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"Getting Your Feet Wet": Veteran Perspectives on a Telemedicine Physician-Pharmacist Management Model for Substance
Courtney Tuegel1,2, Olivia V Fletcher3, Meghan Storms3
1Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System Seattle Division, Seattle, WA, USA. courtney.tuegel@va.gov.
Background:
Substance use disorders (SUDs) are common among United States Veterans. Despite the availability of effective medications for opioid and alcohol use disorders (MOAD), a minority receive them. To address this gap, a telemedicine physician-pharmacist management model (PPMM) was piloted at six Veterans Health Administration (VHA) clinics serving rural Veterans for same-day SUD assessment and medication initiation within primary care.
Objective:
We qualitatively evaluated patient-perceived barriers and facilitators to the PPMM service.
Design:
Qualitative study PARTICIPANTS: We interviewed 20 Veterans referred to the PPMM service across 6 VHA community-based outpatient clinics in the Pacific Northwest.
Approach:
Interview transcripts were reviewed and qualitatively analyzed using a combination of deductive/inductive thematic analysis.
Key Results:
Of those interviewed (N = 20), 80% were male, 80% white, 95% had AUD, 5% had OUD, 25% resided rurally, and 11 (55%) recalled use of the PPMM service. All Veterans who recalled the service would recommend it to others. Participant-identified barriers and facilitators spanned three domains: (1) same-day telemedicine care delivery, (2) quality of PPMM team interactions, and (3) acceptability of pharmacotherapy. (1) Participants reported that telemedicine afforded timely, proactive, and streamlined care, though some described technological and logistical communication challenges with telemedicine. Several participants emphasized the privacy benefits of telemedicine, particularly for SUD care among rural Veterans. (2) Veterans highlighted the importance of the Veteran-provider relationship in SUD treatment, noted that addiction medicine-trained PPMM team members were skilled at thoughtfully providing care, and described that they perceived PPMM team members as genuine. A minority of participants struggled to build rapport with SUD providers. (3) Many participants perceived MOAD positively, describing it as a non-intrusive, easy starting place to "get your feet wet" in SUD treatment.
Conclusions:
PPMM was identified as a good starting point for Veterans to access SUD treatment quickly, conveniently, and privately through primary care.
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