# “It could bring a lot of help to people that aren’t getting help right now”: A qualitative analysis of the impact of virtual care on access to primary care for people with opioid use disorder

## TL;DR

This study explores how virtual care has affected primary care access for people with opioid use disorder in Canada, highlighting both benefits and challenges.

## Contribution

The study provides new insights into how virtual care can be tailored to improve equitable access to primary care for people with opioid use disorder.

## Key findings

- Virtual visits were seen as valuable for accessing primary care needs beyond opioid use disorder management.
- Tailoring virtual care to individual needs can promote equitable access for people with opioid use disorder.
- Virtual care experiences are influenced by dimensions like availability, accessibility, and affordability.

## Abstract

Primary care plays a vital role for people with opioid use disorder and the COVID-19 pandemic introduced new challenges for this population to access primary care. While the expansion of virtual care was intended to support access to essential primary care, little is known about how this has affected the ability of people with opioid use disorder to access the full range of primary care services. Our objective is to explore the experiences of family physicians and people with opioid use disorder to understand how virtual care has impacted primary care access for people with opioid use disorder in British Columbia, Canada. We conducted semi-structured interviews with people with opioid use disorder and licensed family physicians who provide care to this population. Interviews were recorded, transcribed, and thematically analyzed. We present participants’ experiences by the six dimensions of access: availability, accessibility, accommodation, affordability, acceptability, and awareness. Virtual visits were perceived by participants as a valuable option for accessing primary care needs, in addition to opioid use disorder management. These data describe how tailoring virtual care to the complex and intersecting needs of people with opioid use disorder can help promote equitable access to primary care. Our findings highlight the varied dimensions of access that influence virtual care experiences for people with opioid use disorder and their primary care providers. As virtual care becomes a routine primary care modality, ensuring equitable access will require attention to each dimension.

The COVID-19 pandemic drove a rapid and near-universal introduction of virtual visits in primary care in Canada. As a public health measure, virtual care provides a means to minimize exposure risks but, as a modality of delivering primary care, virtual care may compromise access for those who do not have the requisite technology or private spaces to accommodate confidential medical consultations. This is particularly salient amongst people with opioid use disorder who frequently face concurrent challenges of poverty, housing insecurity, and multiple ongoing health concerns. This not only compromises opioid use disorder care but also management of individuals’ overall health and wellbeing. Given the persistence of virtual care as a core primary care delivery modality beyond the pandemic, we conducted interviews with family physicians and people with opioid use disorder to understand how virtual care has impacted access to primary care. Our results demonstrate that virtual modalities can be a viable and desirable modality for accessing primary care. To promote more equitable access to primary care, however, family physicians must tailor their use of virtual care to the varied needs of people with opioid use disorder.