Facilitated telemedicine for HCV: Addressing challenges for improving health and life for people with opioid use disorder
addict”’.‘If, go”’.‘Confidentiality, pain, hepatitis C, drug abuse, hepatitis
HEPATITIS C, VIRUS, SAID, HEPATITIS
Participants underscore the convenience and confidentiality of facilitated telemedicine integrated into the OTP, providing access to patient‐centred care, and circumventing external providers. They embrace facilitated telemedicine as promoting a therapeutic relationship between patients and telemedicine providers. These relationships are facilitated by a case manager who builds trust with patients, answers their questions, and facilitates the telemedicine encounter (Additional supportive participant quotations.‘I think it [telemedicine] was great for me because I don't like doctors, I don't like hospitals, and to be able get this done while coming into the clinic was wonderful’.‘Telemedicine is a good experience, just like [the doctor] was there, easy conversation’.‘I know it's going to take a while for telemedicine to [go] into effect, but it would be wonderful because so many more people will get treatment’.‘Phlebotomist and case manager were very helpful. They were very knowledgeable; they were gentle with me because I am an emotional type of person’.‘[We] talked about it, and I was scared. He [case manager] told me I was going to be all right. He helped me get through it. He kept on telling me “You're going to be fine”’.‘I don't have to go [to outside providers] and wait two hours just to [be] sent home with ibuprofen and a cup of water. I could call the [case manager] to explain what was going on, and I really appreciate that’.‘I felt that they were involved with me every step of the process… When I had to give blood, they told me exactly what it was for. They told me how I should be feeling at this point, and three weeks down the road, how I should be feeling’.‘The first moment, I [was] scared. After I started treatment, I felt good. I feel comfortable with the medicine. The doctor explained everything, and I understood I needed the treatment, and I said “let's go”’.‘Confidentiality, as far as people not knowing my situation, they're very discreet… They do a really good job not discussing other clients' situations. It's a one‐on‐one type of atmosphere’.‘The counselors would be walking around [and] if they see you, they would say, “I just wanted to say hi” and “When you are done getting dosed, can we sit down for two minutes? I just want to know how your day is going”. They are involved 100%’.‘I trust the [OTP] community, but it took some time for me to trust them. [At first] I didn't want to hear nothing… I just wanted to come in and leave. The counselors took their time; they were very patient, even when I was disrespectful… They changed my life around, the counselors, because I was heading to a graveyard’.‘The methadone clinic is the best place that I've ever been to. This is the most comfortable I've ever been in a setting with so many people’.‘Once I got addicted to the pain pills… it took years of counselling and medication… If I were to stop taking methadone [which] I am nervous to do… I feel that I would go right back to the opiates’.‘I wish you had known me 20 years ago. You would be amazed at the transformation, the change through this programme. When I first came here, I was a total mess’.‘I had a negative attitude about myself, people around me, doctors and nurses. I took a good look at myself, and I went back to college, and I graduated. It was a counsellor in the methadone programme that changed me. I never looked back. I changed my ways, and it was for the better. And this [programme] made me the person I am today’.‘The experience with the methadone is absolutely phenomenal compared to what I was doing on the street’.‘It's a great programme and saved my life, methadone is turning my life around. I've been here two years, hard to come, harder to stay, [stay] as long as it takes’.‘Going to the hospital and knowing you're on methadone, they think you're a heroin addict. People try to hide it but they look at you a little different, “Oh, here comes another addict”’.‘If it's somebody new [physician] and with addicts, I get the feeling that doctors think that we're always doctor‐shopping or trying to get drugs… Sometimes it happens, and sometimes it's uncomfortable’.‘I've been with my doctor a couple years now, but when they find out you're on methadone, they don't want to give you the meds that you need’.‘When I go to the emergency room, I need to tell them [about methadone]. They need to know that I'm on methadone because it could be a contraindication to another medication’.‘I've spoken to other doctors who tell me that addiction providers are considered the bottom of the totem pole [in] the medical field… How much training does the doctor have on drug treatment? Misconception about drug abuse, period’.‘I have had an incident when I said, “I'm on methadone” and they [police] look you up and down “what the hell kind of drug are you talking about? Are you smoking crystal meth?” and I've been pulled out of my vehicle… It makes me slow down and think’.‘Certain people, I won't talk to them, and they don't talk to me. People get off the train, and we're having coffee on the corner, some of them look at us and think that we're all addicts, we're not’.‘I say, "I'm in the methadone programme"… They know exactly what you're talking about… If you [say] I'm on methadone, they start questioning you, and they don't know what you're talking about… I'm telling people that I am in the programme, and I'm physically in here, not on it’.‘I was never an IV drug user, so how did I get hepatitis? The doctor told me you could get it by sharing a straw. I automatically assumed that [HCV] went with IV drug use’.‘Nobody told me there was a treatment and that I can be cured. I thought it was something I had to live with for the rest of my life’.‘Now, when you're tired, you don't think anything's wrong. But once you find out you have it [HCV], they can get you on the right medication, get you out on the right path, and you will be fine’.‘I have kids and I didn't want to have an old razor laying around… I wanted to get my health back on track, so I said yes to the study [and HCV treatment]’.‘Overall, it was a great experience. I had no problems with the medication. I was very fearful going into it because of the past, how the treatment used to be literally like chemo. I don't think people understand how different this new treatment is’.‘Lots of patients [are] still suffering from hepatitis C, and they [are] not aware of the new medicine… [they] still think that it's the old, long, heavy treatment’.‘I got more energy. I feel rejuvenated… I feel 100% better… By getting cured from hepatitis C that prolonged my life’.‘The nurse said “you no longer come up as infected with hep C” so that was a great feeling, like a bond to not expose myself again. I know people that have… I told them, listen, it works, and you'll be free of that and then live a healthier life’.‘Before the medicine, I was tired all the time. I didn't want to get out of bed to do the things that I love: fishing, hunting, camping, or going out to dinner. Now, with methadone [and] hepatitis treatment being over, I feel amazing. I'm writing a book on my life… I'm 483 pages into it, and I just need to get a publisher. I'm getting married next month; I'm buying a house to fix up for me and my wife, and things are going the way that they should be’.‘Right now, my fiancé's making scrambled eggs, steak, potatoes, and French toast. We have our goals, we have our days planned out. Before I would be lying in bed, and she would have to bring breakfast to me because of the hepatitis and how much it takes out of you. Everything's back on track, and I feel amazing’.Abbreviations: HCV; hepatitis C virus, OTP; opioid treatment programme.Study themes as revealed by participant interviews. Integrating facilitated telemedicine for hepatitis C virus treatment into opioid treatment programmes facilitates commitment to substance use and HCV treatment enabling participants to mitigate negative perceptions of these conditions and leading to improved health.