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Guyon-Harris KL, Krans EE, Gill A, Karnosh C, Shaw DS. Supporting positive parenting among pregnant people in recovery from opioid use disorder: Introducing family check‐up–prenatal. Infant Ment Health J 2024. [PMID: 39118311 DOI: 10.1002/imhj.22132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 06/14/2024] [Accepted: 06/25/2024] [Indexed: 08/10/2024]
Abstract
Opioid use disorder (OUD) among pregnant people has increased dramatically during the opioid epidemic, affecting a significant number of families with young children. Parents with OUD commonly face significant challenges as they are often balancing the stress of caring for young children with maintaining recovery and co-occurring psychosocial challenges (e.g., mental health, low social support). Toward designing interventions to address parenting needs among parents with OUD, we conducted a mixed-methods study to understand the acceptability of receiving parenting support prenatally among pregnant people with OUD residing in the United States. Semi-structured interviews were conducted among 18 pregnant and early postpartum people recruited from a substance use treatment program specializing in the care of pregnant and parenting populations. Among all participants, a prenatal parenting program that comprehensively addresses recovery, parenting, and wellbeing was found to be widely acceptable. Regarding content most desirable within a parenting intervention, participants indicated an interest in breastfeeding, caring for newborns with in-utero opioid exposure, parent-infant bonding, infant soothing techniques, their own wellbeing/mental health, and parenting skills. We introduce a prenatal adaptation of the well-established Family Check-up parenting intervention as a novel, prenatal intervention to prevent negative outcomes for caregivers in recovery and their children.
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Affiliation(s)
- Katherine L Guyon-Harris
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Elizabeth E Krans
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anne Gill
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Caroline Karnosh
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Daniel S Shaw
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Shuman CJ, Choberka D, Morgan ME, Boyd CJ. ArtSpective™ for Perinatal Substance Use: Feasibility of an Arts-Based Intervention Addressing Stigma. J Addict Nurs 2024; 35:43-50. [PMID: 38829993 DOI: 10.1097/jan.0000000000000577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
OBJECTIVE The purpose of this proof-of-concept pilot study was to test the initial feasibility and limited efficacy of ArtSpective™ for perinatal substance use (PSU), a novel, arts-based intervention designed to decrease stigmatizing attitudes toward PSU. METHODS Using a pre-post mixed methods quasi-experimental design, ArtSpective™ for PSU was pilot tested for proof of concept among a convenience sample of 11 undergraduate and graduate students with experience in maternal-infant nursing from a Midwestern U.S. nursing school. As a proof-of-concept pilot study, we evaluated feasibility (acceptability, demand, and implementation) and limited efficacy. Participants completed presurveys and postsurveys that included satisfaction items, demographic items, and an adapted version of the Attitudes About Drug Use in Pregnancy Scale and participated in a focus group. Focus group data were analyzed using constant comparative methods, and survey data were analyzed using descriptive statistics and Wilcoxon signed rank tests. RESULTS Participants reported high demand and satisfaction with the intervention and provided recommendations to improve scalability. ArtSpective™ demonstrated significant improvement in stigma toward PSU (pre vs. post: p = .003; d = .633). CONCLUSION ArtSpective™ for PSU demonstrated initial feasibility and limited efficacy for improving nurse attitudes toward PSU. Efforts are needed to further test this novel intervention, adapt it to augment existing educational interventions, and improve its scalability.
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Goyal N, Gannon M, Sood E, Harris G, Franko E, Abatemarco DJ, Hand DJ, Leib S, Short VL. Group Well Child Care for Mothers with Opioid Use Disorder: Framework for Implementation. Matern Child Health J 2023; 27:75-86. [PMID: 37515747 PMCID: PMC10692244 DOI: 10.1007/s10995-023-03762-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2023] [Indexed: 07/31/2023]
Abstract
OBJECTIVE For parents with opioid use disorder (OUD) and their children, group well child care (WCC) is an under-studied intervention that may reduce stigma, increase quality of care, and improve clinical outcomes. We explored barriers and facilitators to this intervention using an implementation science framework. METHODS A qualitative study was conducted from October 2020-March 2021 as part of the planning phase of a cluster-randomized trial of group WCC. Parent participants were recruited from one urban, university-affiliated OUD treatment center to participate in semi-structured telephone interviews. Eligible parents had a child under two years old and were English speaking. Clinician participants were recruited from a nearby pediatric primary care practice. Inductive thematic analysis of interview responses was led by two investigators using open coding procedures. RESULTS Thirty-one parents and thirteen pediatric clinicians participated in the interviews. Most parents (68%) reported that they would be likely or very likely to bring their child to the OUD treatment center for WCC. Six themes emerged describing perceived implementation barriers, including intervention difficulty, complexity, and potential negative outcomes such as loss of privacy. Six themes emerged as implementation facilitators: (1) focus on parental OUD and recovery, (2) peer support, (3) accessibility and coordination of care, (4) clinician skill and expertise in parental OUD, (5) increased time for patient care, and (6) continuity of care. CONCLUSIONS FOR PRACTICE Parents and clinicians expressed multiple perceived benefits of this intervention. Identified barriers and facilitators will inform implementation and evaluation of group WCC within one OUD treatment program.
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Affiliation(s)
- Neera Goyal
- Nemours Children's Health, Wilmington, DE, USA.
- Sidney Kimmel Medical College of Medicine, Thomas Jefferson University, Philadelphia, PA, USA.
- Nemours Children's Health Philadelphia, 833 Chestnut St, Ste. 300, Philadelphia, PA, 19107, USA.
| | - Meghan Gannon
- Sidney Kimmel Medical College of Nursing, Philadelphia, PA, USA
| | - Erica Sood
- Nemours Children's Health, Wilmington, DE, USA
- Sidney Kimmel Medical College of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Grace Harris
- Sidney Kimmel Medical College of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Elizabeth Franko
- Sidney Kimmel Medical College of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Dennis J Hand
- Sidney Kimmel Medical College of Nursing, Philadelphia, PA, USA
| | - Susan Leib
- Department of Pediatric and Adolescent Medicine, Einstein Medical Center Philadelphia, Philadelphia, PA, USA
| | - Vanessa L Short
- Sidney Kimmel Medical College of Nursing, Philadelphia, PA, USA
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Guille C, Henrich N, Brinson AK, Jahnke HR. Improving the Management of Maternal Mental Health with Digital Health Care. PSYCHIATRIC RESEARCH AND CLINICAL PRACTICE 2023; 6:23-32. [PMID: 38510485 PMCID: PMC10948940 DOI: 10.1176/appi.prcp.20230035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/28/2023] [Accepted: 09/27/2023] [Indexed: 03/22/2024] Open
Abstract
Objectives Digital health solutions have the potential to improve maternal mental health care. The objective of this study is to determine if utilization of a digital health platform, Maven, is associated with improved management of mental health among peripartum people with a history of mental health disorders and determine which components of utilization associate with maternal mental health outcomes. Methods Participants in this retrospective cohort analysis (n = 1561) accessed Maven as an employer-sponsored health benefit and enrolled during their pregnancy and delivered from January 2020 through September 2022. Participants completed health surveys at enrollment, including history of a mood disorder, and post-delivery. Maven includes online articles, asynchronous and synchronous virtual classes, app-based mental health screenings, access to allied health professional and maternity care providers via messaging and telehealth appointments. Quantile g-computation was used to estimate the effects of multi-utilization exposures on reports of postpartum depression (PPD) and management of mental health. Results Multi-utilization exposure mixture models demonstrated that increasing use of digital resources by one quartile is associated with an increased odds of reporting that Maven helped users manage their mental health (aOR: 12.58 [95% CI: 6.74, 23.48]) and was not associated with self-reported incidence of PPD (aOR: 1.30 [95% CI: 0.52, 3.27]). Care advocate appointments, provider messages, and article reads were positively associated with improved mental health management. Conclusions Digital health platforms, such as Maven, may play an important role in managing maternal mental health conditions among pregnant and postpartum people at high risk for PPD.
