Theme 1: Embracing facilitated telemedicine in the OTP
hepatitis
DISORDER, VIRUS, HEPATITIS C, LITTLE, HEPATITIS
Participants viewed their OTPs as supportive and trusting environments, qualities that extended to the telemedicine encounter and provider. Overall, participants were enthusiastic about healthcare delivery through facilitated telemedicine. One participant explained that onsite facilitated telemedicine for healthcare delivery mitigated the apprehension he/she faced as a substance user when referred to offsite healthcare settings. ‘I would be more comfortable at my methadone clinic than going to a primary care doctor or the emergency room’. Participants elaborated how facilitated telemedicine expanded healthcare access in a convenient setting and removed barriers to care, such as transportation:I honestly wouldn't have done it [HCV treatment]; I would have put it off. Telemedicine saves so much time, as opposed to getting in the car, going to the doctor, waiting in line, [and] checking in. It's been a wonderful experience.Participants were initially anxious about telemedicine encounters. After the study‐supported case manager provided HCV education that also addressed misconceptions and assured privacy and confidentiality during the encounter, they became more accepting of facilitated telemedicine. One participant elaborated:They didn't push anything, they explained how it works and broke it down in [an] understandable way. They're very discreet… It's a one‐on‐one type of atmosphere.The case manager was also an onsite telemedicine facilitator as well as a convenient go‐to person who alleviated study participants' fears and concerns, encouraging and integrating patient‐centred care into the OTP for hepatitis CWhen I got my [test] results that I have hepatitis C again, [the case manager] called me to the office and spoke to me in person [about] treatment. She explained [that the] new medicine is not the old medicine.The case managers leveraged the caring atmospheres of the OTP for effective facilitated telemedicine:The case manager made me feel the most comfortable that I've ever felt, even though they knew I was an IV drug user. They actually will take your hand if you're having a bad day and give you a hug. Little things like that, they're constantly smiling, telling you good things about how you're doing, showing you the levels [of the virus], that just makes you feel good.Participants also valued the integration of HCV treatment within the OTP that provided seamless interactions between the case manager and OTP staff:Everybody that participated, doctors, workers, I couldn't ask for a better group. Always checking on you… I still tell people to this day how excellent it was.Participants also valued onsite care and summarized advantages that are related to colocation of HCV care within the OTP:Even if you're somebody that goes to the clinic every day, being able to get your [HCV] dose at the window is perfect, because a lot of people forget about taking their dose. You're already there and you're already taking your [substance use disorder] medication.