“I also had my own personal experience when I had my third child, he was a premature baby,” Adepoju said. “We had a million-dollar hospital bill. Talk about living through this very disjointed healthcare system.”
It was this experience that inspired her work to explore access to care in a more fundamental way, through the intersection of cost and quality. A distinguished health services researcher, Adepoju serves as a Director of Research at the Humana Integrated Health Institute. She also works as a Clinical Associate Professor at the Tilman J. Fertitta Family College of Medicine. Adepoju’s focus is deeply rooted in weighing all factors behind access to care.
“We want to improve quality and we want to improve real access, not perceived access,” Adepoju said. “The way a country’s system is structured can make or mar health outcomes. When people think of access, they think of health insurance. There are other factors beyond having health insurance that can impact access.”
Through a new NOSI grant, Adepoju’s study is entitled, Evaluating Telemedicine-Related Opioid Use Disorder (OUD) Services in Underserved Populations: A Comparison of Waiver and Post-waiver Periods. The initiative was funded $155,000 by NIHMD and HEALTH–RCMI [P.I. Dr. Ezemenari Obasi]. Adepoju is collaborating on the NOSI initiative with Dr. Lauren Gilbert who serves as the Co-Principal Investigator (Co-PI) of the study.
“I’m interested in understanding access to care—understanding the nuances that make people access or not access health care,” Adepoju said.
According to a study cited by the CDC’s National Center of Injury and Prevention and Control, telemedicine usage for Opioid Use Disorder during the pandemic was linked to a significant 33 percent lower risk for fatal overdose. Adepoju echoed that telemedicine has been a crucial factor in providing easy access to care to those who are struggling with Opioid Use Disorder.
“Telemedicine takes away some of the concerns like transportation we have but it also adds some access barrier layers,” Adepoju said. “People may have digital literacy issues or lack of reliable, consistent internet. They may have other concerns about using technology. Perhaps they think it’s an added expense, the list goes on.”
Through her NOSI study, Adepoju will explore the waiver and post-waiver period of Opioid Use Disorder treatment. Key medications such as methadone, buprenorphine, and naltrexone can be quite effective for treating opioid use disorder. However, these medications are regulated in the U.S., which can hinder their use.
“In order for physicians to provide OUD treatment, providers had to do some extra training. It required a lot of paperwork, and providers had to be specialized physicians. In the post-waiver period, which we are currently in, that requirement no longer exists.”
During the project, Adepoju plans to interview African Americans and Hispanic Americans to discuss their experience in the waiver era and the post-waiver period. Over 48 interviews with patients will be conducted during the study, and 18 providers will also be interviewed.
The “big-picture” idea behind this project is documenting experiences and barriers for OUD patients---and facilitators with access to OUD and OUD-related telemedicine for treatment initiation, Adepoju explained.
“We want to explore—what are some of the barriers, experiences with some of the facilitators? The project's second part will be interviewing providers and licensed chemical dependency counselors. We hope to understand on a small scale what their experiences are.”
Adepoju elaborated that one of the main objectives of the NOSI study was ensuring treatment and retention which may prevent overdoses.
“In terms of my overarching goal for this NOSI, my goal is to reduce disparities and explore OUD treatment continuation,” Adepoju said. “If a patient could see a physician in-person the first time and have a couple of telemedicine visits, and then come in for check-up the next month—who knows, could that help? Ideally, I would like to use data from this work to develop a culturally informed telemedicine framework. If I can use data from the study to support that, I would be excited.”
Adepoju’s passion for improving the healthcare experience in the U.S. has defined her educational journey.
“When I began studying public health, I wanted to improve health on a broader scale—how do we tweak the system to make it better for everyone?” Adepoju said. “I have the heart of a researcher—just trying to find ways to tell stories, not to tell a story for the story’s sake but using that to inform policy and using that to shift the paradigm.”
—Alison Medley
If you would like more information about this topic, please contact Alison Medley at 713.320.0933 or email aemedle2@central.uh.edu