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Affiliation(s)
- Constance Guille
- Department of Psychiatry and Behavioral SciencesMedical University of South CarolinaCharlestonSouth CarolinaUSA
- Department of Obstetrics and GynecologyMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | | | - Alison K. Brinson
- Maven ClinicNew YorkNew YorkUSA
- Department of AnthropologyUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- Carolina Population CenterUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
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Fryer K, Reid CN, Elmore AL, Mehra S, Carr C, Salemi JL, Cogle CR, Pelletier C, Pacheco Garrillo M, Sappenfield WS, Marshall J. Access to Prenatal Care Among Patients With Opioid Use Disorder in Florida: Findings From a Secret Shopper Study. Obstet Gynecol 2023; 142:1162-1168. [PMID: 37856854 DOI: 10.1097/aog.0000000000005315] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/20/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE To evaluate access to prenatal care for pregnant patients receiving medication for opioid use disorder (MOUD) under Medicaid coverage in Florida. METHODS A cross-sectional, secret shopper study was conducted in which calls were made to randomly selected obstetric clinicians' offices in Florida. Callers posed as a 14-week-pregnant patient with Medicaid insurance who was receiving MOUD from another physician and requested to schedule a first-time prenatal care appointment. Descriptive statistics were used to report our primary outcome, the callers' success in obtaining appointments from Medicaid-enrolled physicians' offices. Wait time for appointments and reasons the physician offices refused appointments to callers were collected. RESULTS Overall, 2,816 obstetric clinicians are enrolled in Florida Medicaid. Callers made 1,747 attempts to contact 1,023 randomly selected physicians' offices from June to September 2021. Only 48.9% of medical offices (n=500) were successfully reached by phone, of which 39.4% (n=197) offered a prenatal care appointment to the caller. The median wait time until the first appointment was 15 days (quartile 1: 7; quartile 3: 26), with a range of 0-55 days. However, despite offering an appointment, 8.6% of the medical offices stated that they do not accept Medicaid insurance payment or would accept only self-pay. Among the 60.6% of callers unable to secure an appointment, the most common reasons were that the clinician was not accepting patients taking methadone (34.7%) or was not accepting any new patients with Medicaid insurance (23.8%) and that the pregnancy would be too advanced by the time of the first available appointment (7.3%). CONCLUSION This secret shopper study found that the majority of obstetric clinicians' offices enrolled in Florida Medicaid do not accept pregnant patients with Medicaid insurance who are taking MOUD. Policy changes are needed to ensure access to adequate prenatal care for patients with opioid use disorder.
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Affiliation(s)
- Kimberly Fryer
- Department of Obstetrics and Gynecology, College of Medicine, and the College of Public Health, University of South Florida, Tampa, and the Division of Hematology/Oncology, College of Medicine, University of Florida, Gainesville, Florida
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Sozen S, Krag D, Milliren C. Opioid dependence among pregnant and post-partum incarcerated individuals: A review of the literature. J Opioid Manag 2023; 19:123-133. [PMID: 37879667 DOI: 10.5055/jom.2023.0806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
BACKGROUND Pregnant and post-partum women with opioid dependence are an extremely vulnerable population within correctional facilities. A significant number of maternal inmates, however, still lack adequate provision of medications for opioid use disorder (OUD) and are subsequently forced into withdrawal. Currently, there exist no comprehensive reviews on the scope of literature regarding the management of this population. We aimed to provide a review on the research surrounding these women. DESIGN A systematic search of PubMed Central was conducted to identify studies evaluating OUD among pregnant and post-partum incarcerated women. Citations from only the last 20 years were included to ensure both relevance and scope of information. RESULTS The topics that emerged from this review included medications for OUD (MOUD) administration vs detoxification practices, treatment upon incarceration and upon release, and maternal and fetal outcomes. Across all articles, current care management of this population appeared inadequate. We further compiled all author recommendations and perspectives into a framework that can inform potential improvements in care coordination. CONCLUSIONS This review identifies significant gaps in current management-particularly regarding administration of MOUDs-and emphasizes the need for standardization of addiction-related and perinatal healthcare. We also highlight gaps in the literature and potential areas for future research.
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Affiliation(s)
- Serra Sozen
- Department of Medicine, The Robert Larner, MD College of Medicine, University of Vermont, Burlington, Vermont. ORCID: https://orcid.org/0000-0001-6775-0541
| | - David Krag
- Department of Surgery, University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, Vermont
| | - Carly Milliren
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, Massachusetts
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Foti TR, Cragun D, Mackie J, Agu N, Bell M, Marshall J. Personas of pregnant and parenting women with substance use and their barriers and pathways to system engagement. Birth 2023; 50:99-108. [PMID: 36625522 DOI: 10.1111/birt.12703] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 07/16/2022] [Accepted: 12/16/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Women with prenatal substance use have been identified as at-risk for the lack of engagement in perinatal services, such as medical care and home visitation programs. This issue is of particular concern in Florida (United States) where rates of fetal substance exposure have been steadily increasing. METHODS To identify pathways of and barriers to perinatal system and service engagement, journey mapping was used to compile various personas of perinatal women with substance use. A structured guide was developed to elicit maternal personas, system and service touchpoints, and system strengths and weaknesses from focus group participants with statewide stakeholders, including perinatal service administrators and community coalition members within three Florida communities. Workshop transcripts, debriefing, and member-checking sessions were transcribed verbatim and analyzed manually. RESULTS Six journey-mapping workshops and two member-checking meetings with mothers in-recovery were conducted with a total of 109 participants. Four personas were identified: women who (1) have substance use on a recreational basis, (2) have prescription drug use/misuse, (3) have chronic substance dependence, and (4) are in-recovery from substance dependence. Pathways that promote and barriers that prevent perinatal women with substance use from being identified, referred, or willing to accept and engage in medical care and social services were identified. CONCLUSIONS While these personas shed light on differential pathways experienced by women with OUD, they were not intended as fixed-member groups but rather fluid descriptions of circumstances in which individuals could shift over time. These personas are beneficial to understand differences in circumstances, as well as variations in pathways and barriers to service engagement. Additionally, personas may be used to identify approaches to optimize service engagement by perinatal women with substance use and to support system improvements and integrations.
