“It’s kind of a double-edged sword”: a qualitative analysis of quality virtual primary care for people with opioid use disorder

The rapid expansion of virtual care at the outset of the COVID-19 pandemic helped to ensure continued access to primary care throughout stay-at-home closures. As regular primary care services resumed, virtual care has persisted. Existing research does not capture the quality of virtual primary care for people with opioid use disorder (OUD). We sought to understand the perspectives of family physicians (FPs) and people with OUD regarding their respective abilities to provide and access quality primary care via synchronous virtual modalities. We conducted semi-structured interviews with FPs and people with OUD in British Columbia, Canada between March and October 2023. Interviews were audio-recorded, transcribed, and inductively coded. We then used the World Health Organization’s dimensions of quality primary care services to thematically organize and analyze participant data for this focused analysis. All 12 FP and 59% ( n = 16/27) of participants with OUD had any experience with synchronous virtual care. Most participants agreed that virtual modalities have the potential to deliver quality primary care services; however, this was context specific. Both FPs and people with OUD recognized that virtual care can be safe and effective for certain primary care needs, though FPs generally indicated they could address a broader range of primary care concerns through virtual visits than people with OUD felt was appropriate. FPs felt more strongly that they could deliver people-centred and equitable primary care through virtual modalities; people with OUD were more divided on virtual care’s ability to offer these dimensions of quality. Conversely, people with OUD emphasized the efficiency of virtual care, whereas FPs highlighted the role of interdisciplinary teams in supporting delivery of quality primary care using virtual modalities. As policymakers and professional organizations continue to shape virtual care policy, incorporating diverse service user perspectives is essential. Recognizing that virtual primary care can deliver dimensions of quality primary care for people with OUD, decisions about its use should be guided by patient preference, clinical indication, and appointment purpose.