Abstract
Telemedicine (TM) enabled by digital health technologies to provide medical services has been considered a key solution to increasing health care access in rural communities. With the immediate need for remote care due to the COVID-19 pandemic, many health care systems have rapidly incorporated digital technologies to support the delivery of remote care options, including medication treatment for individuals with opioid use disorder (OUD). In responding to the opioid crisis and the COVID-19 pandemic, public health officials and scientific communities strongly support and advocate for greater use of TM-based medication treatment for opioid use disorder (MOUD) to improve access to care and have suggested that broad use of TM during the pandemic should be sustained. Nevertheless, research on the implementation and effectiveness of TM-based MOUD has been limited. To address this knowledge gap, the National Drug Abuse Treatment Clinical Trials Network (CTN) funded (via the NIH HEAL Initiative) a study on Rural Expansion of Medication Treatment for Opioid Use Disorder (Rural MOUD; CTN-0102) to investigate the implementation and effectiveness of adding TM-based MOUD to rural primary care for expanding access to MOUD. In preparation for this large-scale, randomized controlled trial incorporating TM in rural primary care, a feasibility study is being conducted to develop and pilot test implementation procedures. In this commentary, we share some of our experiences, which include several challenges, during the initial two-month period of the feasibility study phase. While these challenges could be due, at least in part, to adjusting to the COVID-19 pandemic and new workflows to accommodate the study, they are notable and could have a substantial impact on the larger, planned pragmatic trial and on TM-based MOUD more broadly. Challenges include low rates of identification of risk for OUD from screening, low rates of referral to TM, digital device and internet access issues, workflow and capacity barriers, and insurance coverage. These challenges also highlight the lack of empirical guidance for best TM practice and quality remote care models. With TM expanding rapidly, understanding implementation and demonstrating what TM approaches are effective are critical for ensuring the best care for persons with OUD.
Highlights
The Project: Rural Expansion of Medication Treatment for Opioid Use Disorder medication treatment for opioid use disorder (OUD) (MOUD) approved by the U.S Food and Drug Administration (FDA) are effective and life-saving, but despite national efforts to increase availability through office-based opioid treatment (OBOT) programs, uptake remains slow
While increasing access to care through TM for people with OUD, especially in rural areas severely impacted by the opioid crisis is desirable, research on the implementation and effectiveness of TM-based medication treatment for OUD (MOUD) is limited
To address this gap in the literature, prior to the COVID-19 pandemic, we conceived of a study designed to address the need for greater access to MOUD by incorporating the option for TM services delivered by an external MOUD provider for patients in rural primary care clinics
Summary
Telemedicine (TM) enabled by digital health technologies to provide medical services has been considered a key solution to increasing health care access in rural communities [1, 2]. While increasing access to care through TM for people with OUD, especially in rural areas severely impacted by the opioid crisis is desirable, research on the implementation and effectiveness of TM-based MOUD is limited. To address this gap in the literature, prior to the COVID-19 pandemic, we conceived of a study designed to address the need for greater access to MOUD by incorporating the option for TM services delivered by an external MOUD provider for patients in rural primary care clinics. There is an immediate need to understand early challenges, given the unprecedented rapid changes in models of healthcare delivery due to the pandemic and a number of clinics beginning to implement TM without implementation guidance or evidence about effectiveness
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