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Affiliation(s)
- Tara R Foti
- Kaiser Permanente of Northern California, Oakland, California, USA
| | - Deborah Cragun
- University of South Florida College of Public Health, Tampa, Florida, USA
| | | | - Ngozichukwuka Agu
- University of South Florida College of Public Health, Tampa, Florida, USA
| | - Megan Bell
- InSync Healthcare Solutions, Tampa, Florida, USA
| | - Jennifer Marshall
- University of South Florida College of Public Health, Tampa, Florida, USA
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Steely Smith MK, Wilson SH, Zielinski MJ. An integrative literature review of substance use treatment service need and provision to pregnant and postpartum populations in carceral settings. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057221147802. [PMID: 36920150 PMCID: PMC10021089 DOI: 10.1177/17455057221147802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/12/2022] [Accepted: 12/08/2022] [Indexed: 03/16/2023]
Abstract
Pregnancy is a critical time to provide access to substance use treatment; this is especially true among incarcerated populations, who are known to be at particularly high risk of poor health outcomes. In this integrated literature review, we (1) report what is known about the prevalence of substance use among incarcerated pregnant and postpartum populations; (2) describe substance use treatment programs and current care practices of pregnant and postpartum populations in carceral settings; and (3) explore recommendations and strategies for increasing access to substance use treatment for incarcerated pregnant and postpartum populations. A comprehensive search of seven electronic databases yielded in the retrieval of 139 articles that were assessed for inclusion. Of the retrieved articles, 33 articles met criteria for inclusion in this review. A review of the literature revealed that the understanding of substance use prevalence among pregnant incarcerated women is limited. We also found that treatment of substance use disorders among pregnant and postpartum populations is not routinely available, enhanced perinatal services are sorely needed, and substance use treatment programs are feasible with the help of community partnerships. More research is required to understand current substance use treatment initiatives and outcomes for pregnant women in prison. In addition, strategies for integrating evidence-based, substance use treatment in carceral settings is also needed. Future directions are discussed.
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Affiliation(s)
| | | | - Melissa J Zielinski
- University of Arkansas for Medical
Sciences, Little Rock, AR, USA
- University of Arkansas, Fayetteville,
AR, USA
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Malthaner LQ, Jetelina KK, Loria H, McLeigh JD. Healthcare utilization among children with a history of neonatal opioid withdrawal syndrome: A matched cohort study. CHILD ABUSE & NEGLECT 2022; 134:105934. [PMID: 36302288 DOI: 10.1016/j.chiabu.2022.105934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 10/04/2022] [Accepted: 10/13/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Compare longitudinal healthcare utilization patterns in children with and without a history of neonatal opioid withdrawal syndrome (NOWS). STUDY DESIGN A retrospective matched cohort study was conducted using billing data extracted from between 2003 and 2016 in North Texas hospitals. The sample included 595 pediatric patients diagnosed with NOWS (i.e. exposed). The unexposed were patients not diagnosed with NOWS and matched 4:1 on sex, age at first encounter, and ethnicity to the exposed who received care during the same period. Multi-level regression models (accounting for clustered data structure of multiple visits per patient) compared number of hospitalizations, number of outpatient visits, number of emergency department (ED) visits, average length of stay, and healthcare expenditures across patients with and without NOWS. RESULTS Hospitalizations were significantly lower among exposed (Incidence Rate Ratio [IRR] = 0.58, 95 % Confidence Interval [CI] = 0.44-0.77) compared to unexposed. Outpatient visits, ED visits, and average length of stay was significantly higher among exposed compared to unexposed (IRR = 1.19, 95 % CI = 1.04-1.36; IRR = 1.22, 95 % CI = 1.04-1.42; IRR = 2.21, 95 % CI = 2.03-2.42, respectively). Overall healthcare expenditure was greater among exposed, as well as for patients with neurologic, endocrine, cardiac, mental disorders, respiratory, perinatal, infectious disease, eye, ear, digestive, congenital anomaly, and skin diagnoses. CONCLUSIONS Children with a diagnosis of NOWS have significantly higher healthcare expenditures, and with the exception of hospitalizations, higher healthcare utilization beyond the newborn visit. These findings suggest the needs for interventions for children with NOWS beyond the immediate neonatal period.
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Affiliation(s)
- Lauren Q Malthaner
- Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center School of Public Health, Dallas, TX, United States of America; Rees-Jones Center for Foster Care Excellence, Children's Health, Dallas, TX, United States of America.
| | - Katelyn K Jetelina
- Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center School of Public Health, Dallas, TX, United States of America; Center for Pediatric Population Health, University of Texas Health Science Center School of Public Health, Dallas, TX, United States of America
| | - Hilda Loria
- Rees-Jones Center for Foster Care Excellence, Children's Health, Dallas, TX, United States of America; University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Jill D McLeigh
- Rees-Jones Center for Foster Care Excellence, Children's Health, Dallas, TX, United States of America; Center for Pediatric Population Health, University of Texas Health Science Center School of Public Health, Dallas, TX, United States of America
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Foti TR, Vereen S, Vamos C, Sappenfield W, Kirby RS. "A Lot of Things Stopped with COVID": Screening Pregnant Patients for Opioid Use and Related Conditions During the COVID-19 Pandemic. Womens Health Issues 2022; 33:242-249. [PMID: 36496340 PMCID: PMC9637513 DOI: 10.1016/j.whi.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 09/12/2022] [Accepted: 11/01/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE We explored the impact of COVID-19 on universal screening programs for opioid use and related conditions among practicing clinicians or staff who work with pregnant patients. METHODS Semi-structured, in-depth qualitative interviews (n = 15) were conducted with practicing clinicians or staff in West-Central Florida between May and October 2020, representing both a range of professions and clinical settings that serve pregnant patients. Interviews were recorded, transcribed verbatim, and reviewed for accuracy. Independent coders conducted thematic content analysis iteratively in MaxQDA to identify emergent themes. RESULTS Four main themes were identified: worsening health and life conditions of pregnant patients, impaired patient-provider interactions, lack of priority and resources, and conducting opioid screening remotely. Pregnant patients often faced worsening mental health, lack of connection with health care providers, and socioenvironmental factors that increased the risk of overdose and intimate partner violence. Health care providers and facilities faced an infectious disease pandemic that simultaneously increased mental burden and reduced resources. Telehealth improved access to health care for many, but also came with implementation challenges such as inadequate technology, the need to address barriers to developing rapport with patients, and difficulty with certain social screens. CONCLUSION These themes describe facilitators of and barriers to implementing opioid and related screening programs during the COVID-19 pandemic, as well as the increasing urgency of screening because of socioenvironmental factors. Patients, health care providers, and health practices may benefit from emergency plans that anticipate screening challenges given their increased importance during times of heightened risk, including disasters and epidemics.
