Acceptability of and Implementation Supports for Video Directly Observed Treatment to Enhance Methadone Dosing Flexibility in a Multisite Opioid Treatment Program: Qualitative Rapid Needs Assessment Study

TL;DR

A study explored how stakeholders in opioid treatment programs view using video to monitor methadone take-home doses, finding potential benefits but also concerns about staff workload.

Contribution

The study provides insights into stakeholder perceptions and needed supports for implementing video DOT in opioid treatment programs.

Findings

Stakeholders believed video DOT could reduce patient barriers like travel and stigma.

Concerns were raised about increased clinical staff workload due to video review.

Implementation supports like additional staff and clear communication were emphasized.

Abstract

Methadone is a first-line treatment for opioid use disorder, which is delivered in federally regulated opioid treatment programs (OTPs). Federal policies require directly observed dosing of methadone followed by graduated provision of nonobserved doses to take at home (ie, “take-home” dosing) after demonstrated stability is achieved. Policy changes since the COVID-19 pandemic have greatly expanded take-home dosing. Video directly observed treatment (video DOT) is an approach in which patients submit videos of themselves taking medications, which are asynchronously reviewed to verify adherence.

In preparation for an implementation trial evaluating the adoption of video DOT in OTP settings, we conducted a rapid needs assessment with multidisciplinary stakeholders to assess acceptability, perceived benefits, and needed support for video DOT to monitor take-home methadone dosing.

In our rapid needs assessment, we explored perspectives of multidisciplinary stakeholders (N=20) at 3 clinical sites within a single OTP in western Washington state. Trained qualitative researchers took ethnographic field notes during meetings with organizational leadership and in-person site visits with clinical and administrative staff. Field notes were analyzed via a team-based rapid assessment process using coding templates informed by the Consolidated Framework for Implementation Research. Summaries of qualitative data were iteratively reviewed by the study team and further confirmed with site stakeholders.

Stakeholders included leadership (n=6, 30%), medical providers (n=4, 20%), substance use disorder counselors (n=7, 35%), and clinic managers and support staff (n=3, 15%). Stakeholders perceived that video DOT could lessen the barriers patients face, including travel burden (eg, time and cost) and stigma. They also identified that video DOT could have important impacts on early care retention, given expansions of take-home dosing. However, stakeholders anticipated an added burden for clinical staff and emphasized the need for implementation supports that would limit burden, such as additional staff support for video submission review and clear communication pathways when video submissions require additional clinical input.

A rapid needs assessment of OTP sites for a future implementation study suggested that stakeholders saw potential benefits for patients receiving video DOT, but there were concerns that this would add to their work burden. Learnings informed the subsequent tailoring of clinical use cases and implementation supports.