PDF(Pubmed)
Abstract：
BACKGROUND: Telemedicine has the potential to remove geographic and temporal obstacles to health care access. Whether and how telemedicine can increase health care access for underserved populations remains an open question. To address this issue, we integrated facilitated telemedicine encounters for the management of hepatitis C virus (HCV), a highly prevalent condition among people with opioid use disorder (OUD), into opioid treatment programs (OTPs). In New York State, OTPs are methadone-dispensing centers that provide patient-centered, evidence-based treatment for OUD. We investigated the integration and impact of facilitated telemedicine into OTP workflows in these settings.
OBJECTIVE: This study aims to understand OTP staff experiences with integrating facilitated telemedicine for HCV treatment into OTPs, including best practices and lessons learned.
METHODS: We conducted semistructured interviews with 45 OTP staff members (13 clinical, 12 administrative, 6 physicians, and 14 support staff members) at least one year after the implementation of facilitated telemedicine for HCV management. We used hermeneutic phenomenological analysis to understand OTP staff experiences.
RESULTS: We identified 4 overarching themes illustrating the successful integration of facilitated telemedicine for HCV care into OTPs. First, integration requires an understanding of the challenges, goals, and values of the OTP. As OTP staff learned about new, highly effective HCV therapies, they valued an HCV cure as a \"win\" for their patients and were excited about the potential to eliminate a highly prevalent infectious disease. Second, the integration of facilitated telemedicine into OTPs fosters social support and reinforces relationships between patients and OTP staff. OTP staff appreciated the ability to have \"eyes on\" patients during telemedicine encounters to assess body language, a necessary component of OUD management. Third, participants described high levels of interprofessional collaboration as a care team that included the blurring of lines between disciplines working toward a common goal of improving patient care. Study case managers were integrated into OTP workflows and established communication channels to improve patient outcomes. Fourth, administrators endorsed the sustained and future expansion of facilitated telemedicine to address comorbidities.
CONCLUSIONS: OTP staff were highly enthusiastic about facilitated telemedicine for an underserved population. They described high levels of collaboration and integration comparable to relevant integrative frameworks. When situated within OTPs, facilitated telemedicine is a high-value application of telemedicine that provides support for underserved populations necessary for high-quality health care. These experiences support sustaining and scaling facilitated telemedicine in comparable settings and evaluating its ability to address other comorbidities.
BACKGROUND: ClinicalTrials.gov NCT02933970; https://clinicaltrials.gov/study/NCT02933970.
OBJECTIVE: This study aims to understand OTP staff experiences with integrating facilitated telemedicine for HCV treatment into OTPs, including best practices and lessons learned.
METHODS: We conducted semistructured interviews with 45 OTP staff members (13 clinical, 12 administrative, 6 physicians, and 14 support staff members) at least one year after the implementation of facilitated telemedicine for HCV management. We used hermeneutic phenomenological analysis to understand OTP staff experiences.
RESULTS: We identified 4 overarching themes illustrating the successful integration of facilitated telemedicine for HCV care into OTPs. First, integration requires an understanding of the challenges, goals, and values of the OTP. As OTP staff learned about new, highly effective HCV therapies, they valued an HCV cure as a \"win\" for their patients and were excited about the potential to eliminate a highly prevalent infectious disease. Second, the integration of facilitated telemedicine into OTPs fosters social support and reinforces relationships between patients and OTP staff. OTP staff appreciated the ability to have \"eyes on\" patients during telemedicine encounters to assess body language, a necessary component of OUD management. Third, participants described high levels of interprofessional collaboration as a care team that included the blurring of lines between disciplines working toward a common goal of improving patient care. Study case managers were integrated into OTP workflows and established communication channels to improve patient outcomes. Fourth, administrators endorsed the sustained and future expansion of facilitated telemedicine to address comorbidities.
CONCLUSIONS: OTP staff were highly enthusiastic about facilitated telemedicine for an underserved population. They described high levels of collaboration and integration comparable to relevant integrative frameworks. When situated within OTPs, facilitated telemedicine is a high-value application of telemedicine that provides support for underserved populations necessary for high-quality health care. These experiences support sustaining and scaling facilitated telemedicine in comparable settings and evaluating its ability to address other comorbidities.
