Careful Implementation of Telemedicine for Medication Treatment for Opioid Use Disorder May Help Expand Access in Rural Communities
Addiction Science Made Easy
CTN Dissemination Library & Northwest ATTC
What’s the Question?
Opioid overdose deaths are increasing rapidly in the United States. Medications for opioid use disorder (MOUD), like buprenorphine and methadone, are effective and can be delivered in primary care settings, but uptake has been limited in rural communities.
Telemedicine (TM) is a useful way to increase access to health care for rural patients, but we don’t know very much about how providers and patients feel about this model for MOUD delivery.
This study, which was a collaboration between UCLA, the RAND Corporation, and 3 nodes in the NIDA Clinical Trials Network, explored TM-MOUD (telemedicine for MOUD) acceptability and feasibility among staff and patients from 7 rural primary care clinics and a TM-MOUD vendor.
How Was This Study Conducted?
Researchers conducted virtual interviews or focus groups with clinic administrators (n=7 interviews), clinic primary care and behavioral health providers (8 groups, n=30), other clinic staff (9 groups, n=37), patients receiving MOUD (n=16 interviews), TM-MOUD vendor staff (n=4 interviews), and vendor-affiliated behavioral health and prescribing providers (n=17 interviews).
In the interviews, researchers asked participants about their experiences with and opinions about MOUD (primarily buprenorphine) and telemedicine, as well what they thought about TM-MOUD referral and coordination models.
What Did Researchers Find Out?
Participants noted several benefits of vendor-based TM-MOUD, including:
- Reduced logistical barriers
- More privacy
- Less stigma
- Increased access to services not available locally (like counseling and pain management)
They also noted several barriers, including:
- Lack of internet or poor connectivity in patients’ homes
- Limited communication and trust between TM-MOUD and clinic providers
- Questions about the value to the clinic of TM-MOUD referral to external vendors
Overall, however, most participants rated the TM-MOUD model highly – ratings were lowest among frontline staff. Several providers and patients also felt strongly that TM-MOUD was best for patients who were already stable on MOUD (meaning either that they were through induction and stabilized on medication or that their mental health and/or living situations had stabilized). Some providers and patients were also concerned that TM-MOUD might not provide enough oversight and support for patients who were struggling to adhere to treatment.
What Are the Implications for the Workforce?
Despite some differences in opinions about and barriers to implementing a TM-MOUD referral and coordination model, most stakeholders agreed that the model is beneficial. It may be especially helpful for patients who have transportation issues or who lack resources in their communities for care. It may also work best for patients who are already stabilized on MOUD and need support for continuation of care, rather than initiation of care.
Careful implementation of a TM-MOUD program is necessary and can help overcome some of the barriers identified. Implementation requires buy-in from all participants, including patients, as well as education about workflow and services offered. Clear communication and trust are vital components, and insufficient internet availability must also be addressed for this model to succeed.
While a TM-MOUD model is not the only way to improve access to OUD treatment for rural communities, offering it as an option for patients may help improve access to and retention on MOUD as part of broader efforts to address rural health disparities and prevent opioid-related deaths.