Patient and provider experiences with opioid use disorder care delivered via telehealth: A systematic mixed-studies review

Introduction Since the onset of the COVID-19 pandemic and loosening of some opioid use disorder (OUD) treatment regulations in the U.S. and Canada, there has been a rapid rise in the use of telehealth for buprenorphine induction, maintenance, and counseling (tele-bupe). Previous reviews highlight that tele-bupe can expand access to OUD care and improve treatment retention, but none to date have synthesized patient and clinician experiences with and perceptions of this care. Objective This review synthesized findings from quantitative, qualitative, and mixed-methods studies that examined patient and provider experiences with tele-bupe. We assessed the perceived effectiveness and acceptability of this treatment modality. Methods Our systematic review followed PRISMA 2020 guidelines. In July 2023, we searched six databases using keywords ‘telehealth AND opioid use disorder’ (and related terms) for papers published in English. Papers were eligible for inclusion if they reported findings about patient or provider experiences. Two reviewers screened studies for inclusion; 40 studies were included. We used a data-based convergent synthesis design to extract and synthesize findings, and the Mixed-Methods Appraisal Tool to appraise studies. Results Patients and providers hold generally positive views of tele-bupe and most support its continued use in some form, citing multiple benefits, including accessibility and convenience. Most studies also identified barriers to tele-bupe, including technological challenges. Patients and providers differed in how they thought telehealth affects the clinical relationship, with providers expressing more concern about rapport-building and patients stating that being in their own environments during visits facilitated comfort and openness. The findings also suggest that providers are conflicted about when and for whom tele-bupe is appropriate. Conclusion Overall, both patients and providers view tele-bupe favorably; however, providers are conflicted about the patients and situations for which it is appropriate, which may lead to inequities in who is offered this form of care.

引言 自新冠疫情爆发以及美国和加拿大一些阿片类药物使用障碍（OUD）治疗规定放宽以来，丁丙诺啡诱导、维持和咨询的远程医疗（远程丁丙诺啡治疗）使用迅速增加。先前的综述强调，远程丁丙诺啡治疗可以扩大获得OUD治疗的途径并提高治疗留存率，但迄今为止，尚未有综述综合患者和临床医生对这种治疗的体验和看法。 目的 本综述综合了定量、定性和混合方法研究的结果，这些研究考察了患者和提供者对远程丁丙诺啡治疗的体验。我们评估了这种治疗方式的感知有效性和可接受性。 方法 我们的系统综述遵循PRISMA 2020指南。2023年7月，我们使用关键词“远程医疗和阿片类药物使用障碍”（及相关术语）在六个数据库中搜索以英语发表的论文。如果论文报告了关于患者或提供者体验的研究结果，则符合纳入标准。两名评审员筛选研究以确定是否纳入；共纳入40项研究。我们使用基于数据的收敛性综合设计来提取和综合研究结果，并使用混合方法评估工具来评价研究。 结果 患者和提供者对远程丁丙诺啡治疗普遍持积极看法，大多数人支持以某种形式继续使用，列举了多种益处，包括可及性和便利性。大多数研究还确定了远程丁丙诺啡治疗的障碍，包括技术挑战。患者和提供者在他们认为远程医疗如何影响临床关系方面存在差异，提供者更担心建立融洽关系，而患者表示就诊时在自己的环境中有助于感到舒适和坦诚。研究结果还表明，提供者对于何时以及对哪些人适合远程丁丙诺啡治疗存在矛盾心理。 结论 总体而言，患者和提供者都对远程丁丙诺啡治疗持积极态度；然而，提供者对于适合的患者和情况存在矛盾心理，这可能导致在提供这种形式的治疗方面存在不公平。