Patient Satisfaction with MOUD Treatment via Telemedicine: Development of a New Assessment

INTRODUCTION/BACKGROUND. Treatment with medications, including buprenorphine and naltrexone, are the frontline treatment for opioid use disorder (OUD). With high rates of opioid overdose deaths and few providers able to prescribe medications, however, rural areas are among the areas most severely impacted by opioid overdose and OUD(1). For these areas, and in light of the COVID-19 pandemic, telemedicine plays an increasingly important role.

Since 2015, the University of Maryland School of Medicine (UMSOM) Division of Addiction Research and Treatment (DART) has been at the forefront of delivering MOUD via telemedicine (tMOUD) to rural areas of the state of Maryland. Partnering with rural intensive outpatient (IOP) and behavioral treatment programs, our clinicians have treated over 500 patients with tMOUD(2).

Several reports have assessed satisfaction with clinical telehealth encounters to show that patient satisfaction is an important driver in the determination of positive treatment outcomes, including reductions in substance use and greater retention, compliance and patient engagement(3). Yet only a handful of reports have investigated patient satisfaction with telemedicine, and no report has been conducted to assess patient satisfaction in the context of tMOUD.

METHODS. Here we report on the development and proof-of-concept implementation of a novel patient satisfaction survey specific to tMOUD. We created a 16-item survey based on characteristics of previously published patient satisfaction surveys, utilizing the following thematic categories to frame the patient’s subjective experience: (i) Communication; (ii) Privacy; (iii) Patient Perceptions; (iv) Technology Utilization; and (v) Treatment Access.

New clients enrolling into tMOUD treatment with one of our rural IOP program partner sites (LEWC, Inc.) were approached between September and October 2019 via convenience sampling. Participants voluntarily completed the anonymous survey following their initial tMOUD encounter. The Likert-like survey was administered via touchscreen tablet and data were electronically recorded and stored in a remote, HIPAA-compliant UMSOM-maintained database.

RESULTS. A total of 14 new intake participants agreed to complete the tMOUD patient satisfaction survey. The preliminary findings showed an overall positive experience with tMOUD, with participants either agreeing/strongly agreeing with statements pertaining to: (i) Communication: 100% experienced a positive exchange of information; (ii) Privacy: 64% were comfortable with the level of session confidentiality; (iii) Patient Perceptions: 86-100% accepted the telemedicine medium, validated the care, and expressed likability/willingness to be seen again by the telemedicine doctor; (iv) Technology Utilization: 100% could see/hear the telemedicine doctor very well; (v) Treatment Access: 36% agreed/agreed strongly that they would not have received MOUD treatment were it not for the tMOUD program, 71% were satisfied with the time the doctor spent with them on the tMOUD session, and 79% were satisfied with the number of days lag between tMOUD enrollment and treatment initiation.

DISCUSSION. Telemedicine provides a feasible method for delivering MOUD in rural areas, and addresses the growing need for remote, contactless methods of health care delivery that has emerged because of COVID-19. As an important implementation outcome that ultimately determines tMOUD uptake and adoption, future studies on patient satisfaction are warranted.

References: 1. Hancock C., Mennenga H., King N., Andrilla H., Larson E., Schou P. Treating the rural opioid epidemic. National Rural Health Association (2017). https://www.ruralhealthweb.org/NRHA/media/Emerge_NRHA/Advocacy/Policy%20documents/2019-NRHA-Policy-Document-Treating-the-Rural-Opioid-Epidemic.pdf

2. Weintraub E., Greenblatt AD., Chang J., et al. Outcomes for patients receiving telemedicine delivered medication-based treatment for opioid use disorder: a retrospective chart review. Heroin Addict Relat Clin Probl (2020). Published ahead of print March 27, 2020. https://www.heroinaddictionrelatedclinicalproblems.org/harcp-archives-doi-articles.php

3. Carlson MJ., Gabriel RM. Patient Satisfaction, Use of Services, and One-Year Outcomes in Publicly Funded Substance Abuse Treatment. Psychiatr Serv (2001) 52:1230–6.