Factors influencing family physicians’ willingness to prescribe opioid agonist therapy using virtual modalities: a qualitative analysis

Introduction: Although opioid agonist therapy (OAT) is the first-line treatment for Opioid Use Disorder (OUD), access, initiation, and retention rates remain low. An avenue to improve these rates is to enhance OAT delivery in primary care settings. As Canada continues to support hybrid models combining in-person and virtual care, evaluating the role of virtual care in supporting OAT prescribing and OUD management is necessary. This qualitative study explores the factors enabling and hindering family physicians' willingness to prescribe OAT virtually. Methods: Utilizing maximum variation sampling, we conducted semi-structured interviews with 12 family physicians providing care to people with OUD in British Columbia, Canada. We audio-recorded, transcribed verbatim, coded, and thematically analyzed interview data using a hybrid inductive-deductive approach. Results: In this focused analysis, we identified themes across patient-, physician-, and health system-level factors in accordance with the Barriers and/or Facilitators to Primary Care Access for Individuals with Mental Health and/or Substance Use Issues framework. Patients' individual characteristics, pre-existing patient-provider relationships, and physicians' perceptions of patient stability each influenced prescribing decisions in virtual modalities. Providing care alongside an interdisciplinary team and access to province-wide centralized patient data systems or medical support networks also impacted physicians' willingness to prescribe OAT virtually. Discussion: This study highlights the key factors influencing physicians' willingness to prescribe OAT virtually and underscores the need for policy frameworks that empower providers to deliver equitable, patient-centred virtual care.