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Creel LM, Feygin YB, Shipley M, Davis DW, Cole Hall T, Downs C, Hoskins S, Pasquenza N, Duncan SD. A case study on variations in network structure and cross-sector alignment in two local systems serving pregnant and parenting women in recovery. Health Serv Res 2024; 59 Suppl 1:e14251. [PMID: 37848179 PMCID: PMC10796293 DOI: 10.1111/1475-6773.14251] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023] Open
Abstract
OBJECTIVE To describe network structure and alignment across organizations in healthcare, public health, and social services sectors that serve pregnant and parenting women with substance use disorder (SUD) in an urban and a rural community. DATA SOURCES AND STUDY SETTINGS Two community networks, one urban and one rural with each including a residential substance use treatment program, in Kentucky during 2021. STUDY DESIGN Social network analysis measured system collaboration and cross-sector alignment between healthcare, public health, and social services organizations, applying the Framework for Aligning Sectors. To understand the alignment and structure of each network, we measured network density overall and between sectors, network centralization, and each organization's degree centrality and effective size. DATA COLLECTION/EXTRACTION METHODS Computer-assisted telephone interviews were conducted to document alignment around shared purpose, data, financing, and governance. PRINCIPAL FINDINGS On average, overall and cross-sector network densities in both communities were similar. However, alignment was highest for data sharing and financing in the urban community and for shared purpose and governance in the rural community. Cross-sector partnerships involving healthcare organizations were more prevalent in the rural county (44% vs. 38% for healthcare/public health, 44% vs. 29% for healthcare/social services), but more prevalent for those involving public health/social services organizations in the urban county (42% vs. 24%). A single healthcare organization had the highest degree centrality (Mdn [IQR] = 26 [26-9.5]) and effective size (Mdn [IQR] = 15.9 [20.6-8.7]) within the rural county. Social services organizations held more central positions in the urban county (degree centrality Mdn [IQR] = 13 [14.8-9.5]; effective size Mdn [IQR] = 10.4 [11.4-7.9]). CONCLUSIONS Cross-sector alignment may strengthen local capacity for comprehensive SUD care for pregnant and parenting women. Healthcare organizations are key players in cross-sector partnerships in the rural community, where one healthcare facility holds the central brokerage role. In contrast, public health agencies are key to cross-sector collaboration with social services in the urban community.
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Affiliation(s)
- Liza M. Creel
- Division of Health Care Policy and Research, Department of Medicine, School of MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Yana B. Feygin
- Norton Children's Research Institute affiliated with the University of Louisville School of MedicineUniversity of Louisville School of MedicineLouisvilleKentuckyUSA
| | - Madeline Shipley
- Scientific and Health Policy InitiativesISPOR – The Professional Society for Health Economics and Outcomes ResearchLawrencevilleNew JerseyUSA
| | - Deborah W. Davis
- Norton Children's Research Institute affiliated with the University of Louisville School of MedicineUniversity of Louisville School of MedicineLouisvilleKentuckyUSA
| | | | - Chaly Downs
- Addition Recovery ServicesVolunteers of America, Mid‐StatesLouisvilleKentuckyUSA
| | - Stephanie Hoskins
- Addition Recovery ServicesVolunteers of America, Mid‐StatesLouisvilleKentuckyUSA
| | - Natalie Pasquenza
- External RelationsVolunteers of America, Mid‐StatesLouisvilleKentuckyUSA
| | - Scott D. Duncan
- Division of Neonatal Medicine, Department of Pediatrics, School of MedicineUniversity of LouisvilleLouisvilleKentuckyUSA
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Hohmeier KC, Cernasev A, Leibold C, Moore TM, Schlesinger E, Arce I, Geminn W, Chisholm-Burns M, Cochran G. Patient reported goals for medications for opioid use disorder: A theory of proximal goal attainment. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 12:100345. [PMID: 37876851 PMCID: PMC10590992 DOI: 10.1016/j.rcsop.2023.100345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 10/26/2023] Open
Abstract
Background There exist substantial patient barriers to accessing medications for opioid use disorder (MOUD), including travel distance, stigma, and availability of MOUD providers. Yet, despite these barriers, there exists a subset of patients who possess the requisite motivation to seek and remain adherent to treatment. Objective To explore patient-derived goals in MOUD treatment-adherent patients. Methods This study used in-depth interviews with patients receiving methadone who were enrolled in opioid treatment programs (OTPs) across Tennessee. Participants were recruited from 12 different OTPs to participate in telephonic semi-structured interviews to a point of saturation. Participants had to be adherent to treatment, in treatment for 6 months or greater, and English speaking. Analysis occurred inductively using a constructivist approach to Grounded Theory. Results In total, 17 patient interviews were conducted in the spring of 2021. Participants described goal setting across three general stages of treatment: (1) addressing acute physical and emotional needs upon treatment entry, (2) development of supportive structure and routine to develop healthy skills facilitated by treatment team, and (3) identifying and pursuing future-focused goals not directly linked to treatment. A Proximal Goals in MOUD Framework is introduced. Conclusion In this qualitative study on patient reported goals in MOUD it was found that goals are transitory and relative to the stage of treatment. Further research is needed to better understand goal evolution over the course of treatment and its impact on treatment retention.