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Affiliation(s)
- Tara R. Foti
- Division of Research, Kaiser Permanente of Northern California, Oakland, California,University of South Florida College of Public Health, Tampa, Florida,Correspondence to: Tara R. Foti, PhD, MPH, Kaiser Permanente of Northern California, Division of Research, 2000 Broadway, Oakland, CA 94612. Tel.: (585) 746-3857
| | - Shanda Vereen
- University of South Florida College of Public Health, Tampa, Florida
| | - Cheryl Vamos
- University of South Florida College of Public Health, Tampa, Florida
| | | | - Russell S. Kirby
- University of South Florida College of Public Health, Tampa, Florida
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Bukowski HB, Combellick JL. Midwifery Care of Pregnant Individuals Experiencing Opioid use Disorder: Changing Regulations, Complexities, and Call to Action. J Midwifery Womens Health 2022; 67:770-776. [PMID: 36269042 DOI: 10.1111/jmwh.13415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 08/18/2022] [Accepted: 08/30/2022] [Indexed: 11/30/2022]
Abstract
Opioid use disorder (OUD), overdose, and death have exploded in the United States in the past 2 decades. The number of pregnant and birthing people reporting opioid use and misuse is also rising. Co-occurring mental illness, multisubstance use, and associated medical comorbidities often complicate care for pregnant individuals with OUD. Neonates who are exposed to opioids in utero are at risk for neonatal opioid withdrawal syndrome and other short- and long-term sequelae. Recent changes to the Department of Health and Human Services Practice Guidelines for the Administration of Buprenorphine for Treating Opioid Use Disorder have now provided a pathway for midwives to prescribe buprenorphine for opioid use disorder (OUD) for up to 30 individuals at one time without further training or certification of ancillary services. Midwives have a key role to play in expanding the availability and quality of interprofessional care provided to individuals with OUD. The Substance Abuse and Mental Health Services Administration and American Society of Addiction Medicine, along with other professional organizations, provide toolkits and guidelines for the provision of MOUD for pregnant people. Midwives who care for individuals with OUD should be familiar with the unique needs of this population and resources to guide their care. This case study highlights midwives' essential role in treating OUD and co-occurring mental disorders.
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Redefining Child Protection: Addressing the Harms of Structural Racism and Punitive Approaches for Birthing People, Dyads, and Families Affected by Substance Use. Obstet Gynecol 2022; 140:167-173. [PMID: 35852265 DOI: 10.1097/aog.0000000000004786] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/24/2022] [Indexed: 11/27/2022]
Abstract
There has been growing attention on the effect of substance use, including opioid use disorder, on pregnant and birthing people and their infants. Although effective medication treatment for opioid use disorder is the standard of care, racial disparities are evident in access during pregnancy. Structural racism affects treatment access and approaches to reporting to child welfare services. Black people and their newborns are more likely to be drug tested in medical settings, and Black newborns are more likely to be reported to child welfare services. Child welfare models often focus on substance use as being the dominant issue that drives risk for abuse or neglect of a child, and current reporting practices, which vary by state, contribute to these disparities. This commentary proposes an alternate way of thinking about family-based support. We suggest changes to law, institutional policy, clinical care, and ideology. Specifically, we propose realigning around shared goals of supporting the birthing person-infant dyad and recognizing that substance use is not synonymous with abuse or neglect; creating an anonymous notification process outside of the child welfare system to meet federal data-collection requirements; limiting perinatal drug testing and requiring written, informed consent for parental and neonatal testing; and developing integrated care teams and hospital settings and policies that support dyadic care.
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Richelle L, Dramaix-Wilmet M, Roland M, Kacenelenbogen N. Factors influencing medical students' attitudes towards substance use during pregnancy. BMC MEDICAL EDUCATION 2022; 22:335. [PMID: 35501752 PMCID: PMC9060417 DOI: 10.1186/s12909-022-03394-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 04/18/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND People with substance use disorder, and pregnant women especially, are subject to a lot of stigmas, which can prevent optimal accessibility and quality of care. In this survey, we investigated attitudes of final year medical students regarding substance use during pregnancy and identified the factors that influence these attitudes. METHOD This cross-sectional study was conducted in 2019 and 2020 in Belgium using the short version of the "Substance Abuse Attitude Survey" questionnaire. We focused on two items regarding punishment of substance use during pregnancy. We analysed the concordance between these two, their correlation with other items (e.g. stereotyping, morality, forced withdrawal, low treatment optimism) and the association between respondents' opinion on punishment and their sociodemographic data. RESULTS The response rate was 65.2% (370/567 online and face-to face questionnaires). 19.2% of respondents were in favour of punishment for alcohol use (n = 353) and 15.1% for drug use (n = 356) during pregnancy. The agreement analysis between the two items showed that 14.3% of students were in favour of punishing both pregnant women who use drugs and those using alcohol. Respondents tended to be more in favour of punishment if they were male students, older, their mothers' had a lower education level or had no personal or family history of substance use. Attitudes appeared to be more punitive among students with limited contact with people with substance use disorder (i.e. none or limited to hospital). Students intending to specialise in internal medicine were more in favour of punishment of women whereas none of those intending to specialise in psychiatry were in favour. CONCLUSION Our study shows that about 20% of surveyed medical students favoured punishing substance-using pregnant women. Awareness and training work seems to be necessary to ensure adequate care and support for this already vulnerable population.
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Affiliation(s)
- Lou Richelle
- Department of General Medicine, Université Libre de Bruxelles, Route de Lennik 808, 612 1070, Brussels, CP, Belgium.
| | - Michèle Dramaix-Wilmet
- Department of Epidemiology and Biostatistics, School of Public Health, Université Libre de Bruxelles, Route de Lennik 808, 591 1070, Brussels, CP, Belgium
| | - Michel Roland
- Department of General Medicine, Université Libre de Bruxelles, Route de Lennik 808, 612 1070, Brussels, CP, Belgium
| | - Nadine Kacenelenbogen
- Department of General Medicine, Université Libre de Bruxelles, Route de Lennik 808, 612 1070, Brussels, CP, Belgium
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Virtual Peer Support in Women's Health for Pregnant People and Mothers With Substance Use Disorder. Nurs Womens Health 2022; 26:226-233. [PMID: 35460640 DOI: 10.1016/j.nwh.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 01/10/2022] [Accepted: 03/03/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of a virtual peer support group associated with a women's health unit for mothers and pregnant people with substance use disorder. DESIGN The project was guided by the Centers for Disease Control and Prevention's Framework for Program Evaluation in Public Health. Pre-/postintervention surveys were used to evaluate outcomes. SETTING Women's health unit in a 325-bed hospital with 900 births a year in the U.S. Midwest and a virtual online meeting format. PARTICIPANTS Thirteen people with substance use disorder. INTERVENTION/MEASUREMENTS Participants were recruited by nurses on the women's health unit and in existing online meetings. Participants attended a 12-week session of facilitated substance use disorder peer support meetings through an online virtual format. Surveys included the Depression, Anxiety, and Stress Scale; the Alcoholics Anonymous Intention Scale; and pre-/postintervention surveys developed by the authors. Descriptive statistics and narrative description of qualitative data were used. RESULTS The Depression, Anxiety, and Stress Scale scores were reduced, on average, by 25%, indicating that participants showed improvement in these conditions. Responses to open-ended questions showed that participants found the meetings helpful for developing coping mechanisms. The virtual space was seen as a comfortable, safe space where participants were able to develop community. CONCLUSION Substance use disorder treatment continues to challenge health care providers across the United States. Peer support meetings have been effective in the treatment of people with substance use disorder. Nursing has the holistic historical precedence of creating effectual education and support programs. This program evaluation exemplifies that women's health units are an appropriate location where nurses can integrate this established evidence-based treatment modality.
