Developing a risk management framework for, and piloting, telemedicine-delivered medication for opioid use disorder (TMOUD3)
The Scottish Medication Assisted Treatment (MAT) standards are an integral part of addressing rising drug deaths in Scotland. The first five standards are specific to the delivery of Medications for Opioid Use Disorder (MOUD) such as methadone and buprenorphine and include provision for same day access, choice of medication, assertive outreach and anticipatory care, harm reduction and retention in treatment. Implicit within the successful implementation of these first five MAT standards is that numbers in treatment will grow, and services will need to adapt, evolve, and innovate to provide ongoing safe and effective interventions.
Providers in the US, with similar drug deaths crises, developed models of Telemedicine delivered MOUD (TMOUD) to address service capacity needs and to expand access to evidence based treatment for OUD.
Scotland is primed and ready for TMOUD from an infrastructure, policy, and governance perspective. There has been a strategic development plan for telemedicine and telecare in Scotland since 2012, and an established platform to deliver telemedicine through the Attend Anywhere / Near Me video consulting service since 2016 supported by an implementation framework provided by Technology Enabled Care (TEC) Scotland. Indeed, this background work meant that Scotland was able to successfully introduce a rapid roll out initiative of video consulting in the context of the COVID-19 pandemic. Unfortunately, addiction services have consistently lagged other health specialties in using the Near Me video consulting service both before and after the rapid roll out initiative. This discrepancy of uptake of TMOUD was in fact anticipated, as it is in line with international experiences.
Since October 2020, DigitAS has conducted a series of exploratory systematic reviews examining the implementation factors involved in the uptake and embedding of TMOUD3 and the different care models in delivering TMOUD. We have also conducted a national engagement seminar to disseminate international experiences of delivering TMOUD in March 2021, and coordinated a consensus process to develop a implementation model for TMOUD.
A key finding from this body of work is the importance of actively engaging key stakeholders on implementation and delivery processes, and clinical risk management. Consequently, a corollary to the TMOUD implementation model has been an evidence based six-domain clinical risk management framework for TMOUD incorporating the design and implementation context, entry points and triage, diagnosis and MOUD induction, treatment maintenance and review, continuity of care and patient attrition mitigation strategies.
Outputs
Tay Wee Teck, J. (October 2022) Re-thinking collaborative risk assessment and management in providing virtual addiction care: A state of the art review of the literature. ISAM International Congress, Valletta, Malta.