. 2023 Oct 18;10:e47186. doi: 10.2196/47186

Table 1.

Medication-assisted treatment (MAT) standards 1 to 5 mapped against telemedicine-delivered medication for opioid use disorder (TMOUD) models of care.

Scottish MAT standards and what to measure			Mapping against TMOUD models of care		Implications for TMOUD quality
Standard 1: same-day access
	Time from first contact with any partner in the multiagency partnership within an episode of care to the commencement of MOUD^a	TM^b 1.0: inclusion health focus TM 1.1: places of safety TM 1.3: low threshold TM 3.1: multidisciplinary and multisectoral care		Same-day access is made possible by low thresholds for treatment initiation (TM 1.3). Multidisciplinary and multisectoral care (TM 3.1) increases opportunity for people to be seen where they feel safe (TM 1.1).
	Number of people started on MOUD	TM 1.3: low threshold TM 4.0: service resilience and quality		Higher numbers in treatment are a measure of treatment threshold (TM 1.3) and may be an outcome measure required by a service adopting TMOUD (TM 4.0).
Standard 2: choice
	The number of people in treatment taking methadone or sublingual buprenorphine at the appropriate dose and with opportunities to change their choice	TM 1.2: trauma informed TM 3.3: education and empowerment TM 4.0: service resilience and quality TM 4.3: coproduced clinical pathways		Choice in treatment is a principle of trauma-informed care (TM 1.2), and people with opioid use disorder may need to be empowered to demand these choices (TM 3.3). Services need to have time and resources (TM 4.0) and appropriate clinical pathways (TM 4.3) to respond to demand.
	The number of people in treatment receiving injectable buprenorphine	TM 1.0: inclusion health focus TM 3.3: education and empowerment TM 4.0: service resilience and quality		Some groups may be excluded from being offered injectable buprenorphine (TM 1.0) or may not have knowledge of it (TM 4.0). Services must adapt to introduce injectable buprenorphine, and adopting TMOUD may increase the capacity to do so (TM 4.0).
	The number of people receiving HAT^c	TM 1.0: inclusion health focus TM 3.0: complexity of care needs TM 4.0: service resilience and quality		HAT is a relatively novel intervention, potentially benefiting marginalized populations (TM 1.0) with complex care needs (TM 3.0). It is a resource-heavy intervention, and TMOUD may be used to free up capacity to deliver it (TM 4.0).
Standard 3: assertive outreach and anticipatory care
	Duration from when first identified as at risk to initial contact and assessment; number of people followed up with and for whom an initial assessment is performed	TM 2.0: transition through care TM 2.1: patient journey mapping TM 2.2: process mapping and risk mitigation		This measure may provide empirical data to test service understandings of the patient journey (TM 2.1) and processes that may increase or decrease risk (TM 2.2) during transitions in care (TM 2.0).
	Proportion of people by age, gender, and race identified as at risk by source of risk event (service that identified and actioned the risk); identification and outcome of the intervention	TM 1.0: inclusion health focus TM 1.1: places of safety TM 2.0: transition through care TM 2.2: process mapping and risk mitigation		Disaggregation of data by age, gender, race, and other characteristics measures the extent to which inclusivity is improved (TM 1.0), what services are favored by specific groups (TM 1.1), and whether risk mitigation (TM 2.2) during care transitions (TM 2.0) reaches all affected groups equally.
Standard 4: harm reduction
	Proportion of MOUD services offering BBV^d testing and vaccination, naloxone and overdose awareness, wound care, assessment of injecting risk and injecting equipment provision, and virtual supervised injecting services	TM 3.0: complexity of care needs TM 3.2: flexibility to tailor interventions TM 4.0: service resilience and quality TM 4.3: coproduced clinical pathways		This measure quantifies the extent to which TMOUD services the complexity of the needs of people with opioid use disorder (TM 3.0) and the extent to which it can innovate or adapt to address gaps (TM 3.2). Furthermore, services may introduce telemedicine (TM 4.0) and coproduce pathways to integrate harm reduction and MOUD provision.
Standard 5: retention
	Attrition rate: number of people currently on MOUD treatment and number of people discharged within a set time by setting, age, gender, and race	TM 2.0: transition through care TM 2.1: patient journey mapping TM 2.2: process mapping and risk mitigation TM 4.0: service resilience and quality TM 4.3: coproduced clinical pathways		This directly measures the service’s ability to support continuity through transitions in care (TM 2.0) and provides empirical data to test mapping and risk mitigation (TM 2.1 and 2.2). TMOUD may be adopted to improve retention in treatment (TM 4.0) through specific clinical pathways (TM 4.3).
	Reason for discharge (eg, planned or unplanned)	TM 3.0: complexity of care needs TM 3.2: flexibility to tailor interventions TM 4.0: service resilience and quality TM 4.2: predefined intake criteria		Services designed to meet complex needs (TM 3.0) develop interventions to match these needs (TM 3.2) and, theoretically, will have low unplanned discharges. Services introducing TMOUD to increase efficiency (TM 4.0) may set high-threshold intake criteria (TM 4.2), which excludes some groups.

^aMOUD: medication for opioid use disorder.

^bTM: TMOUD model.

^cHAT: heroin-assisted treatment.

^dBBV: blood-borne virus.