Substance Use Disorder Treatment Through Telemedicine in the Age of CoVID-19.

ABSTRACT: Telemedicine has been effective at bridging the gap between patients, providers, and health systems. As part of a large, academic medical center in Baltimore, MD, it has been found that using digital tools, particularly when access to care is otherwise limited, is beneficial to supporting recovery. However, there are barriers to telemedicine surrounding patient privacy and increased tendency of patients to avoid treatment. Maintaining personalized, evidence-based clinical care while limiting the spread of CoVID-19 has required swift adaptation from healthcare providers. The intent of this article is to discuss provider perspectives of benefits and barriers to telemedicine for substance use disorder treatment during the CoVID-19 pandemic.

COVID-19: Implications for Nursing and Health Care in the United States.

PURPOSE: COVID-19 and other recent infectious disease outbreaks have highlighted the urgency of robust, resilient health systems. We may now have the opportunity to reform the flawed health care system that made COVID-19 far more damaging in the United States (U.S.) than necessary. DESIGN AND METHODS: Guided by the World Health Organization (WHO) Health System Building Blocks framework (WHO, 2007) and the socio-ecological model (e.g., McLeroy et al., 1988), we identified challenges in and strengths of the U.S.' handling of the pandemic, lessons learned, and policy implications for more resilient future health care delivery in the U.S. Using the aforementioned frameworks, we identified crucial, intertwined domains that have influenced and been influenced by health care delivery in the U.S. during the COVID-19 pandemic through a review and analysis of the COVID-19 literature and the collective expertise of a panel of research and clinical experts. An iterative process using a modified Delphi technique was used to reach consensus. FINDINGS: Four critically important, inter-related domains needing improvement individually, interpersonally, within communities, and for critical public policy reform were identified: Social determinants of health, mental health, communication, and the nursing workforce. CONCLUSIONS: The four domains identified in this analysis demonstrate the challenges generated or intensified by the COVID-19 pandemic, their dynamic interconnectedness, and the critical importance of health equity to resilient health systems, an effective pandemic response, and better health for all. CLINICAL RELEVANCE: The novel coronavirus is unlikely to be the last pandemic in the U.S. and globally. To control COVID-19 and prevent unnecessary suffering and social and economic damage from future pandemics, the U.S. will need to improve its capacity to protect the public's health. Complex problems require multi-level solutions across critical domains. The COVID-19 pandemic has underscored four interrelated domains that reveal and compound deep underlying problems in the socioeconomic structure and health care system of the U.S. In so doing, however, the pandemic illuminates the way toward reforms that could improve our ability not only to cope with likely future epidemics but also to better serve the health care needs of the entire population. This article highlights the pressing need for multi-level individual, interpersonal, community, and public policy reforms to improve clinical care and public health outcomes in the current COVID-19 pandemic and future pandemics, and offers recommendations to achieve these aims.

Substance Use Disorder Treatment via Telemedicine During Coronavirus Disease 2019.

Telemedicine has been effective at bridging the gap among patients, providers, and health systems. Authors from a large academic medical center in Baltimore, MD, anecdotally found that digital tools were beneficial in supporting substance use disorder recovery during a global pandemic. Audiovisual tools like Zoom (Zoom Video Communications, Inc, San Jose, CA) and Doximity (Doximity, Inc, San Francisco, CA), as well as increased frequency of communication with patients, have been most helpful to supporting recovery. The barriers noted were related to patient privacy and increased tendency of patients to avoid treatment, similar barriers as when treatment is provided in the clinic. The intent of this narrative is to discuss provider perspectives of benefits and barriers to telemedicine for substance use disorder treatment during the coronavirus disease 2019 pandemic.