Facilitated Telemedicine as a Patient-Centered, Sociotechnical Intervention to Integrate Hepatitis C Treatment Into Opioid Treatment Programs and Overcome the Digital Divide Among Underserved Populations: Qualitative Study
Notice bibliographique
Résumé
Background: People with opioid use disorder (OUD) have the highest rates of hepatitis C virus (HCV) infection. Despite the availability of curative HCV medication, people with OUD have limited health care access largely due to stigma. In a recent, pragmatic, randomized controlled trial (RCT), we compared a facilitated telemedicine intervention for HCV treatment integrated into opioid treatment programs (OTPs) with off-site referral. Facilitated telemedicine is bidirectional videoconferencing between a remote provider and a patient, supported by a case manager who facilitates the telemedicine encounter. The case manager schedules telemedicine visits, provides appointment reminders, and operates the digital equipment. Among 602 participants in the RCT, 90% (n=262) were cured through facilitated telemedicine and 39% (n=123) were cured through off-site referral. In this work, a multidisciplinary group of investigators, who directed the RCT, conducted a workshop, "Advancing Viral Hepatitis Screening and Treatment in Opioid Treatment Settings - Models & Resources," at the American Association for Treatment of Opioid Dependence Conference in May 2024 to disseminate knowledge of facilitated telemedicine, including implementation considerations. We highlighted facilitated telemedicine as a patient-centered, sociotechnical, pragmatic health care delivery model for underserved populations. Objective: This study aimed to identify lessons learned to successfully overcome challenges of facilitated telemedicine implementation for HCV treatment integrated into OTPs. Methods: We partnered with the National Alliance of State and Territorial AIDS Directors in planning the workshop. The workshop consisted of 7 presentations on topics related to facilitated telemedicine implementation. The workshop was recorded and transcribed by Zoom (Zoom Communications). The transcripts served as data for the thematic analysis. The transcripts were interpreted to elucidate patterns of meanings and nuances derived from each presentation. In an iterative process, preliminary findings were compared and coalesced into themes. Verbatim quotes from the workshop were highlighted to support the themes. Results: We developed 3 themes. First, patient-centered care promotes HCV treatment for underserved populations through facilitated telemedicine. Case managers leveraged the destigmatizing environment of the OTP to build trust with patients, promoting an HCV cure through facilitated telemedicine. Second, sociotechnical approaches expand health care access for people with OUD. To be effective, facilitated telemedicine integrates 2 necessary components, a social aspect and a technical aspect. Third, facilitated telemedicine supports pragmatic research emphasizing people with OUD. Pragmatic research of facilitated telemedicine is needed to assess sustainability and scaling considerations beyond OTPs. Overall, we found that facilitated telemedicine overcame the digital divide, promoting access to digital technology, internet provision, and digital literacy. Conclusions: Facilitated telemedicine incorporates both a technical and a social component. The technical component largely addresses geographical challenges, while the social component addresses temporal (ie, care coordination) issues, promotes trust, and largely assuages patients' concerns related to HCV treatment. The patient-centered, sociotechnical intervention can address the digital divide, thereby increasing health care access.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,016 | 0,017 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,006 | 0,005 |
| Communication savante | 0,002 | 0,003 |
| Science ouverte | 0,001 | 0,004 |
| Intégrité de la recherche | 0,001 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».