Provider and administrator attitudes and experiences with implementing telebuprenorphine during the COVID-19 pandemic: a mixed-methods survey

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.

KEYWORDS:

• Buprenorphine
• COVID-19
• opioid use disorder
• telemedicine

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.

Additional information

Funding

The project was supported by the National Institute on Drug Abuse [K23DA042140-01A1]. Dr. Wightman is partially supported by the National Institute of General Medical Sciences of the NIH under grant number P20GM125507 and NIDA under grant number R21DA055023. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.