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St Louis J, Barreto T, Taylor M, Kane C, Worringer E, Eden AR. Barriers to care for perinatal patients with opioid use disorder: family physician perspectives. Fam Pract 2022; 39:249-256. [PMID: 35325109 DOI: 10.1093/fampra/cmab154] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND While barriers to care for pregnant patients with opioid use disorder (OUD) have been described, the experiences and challenges of the physicians providing care to these patients are poorly understood. OBJECTIVES To describe the experiences of family physicians providing comprehensive care to pregnant people with OUD and the challenges they face in providing such care. METHODS Qualitative thematic analysis of 17 semistructured interviews conducted from July 2019 to September 2020 with family physicians who possess a Drug Enforcement Administration "X" waiver and provide care to pregnant patients. RESULTS Seventeen family physicians practicing in the United States who care for pregnant people with OUD were interviewed. They described physician-, patient-, and systems-level barriers to providing and accessing care for this patient population. Of the 12 interrelated themes regarding challenges to delivering and accessing this care, 3 were particularly salient: the pervasive effects of social determinants of health, a lack of adequately trained providers, and social stigma associated with pregnant people with OUD. CONCLUSION A comprehensive, multilevel, and multidisciplinary approach is necessary to address these barriers and move towards health equity for this vulnerable patient population.
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Affiliation(s)
- Joshua St Louis
- Lawrence Family Medicine Residency, Lawrence, MA, United States
| | - Tyler Barreto
- Sea Mar Marysville Family Medicine Residency, Marysville, WA, United States
| | - Melina Taylor
- American Board of Family Medicine, Lexington, KY, United States
| | - Claire Kane
- Robert Graham Center for Policy Studies in Family Medicine, Washington, DC, United States
| | - Emma Worringer
- PCC Community Wellness Center, Oak Park, IL, United States
| | - Aimee R Eden
- American Board of Family Medicine, Lexington, KY, United States
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Khachikian T, Amaro H, Guerrero E, Kong Y, Marsh JC. Disparities in opioid treatment access and retention among women based on pregnancy status from 2006 to 2017. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 2. [PMID: 35369381 PMCID: PMC8975179 DOI: 10.1016/j.dadr.2022.100030] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: The purpose of this study is to assess differences in wait time and retention in opioid use disorder (OUD) treatment among a sample of pregnant and non-pregnant women from low-income urban communities in Los Angeles, California. Methods: Data were collected in 9 waves consisting of consecutive years from 2006 to 2011, and then including 2013, 2015, and 2017. The sample consisted of 12,558 women, with 285 being pregnant and 12,273 being non-pregnant. We compared pregnant women with non-pregnant women at admission on key characteristics and relied on two multilevel negative binomial regressions analyses to examine factors related to access (days on the waiting list) and retention (days in treatment). Results: We detected disparities existed in access and retention. Pregnant women spent less time waiting to initate treatment than non-pregnant women and, once in treatment, had longer treatment episodes. Among pregnant women, clients identifying as Latina or Other waited longer to enter treatment compared to clients identifying as non-Latina White or Black. Women entering residential waited longer than those entering methadone or counseling services. Pregnant women were more likely to be in treatment longer if they had mental health issues, greater parenting responsibilities (number of children less than 18), and greater SUD severity (number of prior treatment episodes). Conclusions: Findings suggest pregnant women’s access and retention can be improved through Medicaid coverage and through the implementation of a standard of care that includes MOUD (methadone) along with ancillary health and social services.
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Affiliation(s)
- Tenie Khachikian
- University of Chicago, School of Social Service Administration, 969 E. 60th Street, Chicago, IL 60637, USA
- Corresponding author.
| | - Hortensia Amaro
- Florida International University, Herbert Wertheim College of Medicine and Robert Stempel College of Public Health and Social Work, 11200 SW 8th St, AHC4, Miami, Florida 33199, USA
| | - Erick Guerrero
- I-LEAD Institute, Research to End Healthcare Disparities Corp, 12300 Wilshire Blvd, Suite 210, Los Angeles, CA 90025 USA
| | - Yinfei Kong
- California State University, Fullerton, College of Business and Economics, 800N State College Blvd, Fullerton CA 92831 USA
| | - Jeanne C. Marsh
- University of Chicago, School of Social Service Administration, 969 E. 60th Street, Chicago, IL 60637, USA
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Gaps in the congenital syphilis prevention cascade: qualitative findings from Kern County, California. BMC Infect Dis 2022; 22:129. [PMID: 35123425 PMCID: PMC8818245 DOI: 10.1186/s12879-022-07100-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/18/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Congenital syphilis is preventable through timely access to prenatal care, syphilis screening and treatment of pregnant women diagnosed as infected. In 2018, California had the second highest number of congenital syphilis cases in the United States (U.S.), a nearly twofold increase in cases since 2014. This study assessed gaps in preventing congenital syphilis in the high morbidity region of Kern County, California.
Methods
Between May 2018 and January 2019, we conducted five focus group discussions with pregnant/postpartum women and ten semi-structured interviews with prenatal care providers in Kern County. Focus group and interview data were recorded, transcribed, and analyzed to identify emergent themes pertaining to facilitators and barriers at each step (prenatal care, syphilis screening and treatment) in the congenital syphilis prevention cascade.
Results
Gaps in congenital syphilis prevention discussed in focus group discussions with pregnant/postpartum women were related to limited prenatal care access, social-, economic-, and cultural-barriers, and substance use and co-occurring intimate partner/domestic violence. The gaps identified from interviews with prenatal care providers included social economic vulnerabilities of pregnant women and stigma and shame around the vulnerabilities, distrust in medical system, prenatal substance use, limited prenatal substance use disorder treatment facilities, and inadequate provider training on context-specific congenital syphilis management strategies. Gaps in partner notification, screening and treatment for syphilis were brought up by pregnant/postpartum women and prenatal care providers.
Conclusions
Congenital syphilis continues to increase in Kern County and throughout the U.S. In high syphilis morbidity areas, comprehensive and tailored public health approaches addressing setting-specific gaps in prenatal screening and treatment are needed.
