ABSTRACT
Introduction
This mixed-methods study assessed buprenorphine provider and administrator perceptions and experiences in offering telebuprenorphine during the COVID-19 pandemic.
Methods
Semi-structured interviews were conducted between June 2021 and September 2021 among telebuprenorphine providers and administrators (N = 16) and assessed for program design and implementation strategies, clinical workflow, patient-level factors influencing program entry and retention, and challenges and solutions to improving clinical care.
Results
Clinician (n = 15) and administrator (n = 1) participants identified changes to clinical workflow, including increased administrative tasks to confirm patient receipt of prescribed medications, completion of referrals to community- or specialty treatment, and locating available pharmacies and laboratory services. Challenges consisted of staff redeployment to COVID-19 related responsibilities, prior authorization requirements for buprenorphine prescriptions, billing structures that under-reimbursed for telephone or video visits, and concerns with changes in government regulations. Strategies to improving telebuprenorphine included offering “hotlines” to facilitate same-day visits, expanding between-visit support, establishing workflows with community pharmacies to ensure seamless dispensing of buprenorphine, co-location of behavioral health providers, and distributing donated mobile phones to patients. Suggested technologies for enhancing care included text messaging (75%) and smartphone applications (56.3%).
Conclusions
Findings from this study highlight considerable heterogeneity in the delivery of telebuprenorphine services.
Disclosure statement
Dr. Lee has received in-kind study drug for recent and current NIDA-funded trials from Alkermes Inc and Indivior PLC. Dr. Lee has received a recent investigator sponsored study grant from Indivior PLC. Dr. Lee is a science advisor to Oar Health LLC. Dr. Tofighi is a consultant to Oar Health LLC.
Authors’ contributions
BT, RL, GA, ES, RW, and JB made substantial contributions to the conception and design; all coauthors were involved with the interpretation of data and drafting the manuscript.