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Affiliation(s)
- Kenneth C. Hohmeier
- University of Tennessee Health Science Center, College of Pharmacy, Department of Clinical Pharmacy and Translational Science, Nashville, TN 37211, USA
| | - Alina Cernasev
- University of Tennessee Health Science Center, College of Pharmacy, Department of Clinical Pharmacy and Translational Science, Nashville, TN 37211, USA
| | - Christina Leibold
- University of Tennessee Health Science Center, College of Pharmacy, Department of Clinical Pharmacy and Translational Science, Nashville, TN 37211, USA
| | - Todd M. Moore
- University of Tennessee, Department of Psychology, Knoxville, TN 37996, USA
| | - Erica Schlesinger
- Tennessee Department of Mental Health & Substance Abuse Services, Nashville, TN 37243, USA
| | - Ileana Arce
- Tennessee Department of Mental Health & Substance Abuse Services, Nashville, TN 37243, USA
| | - Wesley Geminn
- Tennessee Department of Mental Health & Substance Abuse Services, Nashville, TN 37243, USA
| | - Marie Chisholm-Burns
- Oregon Health & Science University, Office of the Provost, Portland, OR 97239, USA
| | - Gerald Cochran
- University of Utah, Division of Epidemiology, Salt Lake City, UT 84112, USA
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Pollack HA, Lee F, Paykin S, Aguilera JAR. Critical access medication for opioid use disorder (MOUD) treatment facilities in the continental United States. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 6:100130. [PMID: 36994373 PMCID: PMC10040320 DOI: 10.1016/j.dadr.2022.100130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 11/25/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022]
Abstract
Research objective Medication opioid use disorder (MOUD) treatment is the first-line approach to the treatment of opioid use disorder (OUD). This analysis seeks to identify "critical access" MOUD facilities that ensure geographic access for MOUD patients. Using public-source data and spatial analysis, we identify the top 100 "critical access" MOUD units across the continental U.S. Study design We use locational data from SAMHSA's Behavioral Health Treatment Services Locator and DATA 2000 waiver buprenorphine providers. We identify the closest MOUDs to each ZIP Code Tabulation Area (ZCTA)'s geographic centroid. We then construct a difference-in-distance metric by computing the difference in this distance measure between closest and second-closest MOUD, multiplied by ZCTA population, ranking MOUDs by difference-distance scores. Population studied All listed MOUD treatment facilities and all listed ZCTA's across the continental U.S., and all listed MOUD providers proximate to these areas. Principal findings We identified the top 100 critical access MOUD units in the continental United States. Many critical providers were in rural areas in the central United States, as well as a band extending east from Texas to Georgia. Twenty-three of the top 100 critical access providers were identified as providing naltrexone. Seventy-seven were identified as providing buprenorphine. Three were identified as providing methadone. Conclusions Significant areas of the United States are dependent on a single critical access MOUD provider. Implications for policy or practice Place-based supports may be warranted to support MOUD treatment access in areas dependent upon critical access providers.