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Forray A, Mele A, Byatt N, Londono Tobon A, Gilstad-Hayden K, Hunkle K, Hong S, Lipkind H, Fiellin DA, Callaghan K, Yonkers KA. Support Models for Addiction Related Treatment (SMART) for pregnant women: Study protocol of a cluster randomized trial of two treatment models for opioid use disorder in prenatal clinics. PLoS One 2022; 17:e0261751. [PMID: 35025898 PMCID: PMC8758001 DOI: 10.1371/journal.pone.0261751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 11/18/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction The prevalence of opioid use disorder (OUD) in pregnancy increased nearly five-fold over the past decade. Despite this, obstetric providers are less likely to treat pregnant women with medication for OUD than non-obstetric providers (75% vs 91%). A major reason is many obstetricians feel unprepared to prescribe medication for opioid use disorder (MOUD). Education and support may increase prescribing and overall comfort in delivering care for pregnant women with OUD, but optimal models of education and support are yet to be determined. Methods and analysis We describe the rationale and conduct of a matched-pair cluster randomized clinical trial to compare the effectiveness of two models of support for reproductive health clinicians to provide care for pregnant and postpartum women with OUD. The primary outcomes of this trial are patient treatment engagement and retention in OUD treatment. This study compares two support models: 1) a collaborative care approach, based upon the Massachusetts Office-Based-Opioid Treatment Model, that provides practice-level training and support to providers and patients through the use of care managers, versus 2) a telesupport approach based on the Project Extension for Community Healthcare Outcomes, a remote education model that provides mentorship, guided practice, and participation in a learning community, via video conferencing. Discussion This clustered randomized clinical trial aims to test the effectiveness of two approaches to support practitioners who care for pregnant women with an OUD. The results of this trial will help determine the best model to improve the capacity of obstetrical providers to deliver treatment for OUD in prenatal clinics. Trial registration Clinicaltrials.gov trial registration number: NCT0424039.
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Affiliation(s)
- Ariadna Forray
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States of America
- * E-mail:
| | - Amanda Mele
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Nancy Byatt
- Department of Psychiatry, University of Massachusetts School of Medicine, Worcester, Massachusetts, United States of America
- Department of Ob/Gyn, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Amalia Londono Tobon
- Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island, United States of America
| | - Kathryn Gilstad-Hayden
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Karen Hunkle
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Suyeon Hong
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Heather Lipkind
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - David A. Fiellin
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
- Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Katherine Callaghan
- Department of Ob/Gyn, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Kimberly A. Yonkers
- Department of Psychiatry, University of Massachusetts School of Medicine, Worcester, Massachusetts, United States of America
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Goodman DJ, Saunders EC, Frew JR, Arsan C, Xie H, Bonasia KL, Flanagan VA, Lord SE, Brunette MF. Integrated vs nonintegrated treatment for perinatal opioid use disorder: retrospective cohort study. Am J Obstet Gynecol MFM 2022; 4:100489. [PMID: 34543754 DOI: 10.1016/j.ajogmf.2021.100489] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/31/2021] [Accepted: 09/09/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Pregnant women with opioid use disorder and their infants often experience worse perinatal outcomes than women without opioid use disorder, including longer hospitalizations after delivery and a higher risk for preterm delivery. Integrated treatment models, which combine addiction treatment and maternity care, represent an innovative approach that is widely endorsed, however, limited studies have compared the outcomes between integrated and standard, nonintegrated programs from real-world programs. OBJECTIVE This study aimed to evaluate the perinatal and substance use outcomes for pregnant women with opioid use disorder receiving coordinated, colocated obstetrical care and opioid use disorder treatment (integrated treatment) and to compare it with those of women receiving obstetrical care and opioid use disorder treatment in distinct programs of care (nonintegrated treatment). STUDY DESIGN In this observational, retrospective cohort study, we abstracted the perinatal and opioid use disorder treatment data from the records of pregnant women with opioid use disorder (n=225) who delivered at a rural, academic medical center from 2015 to 2017. The women either received integrated (n=92) or nonintegrated (n=133) opioid use disorder treatment and obstetrical care. Using inverse probability weighted regression models to adjust for a potential covariate imbalance, we evaluated the impact of the treatment model on the risk for preterm delivery and positive meconium or umbilical cord toxicology screens. We explored whether the number of obstetrical visits mediated this relationship by using a quasi-Bayesian Monte Carlo algorithm. RESULTS Women receiving integrated treatment were less likely to deliver prematurely (11.8% vs 26.6%; P<.001) and their infants had shorter hospitalizations (6.5±4.8 vs 10.7±16.2 days). Using a robust inverse probability weighted model showed that receiving integrated treatment was associated with a 74.7% decrease in the predicted probability of preterm delivery (average treatment effect, -0.19; standard error, 0.14; P<.001). There were no differences in the risk for a positive meconium or umbilical cord toxicology screen, a marker for second and third trimester substance use, between women receiving integrated treatment and those receiving coordinated treatment (29.4% vs 34.6%; P=.41), however, integrated treatment was associated with significantly lower rates of positive maternal urine toxicology screens at the time of delivery (35.9% vs 74.4%; P<.001). CONCLUSION Among a cohort of rural pregnant women with opioid use disorder, receiving integrated obstetrical care and opioid use disorder treatment was associated with a reduced risk for preterm birth, a lower risk for positive maternal urine toxicology screen at the time of delivery, and shorter infant hospitalization. This relationship was mediated by the number of obstetrical visits attended during pregnancy, suggesting that increased engagement with obstetrical care through integration of services may contribute to improved perinatal outcomes.
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Affiliation(s)
- Daisy J Goodman
- Dartmouth Geisel School of Medicine, Hanover, NH (Drs Goodman, Saunders, Frew, Arsan, Xie, Bonasia, Lord, and Brunette); Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, NH (Dr Goodman and Ms Flanagan); The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH (Dr Goodman)
| | - Elizabeth C Saunders
- Dartmouth Geisel School of Medicine, Hanover, NH (Drs Goodman, Saunders, Frew, Arsan, Xie, Bonasia, Lord, and Brunette).
