Literature Collection

Background: Opioid treatment programs are an essential component of the management of opioid use disorder (OUD). They have also been proposed as "medical homes" to expand health care access for underserved populations. We utilized telemedicine as a method to increase access for hepatitis C virus (HCV) care among people with OUD. Methods: We interviewed 30 staff and 15 administrators regarding the integration of facilitated telemedicine for HCV into opioid treatment programs. Participants provided feedback and insight for sustaining and scaling facilitated telemedicine for people with OUD. We utilized hermeneutic phenomenology to develop themes related to telemedicine sustainability in opioid treatment programs. Results: Three themes emerged on sustaining the facilitated telemedicine model: (1) Telemedicine as a Technical Innovation in Opioid Treatment Programs, (2) Technology Transcending Space and Time, and (3) COVID-19 Disrupting the Status Quo. Participants identified skilled staff, ongoing training, technology infrastructure and support, and an effective marketing campaign as key to maintaining the facilitated telemedicine model. Participants highlighted the study-supported case manager's role in managing the technology to transcend temporal and geographical challenges for HCV treatment access for people with OUD. COVID-19 fueled changes in health care delivery, including facilitated telemedicine, to expand the opioid treatment program's mission as a medical home for people with OUD. Conclusions: Opioid treatment programs can sustain facilitated telemedicine to increase health care access for underserved populations. COVID-19-induced disruptions promoted innovation and policy changes recognizing telemedicine's role in expanding health care access to underserved populations. ClinicalTrials.gov Identifier: NCT02933970.

BACKGROUND: Patients with schizophrenia have a significantly shorter life expectancy, emphasizing the need for better interventions for physical illness. Limited knowledge, unclear responsibilities, and insufficient collaboration between psychiatric and primary care services increase the risk of inadequate, uncoordinated, and delayed treatment for this vulnerable group. Therefore, the aim of this study was to explore healthcare professionals' experiences regarding support, treatment, and interprofessional collaboration for patients with schizophrenia and physical illness. METHOD: A qualitative study with semi-structured interviews of nine psychiatric and primary care professionals. Data were analyzed using qualitative content analysis. RESULTS: The analysis generated in an overall theme, Insufficient care coordination for patients with schizophrenia and physical illness of three categories, each with two subcategories. The first category, Inadequate internal clinical protocol, included the subcategories: difficulties in identifying physical illness and differing use of guidelines among healthcare institutions involved. The second category, Deficient division of responsibility included the subcategories: unclear defined division of responsibility for coordinating support and treatment and consequences of shared responsibility for pharmacotherapy. The third category, Lack of common clinical protocols included the subcategories: difficult to get in contact with one another and concrete suggestions concerning common clinical protocols. CONCLUSION: To counteract fragmented care for patient group, a more integrated care model is needed. The study highlights the importance of clearer allocation of responsibility, improved communication, standardized routines, and the implementation of coordinated individual care plans (CIP), as well as more user-friendly screening tools to enhance care quality and reduce the risk of treatment errors.