BACKGROUND: ClinicalTrials.gov NCT02933970; https://clinicaltrials.gov/study/NCT02933970.
摘要：
背景：远程医疗具有消除地理和时间障碍的潜力。远程医疗是否以及如何增加服务不足人群的医疗保健机会仍然是一个悬而未决的问题。为了解决这个问题，我们整合了促进的远程医疗相遇，以管理丙型肝炎病毒（HCV），阿片类药物使用障碍（OUD）人群中非常普遍的疾病，阿片类药物治疗计划(OTP)。在纽约州,OTP是美沙酮配药中心，以患者为中心，OUD的循证治疗。我们调查了在这些设置中促进远程医疗与OTP工作流程的整合和影响。
目的：本研究旨在了解OTP工作人员将便利的远程医疗HCV治疗整合到OTP中的经验，包括最佳实践和经验教训。
方法：我们对45名OTP工作人员进行了半结构化访谈（13名临床，12行政、6位医生,和14名支持人员）在实施便利的HCV管理远程医疗后至少一年。我们使用诠释学现象学分析来了解OTP员工的经验。
结果：我们确定了4个总体主题，说明了将便利的远程医疗HCV护理成功整合到OTP中。首先,整合需要对挑战的理解，目标,和OTP的值。随着OTP工作人员了解到新的，高效的HCV疗法，他们认为HCV治愈对患者来说是“胜利”，并对消除高度流行的传染病的潜力感到兴奋。第二,将便利的远程医疗纳入OTP可促进社会支持,并加强患者与OTP工作人员之间的关系.OTP工作人员赞赏在远程医疗接触期间“关注”患者以评估肢体语言的能力，OUD管理的必要组成部分。第三，参与者将高水平的跨专业合作描述为一个护理团队,其中包括为改善患者护理的共同目标而工作的学科之间的界限模糊.研究案例管理人员被整合到OTP工作流程中，并建立了沟通渠道以改善患者预后。第四，管理人员赞同促进远程医疗的持续和未来扩展，以解决合并症。
结论：OTP工作人员非常热衷于为服务不足的人群提供便利的远程医疗服务。他们描述了与相关综合框架相当的高水平协作和整合。当位于OTP内时，便利的远程医疗是远程医疗的高价值应用，为高质量医疗保健所必需的服务不足的人群提供支持。这些经验支持在可比环境中维持和扩展促进远程医疗，并评估其解决其他合并症的能力。
背景：ClinicalTrials.govNCT02933970;https://clinicaltrials.gov/study/NCT02933970。
目的：本研究旨在了解OTP工作人员将便利的远程医疗HCV治疗整合到OTP中的经验，包括最佳实践和经验教训。
方法：我们对45名OTP工作人员进行了半结构化访谈（13名临床，12行政、6位医生,和14名支持人员）在实施便利的HCV管理远程医疗后至少一年。我们使用诠释学现象学分析来了解OTP员工的经验。
结果：我们确定了4个总体主题，说明了将便利的远程医疗HCV护理成功整合到OTP中。首先,整合需要对挑战的理解，目标,和OTP的值。随着OTP工作人员了解到新的，高效的HCV疗法，他们认为HCV治愈对患者来说是“胜利”，并对消除高度流行的传染病的潜力感到兴奋。第二,将便利的远程医疗纳入OTP可促进社会支持,并加强患者与OTP工作人员之间的关系.OTP工作人员赞赏在远程医疗接触期间“关注”患者以评估肢体语言的能力，OUD管理的必要组成部分。第三，参与者将高水平的跨专业合作描述为一个护理团队,其中包括为改善患者护理的共同目标而工作的学科之间的界限模糊.研究案例管理人员被整合到OTP工作流程中，并建立了沟通渠道以改善患者预后。第四，管理人员赞同促进远程医疗的持续和未来扩展，以解决合并症。
结论：OTP工作人员非常热衷于为服务不足的人群提供便利的远程医疗服务。他们描述了与相关综合框架相当的高水平协作和整合。当位于OTP内时，便利的远程医疗是远程医疗的高价值应用，为高质量医疗保健所必需的服务不足的人群提供支持。这些经验支持在可比环境中维持和扩展促进远程医疗，并评估其解决其他合并症的能力。
背景：ClinicalTrials.govNCT02933970;https://clinicaltrials.gov/study/NCT02933970。