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Affiliation(s)
- Harold A. Pollack
- Crown Family School of Social Work, Policy & Practice, University of Chicago. 969 East 60th St., Chicago, IL 60637, United States
- University of Chicago Urban Health Lab, 33 North Lasalle St., Chicago, IL 60602, United States
- Department of Public Health Sciences, University of Chicago, 5841 S Maryland Ave, Chicago, IL 60637, United States
| | - Francis Lee
- Department of Medicine and Epidemiology, University of Chicago, 5841 S Maryland Ave, Chicago, IL 60637, United States
| | - Susan Paykin
- Center for Spatial Data Science, University of Chicago, 1155 East 60th St. Room 212, Chicago, IL 60637, United States
| | - Javier Andres Rojas Aguilera
- Center for Spatial Data Science, University of Chicago, 1155 East 60th St. Room 212, Chicago, IL 60637, United States
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Wakefield M, Sankaranarayanan J, Conroy JM, McLafferty S, Moser R, Murry VM, Slifkin R. National Institutes of Health pathways to prevention workshop: Improving rural health through telehealth-guided provider-to-provider communication. J Telemed Telecare 2022:1357633X221139630. [PMID: 36567435 DOI: 10.1177/1357633x221139630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Rural communities often face chronic challenges of high rates of serious health conditions coupled with inadequate access to health care services-challenges exacerbated by the COVID-19 pandemic. One strategy with the potential to mitigate these problems is the increased use of telehealth technology. A feature of telehealth applications-collaboration between health care providers for consultation and other purposes-referred to herein as Rural Provider-to-Provider Telehealth (RPPT), introduces important expertise that may not exist locally in rural communities. Literature indicates that RPPT is operationalized through many methods with an array of purposes. While RPPT is a promising strategy that brings additional expertise to patient-centered rural care delivery, there is limited evidence addressing important considerations, including how patient access and outcomes, provider satisfaction and performance, and payment may be affected by its use. METHODS Recognizing the significant potential of RPPT and the need for more information associated with its use, the National Institutes of Health convened a Pathways to Prevention (P2P) workshop to further understand RPPT's effectiveness and impact on improving health outcomes in rural settings. The P2P initiative, supported by several federal health agencies, engaged rural health stakeholders and experts to examine four key questions, identify related knowledge gaps, and provide recommendations to advance understanding of the use and impact of RPPT. RESULTS Included in this report is a description of the process used to generate information about RPPT, the identification of key knowledge gaps, and specific recommendations to further build needed evidence. DISCUSSION The emerging use of RPPT is an important tool for bridging gaps in access to care that impacts rural populations. However, to fully understand the value and effects of RPPT, new research is needed to fill the knowledge gaps identified in this report. Additionally, this report should help engage providers, payors, and policymakers interested in supporting evidence-informed RPPT practice, policy, and payment, with the ultimate aim of improving access to health care and health status of rural communities in the United States and worldwide.
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Affiliation(s)
- Mary Wakefield
- Department of Nursing, 12330The University of Texas at Austin, USA
| | | | | | | | - Robert Moser
- 375497University of Kansas Medical Center School of Health Professions, USA
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Cole ES, Allen L, Austin A, Barnes A, Chang CCH, Clark S, Crane D, Cunningham P, Fry CE, Gordon AJ, Hammerslag L, Idala D, Kennedy S, Kim JY, Krishnan S, Lanier P, Mahakalanda S, Mauk R, McDuffie MJ, Mohamoud S, Talbert J, Tang L, Zivin K, Donohue JM. Outpatient follow-up and use of medications for opioid use disorder after residential treatment among Medicaid enrollees in 10 states. Drug Alcohol Depend 2022; 241:109670. [PMID: 36332591 PMCID: PMC10756712 DOI: 10.1016/j.drugalcdep.2022.109670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/04/2022] [Accepted: 10/18/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Follow-up after residential treatment is considered best practice in supporting patients with opioid use disorder (OUD) in their recovery. Yet, little is known about rates of follow-up after discharge. The objective of this analysis was to measure rates of follow-up and use of medications for OUD (MOUD) after residential treatment among Medicaid enrollees in 10 states, and to understand the enrollee and episode characteristics that are associated with both outcomes. METHODS Using a distributed research network to analyze Medicaid claims data, we estimated the likelihood of 4 outcomes occurring within 7 and 30 days post-discharge from residential treatment for OUD using multinomial logit regression: no follow-up or MOUD, follow-up visit only, MOUD only, or both follow-up and MOUD. We used meta-analysis techniques to pool state-specific estimates into global estimates. RESULTS We identified 90,639 episodes of residential treatment for OUD for 69,017 enrollees from 2018 to 2019. We found that 62.5% and 46.9% of episodes did not receive any follow-up or MOUD at 7 days and 30 days, respectively. In adjusted analyses, co-occurring mental health conditions, longer lengths of stay, prior receipt of MOUD or behavioral health counseling, and a recent ED visit for OUD were associated with a greater likelihood of receiving follow-up treatment including MOUD after discharge. CONCLUSIONS Forty-seven percent of residential treatment episodes for Medicaid enrollees are not followed by an outpatient visit or MOUD, and thus are not following best practices.
