an initial, in-person visit with a waivered (prescribing) provider. Some programs only offered counseling via telemedicine. Leading barriers to treatment that tele-OUD program representatives mentioned included regulations on the prescribing of controlled substances, including buprenorphine, and difficulties in sending lab results to distant (prescribing) providers. Nonadopters reported not offering tele-OUD due to regulations in controlled substance prescribing, complexities and regulatory barriers to offering group visits, and the belief that in-person OUD services were meeting patient need.Conclusions: Tele-OUD is being deployed in a variety of ways. Describing current delivery models can inform strategies to promote and implement tele-OUD to combat the opioid epidemic.