Key implementation factors in telemedicine-delivered medications for opioid use disorder: a scoping review informed by normalisation process theory

Teck, Joseph Tay Wee; Zlatkute, Giedre; Pérez, Alberto T.; Dritschel, Heidi; Ghosh, Abhishek; Potenza, Marc N.; Ambekar, Atul; Ekhtiari, Hamed; Stein, Dan J.; Khazaal, Yasser; Arunogiri, Shalini; Torrens, Marta; Ferri, Marica; Galea-Singer, Susanna; Baldacchino, Alex

doi:10.1016/s2215-0366(22)00374-1

Cited by 8 publications

(15 citation statements)

References 76 publications

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“…The development of overdose alert and response technologies (ODART) follows shifts over the past decade towards digitally mediated support options [ 18 , 19 ], while research in this area increased significantly during the COVID-19 pandemic, driven by restrictions on face-to-face service provision [ 20 , 21 ]. Yet, the acceptability of such technologies to PWUO remains a key concern [ 22 ], anticipating a negative impact to the uptake of, and engagement in, these interventions.…”

Section: Introductionmentioning

confidence: 99%

The acceptability of overdose alert and response technologies: introducing the TPOM-ODART framework

et al. 2023

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Background Opioids were implicated in approximately 88,000 fatal overdoses (OD) globally. However, in principle all opioid OD are reversible with the timely administration of naloxone hydrochloride. Despite the widespread availability of naloxone among people who use opioids (PWUO), many who suffer fatal OD use alone, without others present to administer the reversal agent. Recognising this key aspect of the challenge calls for innovations, a number of technological approaches have emerged which aim to connect OD victims with naloxone. However, the acceptability of OD response technologies to PWUO is of key concern. Methods Drawing on the Technology People Organisations Macroenvironment (TPOM) framework, this study sought to integrate acceptability-related findings in this space with primary research data from PWUO, affected family members and service providers to understand the factors involved in harm reduction technology acceptability. A qualitative study using a focus group methodology was conducted. The participant groups were people with lived experience of problem opioid use, affected family members and service providers. Data analysis followed a multi-stage approach to thematic analysis and utilised both inductive and deductive methods. Results Thirty individuals participated in one of six focus groups between November 2021 and September 2022. The analysis generated six major themes, three of which are reported in this article—selected for their close relevance to PWUO and their importance to developers of digital technologies for this group. ‘Trust—in technologies, systems and people’ was a major theme and was closely linked to data security, privacy and confidentiality. ‘Balancing harm reduction, safety and ambivalence’ reflects the delicate balance technological solutions must achieve to be acceptable to PWUO. Lastly, ‘readiness—a double bind’ encapsulates the perception shared across participant groups, that those at the highest risk, may be the least able to engage with interventions. Conclusion Effective digital strategies to prevent fatal OD must be sensitive to the complex relationships between technological, social/human, organisational and wider macroenvironmental factors which can enable or impede intervention delivery. Trust, readiness and performance are central to technology acceptability for PWUO. An augmented TPOM was developed (the TPOM-ODART).

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Section: Introductionmentioning

confidence: 99%

The acceptability of overdose alert and response technologies: introducing the TPOM-ODART framework

et al. 2023

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“…Improving access to and retention of MOUD will inevitably result in growing numbers in treatment, and services will need to adapt, evolve, and innovate to provide ongoing, safe, and effective care. Both the United States and Canada, with similar drug death crises, have developed models of TMOUD to improve service efficiency and the capacity to expand and meet the demand for treatment [ 48 ].…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…Third, the peer-reviewed evidence base for TMOUD has expanded greatly and continued to grow since the COVID-19 pandemic [ 48 ]. There were nearly 4 times more peer-reviewed publications on TMOUD in January 2023 compared with before 2020 [ 48 ]. This evidence base is dominated by US-based research, which differs in critical ways from the Scottish and UK contexts [ 48 ].…”

Section: Methodsmentioning

confidence: 99%

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Developing a Theoretically Informed Implementation Model for Telemedicine-Delivered Medication for Opioid Use Disorder: Qualitative Study With Key Informants

