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Heroin Addiction and Related Clinical Problems: 2023, 25, N3 (pages: 27 - 36)

Telemedicine in Addictions: Feasibility Randomised Controlled Trial

Mayet S., Gledhill A., McCaw I., Hashmani Z., Drozdova Z., Arshad S., Shahbaz S., Huang C., and Phillips T.

Summary: Background. Opioid dependence is high risk. Opioid substitution treatment (OST) improves outcomes and reduces deaths. Nonattendance at addiction specialist prescribers who monitor OST worsens outcomes. Telemedicine has been shown to improve attendance with limited evidence in addictions. Aim. This feasibility trial aimed to assess feasibility for a larger trial assessing attendance, travel, clinical outcomes and satisfaction. Methods. Adult opioid dependent patients prescribed OST, attending outreach clinics within a United Kingdom community addiction service, were recruited to a feasibility randomised controlled trial of Telemedicine versus Face-to-Face addiction prescriber consultations. Patients were offered two appointments in their randomized group. Follow-up research interviews conducted with patients and staff. Analysis undertaken by SPSS. Results. Fifty-nine opioid dependent patients randomised to Telemedicine (n=29) and Face-to-Face (n=30) consultations. Attendance 76.7% Face-to-Face vs 72.4% Telemedicine (first consultation). Attendance at second consultation lower overall as eighteen of 118 consultations not conducted (COVID-19). One-way travel reduced with Telemedicine by 6.3km (first consultation) and 8km (second consultation). Clinical outcomes stable between the groups. Follow up high retention (n=58). Both patient (n=58) and staff (n=19) participants reported similar levels of satisfaction for Telemedicine versus Face-to-Face. Conclusions. Patients and staff found Telemedicine satisfactory, with similar attendance rates, clinical outcomes and reduced travel. This is important given COVID-19 changes where telemedicine has been started. Our study shows a large scale RCT is feasible. Limitations include COVID19 impact, more severe dependence and lack of diversity of recruited population.