Literature Collection

BACKGROUND: The COVID-19 pandemic catalyzed a rapid shift in healthcare delivery towards telehealth services, impacting patient care, including opioid use disorder (OUD) treatment. Regulatory changes eliminated the in-person evaluation requirement for buprenorphine treatment, encouraging adoption of telehealth. This study focused on understanding experiences of primary care providers in predominantly rural areas who used telehealth for OUD treatment during the pandemic. METHODS: Semi-structured interviews were conducted with 22 primary care providers. Participants practiced in 13 rural and 9 urban counties in Kentucky and Arkansas. Data were analyzed using conventional content analysis. RESULTS: The pandemic significantly impacted healthcare delivery. While telehealth was integrated for behavioral health counseling, in-person visits remained crucial, especially for urine drug screenings. Telehealth experiences varied, with some facing technology issues, while others found it efficient. Telehealth proved valuable for behavioral health counseling and sustaining relationships with established patients. Patients with OUD faced unique challenges, including housing, internet, transportation, and counseling needs. Stigma surrounding OUD affected clinical relationships. Building strong patient-provider relationships emerged as a central theme, emphasizing the value of face-to-face interactions. Regarding buprenorphine training, most found waiver training helpful but lacked formal education. CONCLUSION: This research offers vital guidance for improving OUD treatment services, especially in rural areas during crises like the COVID-19 pandemic. It highlights telehealth's value as a tool while acknowledging its limitations. The study underscores the significance of strong patient-provider relationships, the importance of reducing stigma, and the potential for training programs to elevate quality of care in OUD treatment.

BACKGROUND: Medicare annual wellness visits (AWVs) are vital for older adults' preventive care, which was transitioned to telehealth modalities during COVID-19. This study examined primary care providers' perceptions of telehealth-delivered AWVs and explored the factors influencing telehealth implementation using the Practical Robust Implementation and Sustainability Model (PRISM). PARTICIPANTS AND SETTING: Twenty-five primary care providers from eight clinics within an integrated health system in the Midwestern United States were interviewed. Eligibility required having conducted at least one telehealth AWV for patients aged 65 or older between March 2023 and October 2023. METHODS: Semi-structured interviews lasting 30-45 min were conducted using purposeful sampling. Topics aligned with PRISM domains were addressed: program (telehealth utilization), recipient (organizational characteristics), external environment, and implementation infrastructure. Data were analyzed using NVivo software, using inductive and deductive thematic coding. RESULTS: Providers described telehealth AWV as flexible, convenient, and efficient. Benefits included shorter visit durations and the ability to observe patients' home environments. Challenges included difficulty conducting cognitive and mobility assessments, limitations in physical exams, and managing patients with hearing or visual impairments without caregiver support. Most providers did not perceive language as a major barrier, particularly for Spanish-speaking patients (Program domain). Providers noted that limited internet, device access, and lack of community technology support, especially in underserved areas, hindered telehealth use. They also emphasized the importance of maintaining reimbursement parity between telehealth and in-person visits (External Environment). Providers reported minimal formal training and inconsistent access to telehealth-equipped rooms, though support from colleagues and workflow adaptations helped address these limitations (Implementation Infrastructure). Staff support, particularly through pre-visit coordination, technical troubleshooting, and patient preparation, was crucial in implementing telehealth (Recipient). CONCLUSION: This study provided valuable insights into the implementation of telehealth AWVs and underscored the importance of organizational support for sustainable telehealth practices in primary care settings.