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Affiliation(s)
- Evan S Cole
- University of Pittsburgh, A616, 130 DeSoto Street, Pittsburgh, PA 15261, USA
| | | | - Anna Austin
- University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | - Paul Lanier
- University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
| | | | | | | | | | | | - Lu Tang
- University of Pittsburgh, Pittsburgh, PA, USA
| | - Kara Zivin
- University of Michigan, Ann Arbor, MI, USA
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Ellis JD, Pasman E, Brown S, Lister JJ, Agius E, Resko SM. An examination of correlates of simultaneous opioid and benzodiazepine use among patients in medication treatment for opioid use disorder in a small midwestern community. J Addict Dis 2022; 40:542-551. [PMID: 35285423 PMCID: PMC9969715 DOI: 10.1080/10550887.2022.2042152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background: Concurrent and/or simultaneous use of opioids and benzodiazepines has been associated with increased risk of accident and injury, as well as with co-occurring psychopathology. Objectives: The purpose of the present study was to explore potential correlates of simultaneous opioid and benzodiazepine use in a small community, including perceived risk, positive screens for psychiatric symptoms, and opioid-related consequences. Methods: A sample of 267 participants were recruited from a medication treatment provider that serves a small Midwestern community. Multinomial logistic regression was used to explore demographic and mental health correlates associated with self-reports of past-year simultaneous use. Zero-inflated Poisson regression was used to explore past-year consequences associated with reported simultaneous benzodiazepine and opioid use. Results: Intentional simultaneous use of opioids and benzodiazepines was associated with greater anxiety and depression symptoms, greater likelihood of a positive PTSD screen, and low self-perceived risk of simultaneous use. Individuals reporting opioid/benzodiazepine simultaneous use were also more likely to report opioid-related consequences. Conclusions: Results highlight the importance of assessing and treating simultaneous opioid/benzodiazepine co-use, as well as relevant comorbidities.
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Affiliation(s)
- Jennifer D. Ellis
- Johns Hopkins University School of Medicine, Baltimore, MD
- Wayne State University School of Social Work, Detroit, MI
| | - Emily Pasman
- Wayne State University School of Social Work, Detroit, MI
| | - Suzanne Brown
- Wayne State University School of Social Work, Detroit, MI
| | - Jamey J. Lister
- Wayne State University School of Social Work, Detroit, MI
- Rutgers School of Social Work, New Brunswick, NJ
| | | | - Stella M. Resko
- Wayne State University School of Social Work, Detroit, MI
- Wayne State University Merrill Palmer Skillman Institute, Detroit, MI
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Saloner B, Landis RK, Jayakrishnan R, Stein BD, Barry CL. A bridge too far? Distance to waivered physicians and utilization of buprenorphine treatment for opioid use disorder in West Virginia Medicaid. Subst Abus 2022; 43:682-690. [PMID: 35099362 PMCID: PMC10105979 DOI: 10.1080/08897077.2021.1986882] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background: Travel distance to medication treatment for opioid use disorder (OUD) is a challenge for many patients, but little is known about how distance is associated with medication treatment utilization. This study examines the association between distance to the nearest physician waivered to prescribe buprenorphine and patient-level buprenorphine treatment among West Virginia Medicaid expansion enrollees with diagnosed OUD. Methods: We conducted a cross-sectional spatial analysis with 2016 Medicaid claims data, separately examining individuals living in metropolitan and non-metropolitan areas. We calculated the driving distance from the centroid of patients' residential ZIP codes to the street address of the nearest waivered physician derived from the 2015 Drug Enforcement Administration listing. Regression models examined the association between distance and initiation and duration of buprenorphine (among those initiating). Results: We focused on 8,008 individuals with OUD in 2016. The nearest waivered prescriber in metropolitan areas was an average of 7.13 miles away from patients' residential ZIP codes and 14.54 miles in non-metropolitan areas. The providers they actually visited were a mean of 33.63 miles away in metro areas and 46.36 in non-metropolitan areas. In multivariable analyses, compared to those living <10 miles from a waivered physician, living >20 miles from a waivered physician was associated with -32.13 fewer days of treatment (95% CI: -57.86, -6.40) in metro areas and -16.70 fewer days in non-metro areas (95% CI: -32.32, -1.08). Conclusions: Longer travel distance to buprenorphine treatment is associated with a shorter duration of care that is likely to be clinically meaningful.
