Redesigning Access: Implementation and Evaluation of a Drop-In Clinic for Telehealth Opioid Use Disorder Treatment

Despite expanded access offered by telehealth, many people with opioid use disorder (OUD) miss treatment appointments due to personal and logistical challenges. While strategies such as reminders, incentives, and structured protocols aim to enhance continuity of care, little attention has been given to re-engagement strategies once a visit is missed. Ophelia, a telehealth-based OUD clinic, piloted a virtual drop-in clinic (DC) model to welcome patients back without shame, penalty, or delay.

The implementation of the DC was described, and confirmation and attendance rates were reported. Time between last missed appointment and next attended visit, and proportion of patients not attending any additional visits were reported among patients attending and not attending the DC. An anonymous feedback survey was sent to all DC participants, and results were summarized.

Seventy-one DCs were conducted, with 4029 invitations sent following missed appointments (2731 unique patients). Of these, 1014 (25%) confirmations were received (908 unique patients), 626 (62%) attended, and 554 (55%; 526 unique patients) were seen by a clinician. Among those seen, patients attended a mean of 1.1 (SD 0.2) DC visits. Patient satisfaction had mean ratings of 4.85/5 for overall experience and 4.90/5 for quality of care. Most respondents (97%) reported convenience and no issues with wait times. Mean time from a missed appointment to the next attended visit was 1.7 (SD 1.2) days for DC attendees, compared to 12.9 (SD 18.2) days among patients who confirmed but did not attend and 14.4 (SD 18.6) days among those who did not confirm. Discontinuation without return occurred in 7.8% and 21.4% of these groups, respectively.

The DC model is a feasible, novel approach to improving access to and continuity of OUD care. Future research should explore expanding the model for broader telehealth integration.