Table 3.

Benefits and challenges of virtual primary care for people with opioid use disorder organized by Consolidated Framework for Implementation Research (CFIR) domains and constructs (N=28).

CFIR domain				CFIR construct		Studies, n (%)		References
Innovation: virtual primary care
	Benefits
		Modality options	Innovation and adaptability		7 (25)		Sivakumar et al [80] Uscher-Pines et al [84] Huskamp et al [72] Jones et al [74] Hser et al [71] Wilson et al [86] Crowley and Delargy [67]
	Challenges
		—a	—		—		—
Outer setting: state
	Benefits
		Regulation changes	Policies and laws		11 (39)		Lin et al [62] Behrends et al [64] Patel et al [77] Huskamp et al [72] Hser and Mooney [70] Jones et al [74] Wang et al [85] Riedel et al [78] Wilson et al [86] Hodgkin et al [69] Leo et al [75]
		COVID-19 public health measures	Critical incidents		4 (14)		Lin et al [62] Uscher-Pines et al [84] Wilson et al [86] Taylor et al [82]
		Billing changes	Policies and laws		4 (14)		Calandra et al [65] Hser and Mooney [70] Caton et al [66] Hodgkin et al [69]
		Insurance reimbursement	Policies and laws		2 (7)		Wilson et al [86] Hodgkin et al [69]
		Support for up-front costs	Financing		1 (4)		Patel et al [77]
		Community engagement	Partnerships and connections		1 (4)		Hser et al [71]
		Changes in the drug market during the pandemic	Critical incidents		1 (4)		Behrends et al [64]
	Challenges
		Regulations	Policies and laws		7 (25)		Sivakumar et al [80] Huskamp et al [72] Hser and Mooney [70] O’Gurek [76] Jones et al [74] Hser et al [71] Riedel et al [78]
		Billing	Policies and laws		4 (14)		Beharie et al [63] Sivakumar et al [80] Calandra et al [65] Jones et al [74]
		Insurance reimbursement	Policies and laws		4 (14)		Hser et al [71] Riedel et al [78] Wilson et al [86] Hodgkin et al [69]
Inner setting: primary care
	Benefits
		Clinical resources available	Available resources		6 (21)		Huskamp et al [72] Hser and Mooney [70] O’Gurek [76] Wang et al [85] Hser et al [71] Wilson et al [86]
		Technological supports	Available resources		5 (18)		Beharie et al [63] Patel et al [77] Hser and Mooney [70] Wang et al [85] Hser et al [71]
		Technology provided	Available resources		5 (18)		Griffin et al [68] Wang et al [85] Hser et al [71] Crowley and Delargy [67] Leo et al [75]
		Clinical setting	Structural characteristics		4 (14)		Lin et al [62] Patel et al [77] Jones et al [74] Riedel et al [78]
		Mobile medication delivery	Available resources		1 (4)		Leo et al [75]
	Challenges
		Clinical setting	Structural characteristics		4 (14)		Lin et al [62] Patel et al [77] Jones et al [74] Riedel et al [78]
		Lack of guidelines and resources	Available resources		4 (14)		Jones et al [74] Wang et al [85] Hser et al [71] Snell-Rood et al [81]
		Need for more administrative support	Structural characteristics		3 (11)		Calandra et al [65] Hser et al [71] Snell-Rood et al [81]
		Cost	Cost		1 (4)		O’Gurek [76]
		Slow uptake of virtual primary care	Capability		3 (11)		Jones et al [74] Hser et al [71] Snell-Rood et al [81]
Individual: innovation deliverer (clinicians)
	Benefits
		Patient stability	Opportunity		5 (18)		Sivakumar et al [80] Calandra et al [65] Riedel et al [78] Caton et al [66] Wilson et al [86]
		Higher patient attendance	Need		5 (18)		Uscher-Pines et al [84] Calandra et al [65] O’Gurek [76] Hser et al [71] Caton et al [66]
		Ability to provide care virtually	Capability		3 (11)		Uscher-Pines et al [84] Huskamp et al [72] Riedel et al [78]
		Experience with OATb or virtual primary care	Capability		3 (11)		Huskamp et al [72] Jones et al [74] Riedel et al [78]
		Continuity of care	Need		3 (11)		Calandra et al [65] Hser et al [71] Leo et al [75]
		Desire for virtual care	Motivation		2 (7)		Uscher-Pines et al [84] Riedel et al [78]
