Patient-Centered Telehealth Solution for Observed Urine Collections in Substance Use Disorder Care Delivery During COVID-19 and Beyond

Telemedicine along the cascade of care for substance use disorders during the COVID-19 pandemic in the United States

BACKGROUND

The COVID-19 pandemic has changed the landscape of healthcare service delivery. This review aims to describe telemedicine-delivered substance use disorder (SUD) treatments and services along the cascade of care in the U.S. after the start of the COVID-19 pandemic.

METHODS

A literature review was conducted on PubMed, Embase, Web of Science, and Cochrane Library (Wiley). English-language articles that describe any healthcare services for patients with SUDs using telemedicine in the U.S. since the onset of the COVID-19 pandemic were identified (N = 33). We narratively summarized telemedicine-based service provision along the cascade of SUD care, such as screening/assessment, prescription, monitoring, recovery support, and other services.

RESULTS

Soon after the onset of COVID-19 and mandated restrictions, cadres of healthcare providers from different specialties mobilized to ramp up video- and audio-based services to remotely treat patients with SUDs. Medication prescription (48.5%) and individual counseling (39.4%) were the most frequently reported services delivered via telemedicine. Other steps of SUD care delivered by telemedicine characterized in our review included SUD screening and assessment (30.3%), induction (21.2%), medication management (27.3%), monitoring (27.3%), recovery support (15.2%), and referral (24.2%). Feasibility issues and challenges to implementing telemedicine included patients' lack of access to technology and health insurance coverage, providers' capacity limits and concerns, and clinics' financial and office-space constraints.

CONCLUSION

The COVID-19 pandemic has offered a window of opportunity to advance telemedicine expertise by formalizing clinical guidance and routinizing provider in-service training in virtual SUD treatment. Findings suggest enhanced efforts to reduce disparities in telemedicine-based services.

Patient Experience from an eHealth Perspective: A Scoping Review of Approaches and Recent Trends

OBJECTIVES

Patients' experiences are increasingly gaining interest in multiple research fields. Researchers have applied various approaches to studying patient experience (PX); however, there is no commonly agreed-upon definition of PX. This scoping review focuses on PX from an eHealth perspective. Our aim was to: 1) describe how PX has been defined, 2) investigate which factors influencing PX and components of PX have been identified and researched, 3) explore the methods used in studying PX, and 4) find out the recent trends in PX research from an eHealth perspective.

METHODS

We selected six major journals covering the fields of health informatics, PX, and nursing informatics. Using the search terms "patient experience" and technology-related terms (e.g., digital, eHealth), we searched for articles published between 2019 and 2021. From 426 articles, 44 were included in the analysis.

RESULTS

Multiple concepts and meanings are used to refer to PX. Few articles include vague descriptions of the concept. Numerous eHealth factors are influencing PX, as well as components considering PX. The influencing factors were related to eHealth solutions' type and quality, and care process, when the components of PX were related to communication, remote interaction, risks and concerns, and patients' attitudes towards telehealth. Surveys were the main method used to study PX, followed by interviews.

CONCLUSIONS

PX is a complex and multifaceted phenomenon, and it is described as a synonym for patient satisfaction and telehealth experiences. Further multidisciplinary research is needed to understand PX as a phenomenon and to outline a framework for the research.

The North American opioid epidemic: opportunities and challenges for clinical laboratories

Since 1999, the opioid epidemic in North America has resulted in over 1 million deaths, and it continues to escalate despite numerous efforts in various arenas to combat the upward trend. Clinical laboratories provide drug testing to support practices such as emergency medicine, substance use disorder treatment, and pain management; increasingly, these laboratories are collaborating in novel partnerships including drug-checking services (DCS) and multidisciplinary treatment teams. This review examines drug testing related to management of licit and illicit opioid use, new technologies and test strategies employed by clinical laboratories, barriers hindering laboratory response to the opioid epidemic, and areas for improvement and standardization within drug testing. Literature search terms included combinations of "opioid," "opiate," "fentanyl," "laboratory," "epidemic," "crisis," "mass spectrometry," "immunoassay," "drug screen," "drug test," "guidelines," plus review of PubMed "similar articles" and references within publications. While immunoassay (IA) and point-of-care (POC) test options for synthetic opioids are increasingly available, mass spectrometry (MS) platforms offer the greatest flexibility and sensitivity for detecting novel, potent opioids. Previously reserved as a second-tier application in most drug test algorithms, MS assays are gaining a larger role in initial screening for specific patients and DCS. However, there are substantial differences among laboratories in terms of updating test menus, algorithms, and technologies to meet changing clinical needs. While some clinical laboratories lack the resources and expertise to implement MS, many are also slow to adopt available IA and POC tests for newer opioids such as fentanyl. MS-based testing also presents challenges, including gaps in available guidance for assay validation and ongoing performance assessment that contribute to a dramatic lack of standardization among laboratories. We identify opportunities for improvement in laboratory operations, reporting, and interpretation of drug test results, including laboratorian and provider education and laboratory-focused guidelines. We also highlight the need for collaboration with providers, assay and instrument manufacturers, and national organizations to increase the effectiveness of clinical laboratory and provider efforts in preventing morbidity and mortality associated with opioid use and misuse.