Harm reduction journal · 2025
Harnessing telemedicine to deliver patient-centered opioid agonist treatment within a community-based harm reduction service: a mixed methods evaluation.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Høj Stine Bordier, Coignard-Friedman Rémi, Sako Aissata, de Montigny Catherine, Beauchemin-Nadeau Marie-Ève, Léandre Robert, Minoyan Nanor, Boyer-Legault Geneviève, Chougar Sofiane, Lamont Sara-Kim, Bruneau Julie
Аннотация
BACKGROUND: Patient-centered approaches may facilitate retention in opioid agonist treatment (OAT) but are challenging to implement in rigid or stigmatizing service contexts. We evaluate a telemedicine program delivering flexible, patient-centered OAT from a community-based harm reduction setting in Montreal, Canada.
METHODS: An OAT clinic was established in a community-based harm reduction setting with hospital-based addiction medicine services delivered remotely via telemedicine. Community workers screened clients, established telemedicine connections, and offered holistic patient follow-up. The medical team offered individualized OAT and other health services. Patients chose between treatment with methadone, buprenorphine/naloxone, or slow-release oral morphine. Hydromorphone co-prescription was also available. Effectiveness was assessed via longitudinal chart review and semi-structured interviews (n = 20). A convergent mixed method design was used to quantify retention rates and blood borne infection care up to 12 month follow up, and to examine patient reported program experiences.
RESULTS: Sixty-nine patients (46 men, 23 women; median age 38) initiated OAT between April 2020-March 2022. Most (96%) were injecting opioids, 56% were unstably housed, and 71% reported prior OAT. Patients typically initiated treatment with methadone (54%) or slow-release oral morphine (35%); 78% also received hydromorphone. Continuous retention in the first OAT episode was 83% at one month, 74% at three months, and 54% at 12 months. Disregarding prior treatment interruptions, 71% of patients were receiving OAT at 12 months. Most patients were assessed for HIV (77%) and HCV (78%), and 13/15 confirmed as HCV-positive initiated antiviral treatment. Trust, respect, and the alignment of practices with patient-centered care and harm reduction principles were critical to success. Integrating treatment within a community-based harm reduction setting enhanced accessibility and care coordination, and created a welcoming service environment. Diverse medication options, collaborative treatment planning, and a non-judgmental/non-punitive approach were key to developing positive therapeutic relationships.
CONCLUSION: Our community-based telemedicine program presents a novel framework for OAT delivery that efficiently bridges the health and community sectors. Working collaboratively around the patient, program partners leveraged their strengths to improve treatment experiences and promote retention.
METHODS: An OAT clinic was established in a community-based harm reduction setting with hospital-based addiction medicine services delivered remotely via telemedicine. Community workers screened clients, established telemedicine connections, and offered holistic patient follow-up. The medical team offered individualized OAT and other health services. Patients chose between treatment with methadone, buprenorphine/naloxone, or slow-release oral morphine. Hydromorphone co-prescription was also available. Effectiveness was assessed via longitudinal chart review and semi-structured interviews (n = 20). A convergent mixed method design was used to quantify retention rates and blood borne infection care up to 12 month follow up, and to examine patient reported program experiences.
RESULTS: Sixty-nine patients (46 men, 23 women; median age 38) initiated OAT between April 2020-March 2022. Most (96%) were injecting opioids, 56% were unstably housed, and 71% reported prior OAT. Patients typically initiated treatment with methadone (54%) or slow-release oral morphine (35%); 78% also received hydromorphone. Continuous retention in the first OAT episode was 83% at one month, 74% at three months, and 54% at 12 months. Disregarding prior treatment interruptions, 71% of patients were receiving OAT at 12 months. Most patients were assessed for HIV (77%) and HCV (78%), and 13/15 confirmed as HCV-positive initiated antiviral treatment. Trust, respect, and the alignment of practices with patient-centered care and harm reduction principles were critical to success. Integrating treatment within a community-based harm reduction setting enhanced accessibility and care coordination, and created a welcoming service environment. Diverse medication options, collaborative treatment planning, and a non-judgmental/non-punitive approach were key to developing positive therapeutic relationships.
CONCLUSION: Our community-based telemedicine program presents a novel framework for OAT delivery that efficiently bridges the health and community sectors. Working collaboratively around the patient, program partners leveraged their strengths to improve treatment experiences and promote retention.