		Patient bias	Need		1 (4)		Wang et al [85]
		Convenience and efficiency	Need		1 (4)		O’Gurek [76]
		Video appointments for higher-risk patients	Need		1 (4)		Riedel et al [78]
		Younger clinician age	Capability		1 (4)		Jones et al [74]
		Managing clinical complexity	Need		1 (4)		Hser and Mooney [70]
	Challenges
		Higher risk and liability	Need		10 (36)		Lin et al [62] Sivakumar et al [80] Uscher-Pines et al [84] Huskamp et al [72] Jones et al [74] Wang et al [85] Riedel et al [78] Caton et al [66] Wilson et al [86] Crowley and Delargy [67]
		Hinders patient relations	Need		3 (11)		Beharie et al [63] Uscher-Pines et al [84] Hser et al [71]
		Phone insufficient for care needed	Need		3 (11)		Sivakumar et al [80] Huskamp et al [72] Riedel et al [78]
		Clinician preference for in-person care	Motivation		3 (11)		Huskamp et al [72] Jones et al [74] Riedel et al [78]
		Limited support or guidelines available	Need		3 (11)		Wang et al [85] Hser et al [71] Snell-Rood et al [81]
		Lack of technology knowledge or equipment	Capability		3 (11)		Uscher-Pines et al [84] Jones et al [74] Riedel et al [78]
		Patient needing in-person care	Need		2 (7)		Uscher-Pines et al [84] Calandra et al [65]
		Future of virtual primary care unclear	Motivation		2 (7)		Uscher-Pines et al [84] Hodgkin et al [69]
		Shorter appointment times	Opportunity		1 (4)		Uscher-Pines et al [84]
		Male clinician	Other		1 (4)		Jones et al [74]
Individual: innovation recipient (patients)
	Benefits
		Care access	Need		13 (46)		Lin et al [62] Sivakumar et al [80] Uscher-Pines et al [84] Calandra et al [65] Hser and Mooney [70] O’Gurek [76] Wang et al [85] Hser et al [71] Sahu et al [79] Riedel et al [78] Caton et al [66] Crowley and Delargy [67] Leo et al [75]
		Travel and transportation limitations	Need		10 (36)		Akoto [61] Uscher-Pines et al [84] Calandra et al [65] Hser and Mooney [70] O’Gurek [76] Wang et al [85] Sahu et al [79] Riedel et al [78] Caton et al [66] Crowley and Delargy [67]
		Rurality	Need		6 (21)		Lin et al [62] Calandra et al [65] Hser and Mooney [70] Hser et al [71] Crowley and Delargy [67] Taylor et al [82]
		Concerns about stigma	Need		4 (14)		Sivakumar et al [80] Incze et al [73] Hser and Mooney [70] Wang et al [85]
		Flexibility of appointments	Need		4 (14)		Incze et al [73] Calandra et al [65] Wang et al [85] Sahu et al [79]
		Continuity of care	Need		3 (11)		Lin et al [62] Sahu et al [79] Caton et al [66]
		Convenience and efficiency	Need		2 (7)		Sivakumar et al [80] Uscher-Pines et al [84]
		Patient preference	Need		1 (4)		Hser and Mooney [70]
		Younger patient age	Capability		1 (4)		Lin et al [62]
		White ethnicity	Other		1 (4)		Lin et al [62]
		Female sex	Other		1 (4)		Lin et al [62]
	Challenges
		Digital divide	Capability		12 (43)		Griffin et al [68] Sivakumar et al [80] Patel et al [77] Uscher-Pines et al [84] Huskamp et al [72] Calandra et al [65] Hser and Mooney [70] O’Gurek [76] Wang et al [85] Hser et al [71] Snell-Rood et al [81] Wilson et al [86]
		Mistrust of virtual care	Motivation		3 (11)		Huskamp et al [72] Hser and Mooney [70] Hser et al [71]
		Black ethnicity	Other		2 (7)		Lin et al [62] Patel et al [77]
		Lack of private and secure spaces	Need		2 (7)		Jones et al [74] Hser et al [71]
		Older patient age	Capability		1 (4)		Wang et al [85]
		Minority ethnicity	Other		1 (4)		Wang et al [85]
		Hinders patient relations	Need		1 (4)		Beharie et al [63]
		Cost	Cost		1 (4)		Jones et al [74]
		Virtual care not aligned with treatment philosophy	Need		1 (4)		Hser et al [71]
		Longer wait for appointment	Need		1 (4)		Hser et al [71]
		English as a second language	Capability		1 (4)		Wang et al [85]

^aNo corresponding data.

^bOAT: opioid agonist therapy.