| | - Julia R Frew
- Dartmouth Geisel School of Medicine, Hanover, NH (Drs Goodman, Saunders, Frew, Arsan, Xie, Bonasia, Lord, and Brunette); Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH (Drs Frew, Arsan, Lord, and Brunette)
| | - Cybele Arsan
- Dartmouth Geisel School of Medicine, Hanover, NH (Drs Goodman, Saunders, Frew, Arsan, Xie, Bonasia, Lord, and Brunette); Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH (Drs Frew, Arsan, Lord, and Brunette); Department of Psychiatry, Los Angeles County and Keck Medical Center of University of Southern California, Los Angeles, CA (Dr Arsan)
| | - Haiyi Xie
- Dartmouth Geisel School of Medicine, Hanover, NH (Drs Goodman, Saunders, Frew, Arsan, Xie, Bonasia, Lord, and Brunette)
| | - Kyra L Bonasia
- Dartmouth Geisel School of Medicine, Hanover, NH (Drs Goodman, Saunders, Frew, Arsan, Xie, Bonasia, Lord, and Brunette)
| | - Victoria A Flanagan
- Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, NH (Dr Goodman and Ms Flanagan)
| | - Sarah E Lord
- Dartmouth Geisel School of Medicine, Hanover, NH (Drs Goodman, Saunders, Frew, Arsan, Xie, Bonasia, Lord, and Brunette); Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH (Drs Frew, Arsan, Lord, and Brunette)
| | - Mary F Brunette
- Dartmouth Geisel School of Medicine, Hanover, NH (Drs Goodman, Saunders, Frew, Arsan, Xie, Bonasia, Lord, and Brunette); Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH (Drs Frew, Arsan, Lord, and Brunette)
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20
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Gulbransen K, Thiessen K, Pidutti J, Watson H, Winkler J. Scoping Review of Best Practice Guidelines for Care in the Labor and Birth Setting of Pregnant Women Who Use Methamphetamines. J Obstet Gynecol Neonatal Nurs 2021; 51:141-152. [PMID: 34914926 DOI: 10.1016/j.jogn.2021.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To use a scoping review to explore the existing literature on best practice guidelines for safe, dignified, and compassionate care in the labor and birth setting for pregnant women who use methamphetamines. DATA SOURCES We conducted a systematic search for articles and best practice guidelines from health-related databases (MEDLINE; CINAHL; and the Web of Science, including the Core Collection and Social Science Citation Index, PsycInfo, Women's Studies International, and Sociological Abstracts) and gray literature. Search terms included substance use disorder, methamphetamine, childbirth, and labor and delivery. STUDY SELECTION We included English-language, peer-reviewed reports of primary research, systematic reviews, and practice guidelines from credible databases and organizations published between 1991 and 2020. We screened 1,297 resources and agreed to review 156 articles and 16 gray literature resources in the full-text analysis. Nine of the 156 articles and 16 gray literature resources met the inclusion criteria. DATA EXTRACTION We used the Joanna Briggs Institute review guidelines (2015) criteria for extraction of the following data: author(s); year of publication; type of study; objectives; country of origin; study population and sample size (if applicable); inclusion of best practice guidelines for the labor and birth setting; care approaches specific to safety, dignity, compassion; and the targeted substance(s) discussed (e.g., methamphetamine, opioids, etc.). We further documented the phenomena of interest to determine if articles or best practice guidelines included safe, dignified, and compassionate care approaches specific to pregnant women who use methamphetamine. DATA SYNTHESIS We summarized the best practice guidelines, which included universal screening, assessment, and management of analgesia during labor, as well as broad guidance regarding the inclusion of a multidisciplinary health care team. Safe, dignified, and compassionate care approaches were focused on communication, shared decision making, and the provision of nonjudgmental care. Although evidence about substance use during the childbearing years is increasing, stronger evidence for clinical care approaches in the labor and birth setting is needed, inclusive of all stakeholder perspectives. CONCLUSION The articles and best practice guidelines reviewed provided broad clinical recommendations that were applicable to pregnant women who use methamphetamine. However, we did not find a complete comprehensive best practice guideline for labor and birth that was specific, was solution focused, and delineated a safe, dignified, and compassionate care approach.
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21
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Henry MC, Sanjuan PM, Stone LC, Cairo GF, Lohr-Valdez A, Leeman LM. Alcohol and other substance use disorder recovery during pregnancy among patients with posttraumatic stress disorder symptoms: A qualitative study. DRUG AND ALCOHOL DEPENDENCE REPORTS 2021; 1:100013. [PMID: 36843908 PMCID: PMC9948915 DOI: 10.1016/j.dadr.2021.100013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/22/2021] [Accepted: 11/29/2021] [Indexed: 10/19/2022]
Abstract
Background About 5% of women are pregnant at substance use disorder (SUD) treatment entry, and pregnant women with SUD often belong to marginalized groups experiencing social, economic, and health care barriers associated with stigma from prenatal substance use. Pregnant women in SUD treatment have high rates of trauma and posttraumatic stress disorder (PTSD). This study sought to (1) examine the lived experiences of pregnant individuals with PTSD symptoms in SUD treatment and (2) understand the roles of systematic or contextual barriers to the pursuit of prenatal abstinence. Methods We draw upon in-depth semi-structured interviews to examine relationships between SUD, psychological trauma/PTSD experience, social resources, and lived experiences among patients in prenatal SUD treatment with PTSD symptoms. Our sample was pregnant patients (N = 13) with prior DSM-5 Criterion A trauma and current PTSD symptoms enrolled in a comprehensive program integrating prenatal care, substance use counseling, medication for opioid use disorder and case management at three sites affiliated with an urban academic medical center in New Mexico. Results Using thematic analysis, four main themes identified structural forces influencing alcohol and drug use: (a) lack of access or ability to obtain resources, (b) substance use to cope with negative affect, (c) social stigma, and (d) interpersonal relationships. Conclusions Despite receiving high-quality integrated prenatal and SUD care, these pregnant patients with PTSD symptoms in SUD treatment still experienced substantial social and structural hurdles to achieving abstinence during pregnancy.
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Affiliation(s)
- Melissa C. Henry
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, 2650 Yale Boulevard, SE, Albuquerque, NM 87106, United States
| | - Pilar M. Sanjuan
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, 2650 Yale Boulevard, SE, Albuquerque, NM 87106, United States
- Department of Family and Community Medicine, University of New Mexico School of Medicine MSC08 4720, 1 University of New Mexico, Albuquerque, NM 87131, United States
| | - Lisa Cacari Stone
- College of Population Health, University of New Mexico Health Science Center, 1001 Medical Arts Ave NE, Albuquerque, NM 87102, United States
| | - Grace F. Cairo
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, 2650 Yale Boulevard, SE, Albuquerque, NM 87106, United States
| | - Anthony Lohr-Valdez
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, 2650 Yale Boulevard, SE, Albuquerque, NM 87106, United States
| | - Lawrence M. Leeman
- Department of Family and Community Medicine, University of New Mexico School of Medicine MSC08 4720, 1 University of New Mexico, Albuquerque, NM 87131, United States
- Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, MSC08 4720, 1 University of New Mexico, Albuquerque, NM 87131, United States
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Schwab-Reese LM, Renner LM, King H, Miller RP, Forman D, Krumenacker JS, DeMaria AL. "They're very passionate about making sure that women stay healthy": a qualitative examination of women's experiences participating in a community paramedicine program. BMC Health Serv Res 2021; 21:1167. [PMID: 34706727 PMCID: PMC8550812 DOI: 10.1186/s12913-021-07192-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 09/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Community paramedicine programs (i.e., physician-directed preventive care by emergency medical services personnel embedded in communities) offer a novel approach to community-based health care. Project Swaddle, a community paramedicine program for mothers and their infants, seeks to address (directly or through referrals) the physical, mental, social, and economic needs of its participants. The objective of this process evaluation was to describe women's experiences in Project Swaddle. By understanding their experiences, our work begins to build the foundation for similar programs and future examinations of the efficacy and effectiveness of these approaches. METHODS We completed 21 interviews with women living in Indiana (July 2019-February 2020) who were currently participating in or had graduated from Project Swaddle. Interviews were audio-recorded, transcribed, and analyzed using a six-phase approach to thematic analysis. RESULTS Program enrollment was influenced by the community paramedics' experience and connections, as well as information received in the community from related clinics or organizations. Participants viewed the community paramedic as a trusted provider who supplied necessary health information and support and served as their advocate. In their role as physician extenders, the community paramedics enhanced patient care through monitoring critical situations, facilitating communication with other providers, and supporting routine healthcare. Women noted how community paramedics connected them to outside resources (i.e., other experts, tangible goods), which aimed to support their holistic health and wellbeing. CONCLUSIONS Results demonstrate Project Swaddle helped women connect with other healthcare providers, including increased access to mental health services. The community paramedics were able to help women establish care with primary care providers and pediatricians, then facilitate communication with these providers. Women were supported through their early motherhood experience, received education on parenting and taking control of their health, and gained access to resources that met their diverse needs.
