"The Sky Didn't Fall": Patient and Clinician Experiences With Increased Buprenorphine Prescription Lengths During Pandemic-related Telehealth Expansion.

Abstract

Pandemic-related telehealth expansion changed how buprenorphine care was delivered. However, patient and clinician experiences with how these changes shaped decisions about prescription length remain underexplored, particularly in safety-net settings. From May 2021 to May 2022, we purposively sampled patients and clinicians from an office-based buprenorphine treatment clinic at an urban, safety-net hospital. Trained interviewers used semistructured interview guides to explore experiences with changes in care during the pandemic. We used a collaborative codebook development process and thematic analysis to identify key perspectives on buprenorphine prescription length changes. From interviews with 25 patients and 16 clinicians, 3 topics of relevance emerged: (1) changes to buprenorphine prescribing practices to support patients during the pandemic, (2) factors influencing clinical decision making and criteria for longer prescriptions, and (3) patient views and internalized expectations. Overall, both patients and providers reported increased duration of buprenorphine prescriptions and positive views of this change. Clinicians generally prioritized ensuring medication access over concerns about misuse and diversion. Influences on clinical decision making included medical conditions, transportation access, housing status, and patient communication. To receive longer prescriptions, some patients described deliberate efforts to build and maintain trust with clinicians. We identified largely positive patient and clinician experiences with increased buprenorphine prescription lengths. As practices continue to update their clinic policies, these findings support continued flexibility and extended prescription lengths to support medication access. Findings also demonstrate heterogeneity in clinicians' decision-making and an opportunity for improved transparency and patient-provider communication regarding criteria for extended prescriptions.