Tay Wee Teck,

Gittins,

Zlatkute

et al. 2023

JMIR Ment Health

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Background Telemedicine-delivered medication for opioid use disorder (TMOUD) has become more prevalent during the COVID-19 pandemic, particularly in North America. This is considered a positive development as TMOUD has the potential to increase access to evidence-based treatment for a population heavily affected by the opioid crisis and consequent rising mortality and morbidity rates in relation to opioid use disorder. Despite the increase in the use of TMOUD, there are no established service- and process-focused models to guide the implementation of this intervention. Objective This study aims to develop a process- and service-focused implementation model in collaboration with key stakeholders and bring together peer-reviewed literature, practice-based knowledge, and expert opinions. Methods The simple rules for evidence translation in complex systems framework was applied to guide the development of a 6-step qualitative study. The steps were definition of the scope and objectives of the model, identification of evidence, stakeholder engagement, draft model development, key informant consultation, and final model specification. Results The final specification for the TMOUD implementation model incorporated key strategic priorities, service delivery prerequisites, service design elements, stakeholder identification and engagement, key process domains, and iterative cycles of evaluation and improvement. Conclusions Through stakeholder engagement and key informant consultation, we produced a process- and service-focused TMOUD implementation model. The model is modifiable to different contexts and settings while also in keeping with the current evidence base and national and international standards of high-quality opioid use disorder care.

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“…Telehealth was also allowed to be used to conduct the counseling required for methadone administration and dispensation. Many substance use disorder treatment programs adapted by providing take-home methadone doses and leveraging telehealth for buprenorphine prescribing and delivering behavioral health counseling and other recovery support services during the pandemic; however, some programs closed altogether while others suspended some services and faced other operational and logistical barriers (e.g., staff shortages and limited in-person capacity) [ 49 – 51 , 53 – 58 ].…”

Section: Introductionmentioning

confidence: 99%

Structural and social changes due to the COVID-19 pandemic and their impact on engagement in substance use disorder treatment services: a qualitative study among people with a recent history of injection drug use in Baltimore, Maryland

Patel,

Grieb,

Winiker

et al. 2024

Harm Reduct J

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Background Substance use disorder treatment and recovery support services are critical for achieving and maintaining recovery. There are limited data on how structural and social changes due to the COVID-19 pandemic impacted individual-level experiences with substance use disorder treatment-related services among community-based samples of people who inject drugs. Methods People with a recent history of injection drug use who were enrolled in the community-based AIDS Linked to the IntraVenous Experience study in Baltimore, Maryland participated in a one-time, semi-structured interview between July 2021 and February 2022 about their experiences living through the COVID-19 pandemic (n = 28). An iterative inductive coding process was used to identify themes describing how structural and social changes due to the COVID-19 pandemic affected participants’ experiences with substance use disorder treatment-related services. Results The median age of participants was 54 years (range = 24–73); 10 (36%) participants were female, 16 (57%) were non-Hispanic Black, and 8 (29%) were living with HIV. We identified several structural and social changes due the pandemic that acted as barriers and facilitators to individual-level engagement in treatment with medications for opioid use disorder (MOUD) and recovery support services (e.g., support group meetings). New take-home methadone flexibility policies temporarily facilitated engagement in MOUD treatment, but other pre-existing rigid policies and practices (e.g., zero-tolerance) were counteracting barriers. Changes in the illicit drug market were both a facilitator and barrier to MOUD treatment. Decreased availability and pandemic-related adaptations to in-person services were a barrier to recovery support services. While telehealth expansion facilitated engagement in recovery support group meetings for some participants, other participants faced digital and technological barriers. These changes in service provision also led to diminished perceived quality of both virtual and in-person recovery support group meetings. However, a facilitator of recovery support was increased accessibility of individual service providers (e.g., counselors and Sponsors). Conclusions Structural and social changes across several socioecological levels created new barriers and facilitators of individual-level engagement in substance use disorder treatment-related services. Multilevel interventions are needed to improve access to and engagement in high-quality substance use disorder treatment and recovery support services among people who inject drugs.

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Key implementation factors in telemedicine-delivered medications for opioid use disorder: a scoping review informed by normalisation process theory

Cited by 8 publications

References 76 publications

The acceptability of overdose alert and response technologies: introducing the TPOM-ODART framework

The acceptability of overdose alert and response technologies: introducing the TPOM-ODART framework

Developing a Theoretically Informed Implementation Model for Telemedicine-Delivered Medication for Opioid Use Disorder: Qualitative Study With Key Informants

Structural and social changes due to the COVID-19 pandemic and their impact on engagement in substance use disorder treatment services: a qualitative study among people with a recent history of injection drug use in Baltimore, Maryland

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