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Affiliation(s)
- Brendan Saloner
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rachel K Landis
- Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, District Columbia, USA.,RAND Corporation, Pittsburgh, Pennsylvania, USA
| | - Ritujith Jayakrishnan
- Herbert Wertheim College of Medicine, Florida International University, Orlando, Florida, USA
| | | | - Colleen L Barry
- Jeb E. Brooks School of Public Policy, Cornell University, Ithaca, New York, USA
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Medical Detoxification for Nonopioid Substances Is Associated With Lower Likelihood of Subsequent Linkage to Substance Use Disorder Treatment. J Addict Med 2022; 16:653-658. [PMID: 35245917 PMCID: PMC9433460 DOI: 10.1097/adm.0000000000000984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Although factors associated with completion of medical detoxification treatment for substance use disorders (SUD) are well described, there is limited information on barriers and facilitators to subsequent linkage to SUD treatment in the community. This study aimed to evaluate correlates of successful linkage to community SUD treatment on discharge. METHODS Data were drawn from 2 prospective cohorts of people who use unregulated drugs in Vancouver, Canada between December 2012 and May 2018. Multivariable generalized estimating equations were used to investigate factors associated with linkage to community SUD treatment in the 6-month period after attending detoxification treatment. RESULTS Of the 264 detoxification treatment encounters contributed by 178 people who use unregulated drugs, these were most often (n = 104, 39%) related to polysubstance use, and the majority (n = 174, 66%) resulted in subsequent linkage to community treatment. In the multivariable analysis, compared to attending detoxification treatment for opioid use, attending detoxification treatment for stimulants (adjusted odds ratio [AOR] = 0.23, 95% confidence interval [CI] : 0.10-0.51) and alcohol (AOR = 0.17, 95% CI: 0.06-0.54) were associated with lower odds of subsequent linkage to community treatment. Conversely, later calendar year of detoxification treatment remained associated with higher odds (AOR = 1.23, 95% CI: 1.06-1.42). CONCLUSIONS Only two-thirds of detoxification treatment encounters in Vancouver were subsequently linked to community SUD treatment, with those related to nonopioid substances being less likely. Findings suggest the need for tailored interventions for specific substances to improve linkage to SUD treatment in the community on discharge.
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Cole TO, Robinson D, Kelley-Freeman A, Gandhi D, Greenblatt AD, Weintraub E, Belcher AM. Patient Satisfaction With Medications for Opioid Use Disorder Treatment via Telemedicine: Brief Literature Review and Development of a New Assessment. Front Public Health 2021; 8:557275. [PMID: 33553083 PMCID: PMC7859509 DOI: 10.3389/fpubh.2020.557275] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 12/17/2020] [Indexed: 01/30/2023] Open
Abstract
Telemedicine is increasingly being used to treat patients with opioid use disorder (OUD). It has particular value in rural areas of the United States impacted by the opioid crisis as these areas have a shortage of trained addiction medicine providers. Patient satisfaction significantly impacts positive clinical outcomes in OUD treatment and thus is of great clinical interest. Yet little is known regarding patient satisfaction with the increasingly important platform of telemedicine-delivered medications for opioid use disorder (tMOUD). The goal of this review is to provide a summary of the existing literature regarding patient satisfaction with tMOUD. We also submit a novel survey based on an existing framework designed to assess tMOUD satisfaction, and present pilot data (N = 14) acquired from patients engaged in rural tMOUD care. Telemedicine provides a feasible method for delivering MOUD in rural areas, and our survey provides a useful assessment to measure patient satisfaction with tMOUD. In light of the pressing need for innovative and technology-driven solutions to the opioid epidemic (especially in light of the COVID-19 pandemic), future research should focus on the development and refinement of tools to assess the important implementation goal of patient satisfaction.
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Affiliation(s)
- Thomas O. Cole
- Division of Addiction Research and Treatment, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Darlene Robinson
- Division of Addiction Research and Treatment, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States
| | | | - Devang Gandhi
- Division of Addiction Research and Treatment, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Aaron D. Greenblatt
- Division of Addiction Research and Treatment, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Eric Weintraub
- Division of Addiction Research and Treatment, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Annabelle M. Belcher
- Division of Addiction Research and Treatment, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States
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