High Satisfaction with Patient-Centered Telemedicine for Hepatitis C Virus Delivered to Substance Users: A Mixed-Methods Study

**Background:** Access to satisfactory health care is challenging for vulnerable populations, including people with opioid use disorder (PWOUD). Telemedicine may circumvent these obstacles, but data on PWOUD satisfaction with telemedicine are limited. PWOUD have the highest hepatitis C virus (HCV) incidence and prevalence, yet many do not pursue treatment when referred offsite due to stigma and competing priorities. This study assessed PWOUD satisfaction with HCV care delivered via telemedicine integrated into opioid treatment programs (OTPs) compared to offsite referral.

**Methods:** The study included 344 participants (238 telemedicine, 106 referral) from 12 OTPs throughout New York State who successfully completed HCV treatment. All participants were actively enrolled in an OTP for at least 6 months and were HCV antibody and HCV RNA positive. Telemedicine encounters were facilitated by case managers and occurred entirely within the OTP using uniform wide-screen computers with high-quality cameras, microphones, and speakers. Participants were treated with direct-acting antivirals for 2–3 months followed by 3 months to assess viral elimination. The short-form PSQ (Modified PSQ-18) was administered at the initial and last health care encounters. A partial proportional odds model was used to analyze PSQ scores. Additionally, 25 telemedicine participants were interviewed using a hermeneutic phenomenological approach. Qualitative data were analyzed using NVivo to calculate term frequency-inverse document frequency (tf-idf) normalized weight factors (WF) on a 0–1 scale.

**Key Results:** The mean age of participants was 48 ± 13 years; 63.95% were male, 71.80% were non-Hispanic, and 52.03% were White. Overall health care satisfaction was high: 96.2% of participants scored ≥4 at timepoint 1 and 96.5% scored ≥4 at timepoint 2. At the second timepoint, an approximately 10% shift in scores occurred, increasing by one point (from 4 to 5) compared to the initial timepoint. Less than 2% of patients were dissatisfied or highly dissatisfied overall or on any subscale. No differences in PSQ scores were observed between telemedicine and in-person encounters (98.3% and 98.7% of telemedicine participants provided PSQ scores of satisfied or highly satisfied at each timepoint, respectively). The three most frequently mentioned codes from interviews were 'Time Spent with Doctor' (WF=0.181), 'General Satisfaction' (WF=0.177), and 'Interpersonal Manner' (WF=0.155), while 'Technical Quality' (WF=0.135) and 'Accessibility and Convenience' (WF=0.091) were mentioned less frequently. Three themes emerged from interviews: (1) Communicating information promoting study enrollment and retention, (2) Gaining trust in the OTP to participate in patient-centered telemedicine encounters, and (3) Realizing advantages of patient-centered, virtually integrated HCV treatment. Overall satisfaction improved significantly over time (p=0.0015, 95% CI: -5.2618 to -1.2488). Female participants were significantly more satisfied than males (p=0.0368, 95% CI: -1.4299 to -0.0454). The time coefficient was -0.7155, indicating participants at the second timepoint had a higher probability of assigning higher satisfaction scores. The intraclass correlation coefficient was 0.5858, indicating site-to-site differences in satisfaction.

**Clinical Implications:** This study demonstrates that PWOUD are highly satisfied with HCV telemedicine delivered from destigmatized, familiar OTP sites by empathetic providers, with satisfaction equivalent to in-person care. The facilitated telemedicine model, using familiar staff as facilitators, augments quality, adds value, and achieves high patient satisfaction. Participants valued empathy and trust with providers over accessibility and convenience. The combination of a trusting environment and empathetic provider promotes telemedicine acceptance by PWOUD. The model also enables simultaneous treatment of OUD and HCV, which has been shown to increase medication adherence, retention-in-care, and treatment effectiveness. Limitations include measurement of satisfaction at only two time points, interviews limited to telemedicine participants, unequal group sizes, and the need to assess generalizability beyond New York State.