healthcare Communication Patient Experiences with the Transition to Telephone Counseling during the COVID-19 Pandemic Augustine W. Kang 1, * , Mary Walton 2 , Ariel Hoadley 3 , Courtney DelaCuesta 1 , Linda Hurley 2 and Rosemarie Martin 1   Citation: Kang, A.W.; Walton, M.; Hoadley, A.; DelaCuesta, C.; Hurley, L.; Martin, R. Patient Experiences with the Transition to Telephone Counseling during the COVID-19 Pandemic. Healthcare 2021, 9, 663. https://doi.org/10.3390/ healthcare9060663 Academic Editor: Daniele Giansanti Received: 28 April 2021 Accepted: 31 May 2021 Published: 2 June 2021 Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affil- iations. Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). 1 Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI 02912, USA; Courtney_delacuesta@brown.edu (C.D.); rosemarie_martin@brown.edu (R.M.) 2 CODAC Behavioral Healthcare, Cranston, RI 02910, USA; mwalton@codacinc.org (M.W.); lhurley@codacinc.org (L.H.) 3 Department of Social and Behavioral Sciences, Temple University College of Public Health, Philadelphia, PA 19122, USA; ariel_hoadley@brown.edu * Correspondence: Augustine_kang@brown.edu Abstract: Background: To identify and document the treatment experiences among patients with opioid use disorder (OUD) in the context of the rapid move from in-person to telephone counseling due to the COVID-19 pandemic. Methods: Participants (n = 237) completed a survey with open-ended questions that included the following domains: (1) satisfaction with telephone counseling, (2) per- ceived convenience, (3) changes to the therapeutic relationship, (4) perceived impact on substance use recovery, and (5) general feedback. Responses were coded using thematic analysis. Codes were subsequently organized into themes and subthemes (covering 98% of responses). Interrater reliability for coding of participants’ responses ranged from 0.89 to 0.95. Results: Overall, patients reported that telephone counseling improved the therapeutic experience. Specifically, 74% of respondents were coded as providing responses consistently indicating “positive valency”. “Positive valency” responses include: (1) feeling supported, (2) greater comfort and privacy, (3) increased access to coun- selors, and (4) resolved transportation barriers. Conversely, “negative valency” responses include: (1) impersonal experience and (2) reduced privacy. Conclusions: Telephone counseling presents its own set of challenges that should be investigated further to improve the quality of care and long-term patient outcomes. Keywords: opioid use disorder treatment; telehealth services; qualitative; needs assessment 1. Introduction The ongoing opioid epidemic and the COVID-19 pandemic constitute a syndemic [1]. More than 40 states in the United States have reported increases in opioid-related mortality in the first six months of the pandemic, which has become more complicated and deadly as the pandemic persists [2]. Medications for opioid use disorder (MOUD) are among the most systematically governed treatment approaches in the United States [3]. Although MOUD is the evidence- based standard of care for OUD, access is limited primarily due to the strict federal and state regulations mandating in-person medical and clinical encounters to initiate and maintain MOUD. However, the COVID-19 public health emergency led to an immediate cascade in relaxing laws, regulations, and policies to enable ongoing treatment by reducing financial and administrative obstacles and expanding the role of telemedicine, to name a few [4]. These changes resulted in shifts in the access and delivery of MOUD, providing an opportunity to improve treatment and thus reduce opioid-related morbidity and mortality in a time of national crisis. Rates of telehealth services provisions for substance use disorder (SUD) had been generally low before COVID-19 even though telehealth services increase patient access, Healthcare 2021, 9, 663. https://doi.org/10.3390/healthcare9060663 https://www.mdpi.com/journal/healthcare