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Affiliation(s)
- Laura M Schwab-Reese
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA.
| | - Lynette M Renner
- School of Social Work, College of Education and Human Development, University of Minnesota, St. Paul, MN, USA
| | - Hannah King
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA
| | - R Paul Miller
- City of Crawfordsville Fire Department, Crawfordsville, IN, USA
| | - Darren Forman
- City of Crawfordsville Fire Department, Crawfordsville, IN, USA
| | | | - Andrea L DeMaria
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA
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23
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Sanders AN, Vance DE, Dudding KM, Shorten A, Rice M. Maternal-infant bonding for the opioid exposed dyad: A rodgers' evolutionary concept analysis. Nurs Forum 2021; 57:165-170. [PMID: 34676568 DOI: 10.1111/nuf.12663] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/15/2021] [Accepted: 10/14/2021] [Indexed: 11/28/2022]
Abstract
AIM This concept analysis aimed to offer insight into how opioid exposure affects the quality and construction of the maternal-infant bond. BACKGROUND Maternal-infant bonding can be influenced by maternal opioid use disorder and the neonatal intensive care unit environment. Many interventions for mothers with opioid use disorder focus on enhancing parental skills, but often the emotional and relational features of the maternal-infant bond have been overlooked. DATA SOURCE Literature from Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, PubMed, and PsycINFO published from January 2011 to June 2021 using "attachment theory," "mother-infant attachment," "maternal-infant bonding," "neonatal opioid withdrawal syndrome," and "neonatal abstinence syndrome" as key terms. REVIEW METHODS Rodgers' method of concept analysis was used to determine the antecedents, attributes, and consequences of maternal-infant bonding. RESULTS The key attributes of bonding for the opioid-exposed mother-infant dyad are engaged mothering, recognition of risk, affection, and respectful maternity care. The antecedents are closeness, selflessness, and purposeful touch. The consequences are sobriety, custody, love, and security.
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Affiliation(s)
- Allyson N Sanders
- School of Nursing, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - David E Vance
- School of Nursing, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Katherine M Dudding
- School of Nursing, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Allison Shorten
- School of Nursing, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Marti Rice
- School of Nursing, The University of Alabama at Birmingham, Birmingham, Alabama, USA
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Pentecost R, Schmidt K, Grassley JS. Health Care Providers' Perceived Barriers to Screening for Substance Use During Pregnancy. Nurs Womens Health 2021; 25:272-277. [PMID: 34146524 DOI: 10.1016/j.nwh.2021.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 05/07/2021] [Accepted: 05/01/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To explore health care providers' perceived barriers to conducting standardized screening processes for substance use during pregnancy. DESIGN Descriptive survey. SETTING/LOCAL PROBLEM A health system in the northwestern United States where there was a lack of consistent substance use screening in prenatal clinics. PARTICIPANTS A convenience sample of 12 women's health care providers from two hospitals in the health system, including obstetricians/gynecologists, women's health nurse practitioners, women's health physician assistants, and certified nurse-midwives. INTERVENTION/MEASUREMENTS We created a 16-item questionnaire that identified potential barriers to screening, such as education/resources for providers, screening tools, referral processes, legal implications, patient relations, and infrastructure. RESULTS A majority (n = 8, 66.7%) of participants indicated they had received adequate training regarding substance use during pregnancy and felt comfortable asking pregnant women about their substance use. All (n = 12, 100%) providers indicated that women would feel safe disclosing their substance use but might feel offended if their provider asked them about it. Although most reported screening women for substance use, they did not use a consistent screening tool or process. Participants identified lack of time, legal concerns, and lack of access to resources for referrals as other barriers to screening. CONCLUSION Clinicians perceive barriers to screening for substance use during pregnancy, and they may be unaware of legal implications for patients related to perinatal substance use. Identifying barriers to universal screening may facilitate development of best practices related to counseling patients about substance use during pregnancy.
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Drake C, Nagy D, Nguyen T, Kraemer KL, Mair C, Wallace D, Donohue J. A comparison of methods for measuring spatial access to health care. Health Serv Res 2021; 56:777-787. [PMID: 34250592 DOI: 10.1111/1475-6773.13700] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 04/27/2021] [Accepted: 04/29/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To compare measures of spatial access to care commonly used by policy makers and researchers with the more comprehensive enhanced two-step floating catchment area (E2SFCA) method. STUDY SETTING Fourteen southwestern Pennsylvania counties. STUDY DESIGN We estimated spatial access to buprenorphine-waivered prescribers using three commonly used measures-Euclidean travel distance to the closest prescriber, travel time to the closest provider, and provider-to-population ratios-and the E2SFCA. Unlike other measures, the E2SFCA captures provider capacity, potential patient volume, and travel time to prescribers. DATA COLLECTION/EXTRACTION METHODS We measured provider capacity as the number of buprenorphine prescribers listed at a given address in the Drug Enforcement Agency's 2020 Controlled Substances Act Registrants Database, and we measured potential patient volume as the number of nonelderly adults in a given census tract as reported by the 2018 American Community Survey. We estimated travel times between potential patients and prescribers with Bing Maps and Mapbox application programming interfaces. We then calculated each spatial access measure using the R programming language. We used each measure of spatial access to identify census tracts in the lowest quintile of spatial access to prescribers. PRINCIPAL FINDINGS The Euclidean distance, travel time, and provider-to-population ratio measures identified 48.3%, 47.2%, and 69.9% of the census tracts that the E2SFCA measure identified as being in the lowest quintile of spatial access to care, meaning that these measures misclassify 30%-52% of study area census tracts as having sufficient spatial access to buprenorphine prescribers. CONCLUSIONS Measures of spatial access commonly used by policy makers do not sufficiently accurately identify geographic areas with relatively low access to prescribers of buprenorphine. Using the E2SFCA in addition to the commonly used measures would allow policy makers to precisely target interventions to increase spatial access to opioid use disorder treatment and other types of health care services.
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Affiliation(s)
- Coleman Drake
- Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Dylan Nagy
- Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Thuy Nguyen
- Department of Health Policy and Management, University of Michigan, Ann Arbor, Michigan, USA
| | - Kevin L Kraemer
- Department of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Christina Mair
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - David Wallace
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Julie Donohue
- Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
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Holcomb DS, Pengetnze Y, Steele A, Karam A, Spong C, Nelson DB. Geographic barriers to prenatal care access and their consequences. Am J Obstet Gynecol MFM 2021; 3:100442. [PMID: 34245930 DOI: 10.1016/j.ajogmf.2021.100442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 07/01/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Although prenatal care has long been viewed as an important strategy toward improving maternal morbidity and mortality, limited data exist that support the premise that access to prenatal care impacts perinatal outcomes. Furthermore, little is known about geographic barriers that impact access to care in an underserved population and how this may influence perinatal outcomes. OBJECTIVE This study aimed to (1) evaluate perinatal outcomes among women with and without prenatal care and (2) examine barriers to receiving prenatal care according to block-level data of residence. We hypothesized that women without prenatal care would have worse outcomes and more barriers to receiving prenatal care services. STUDY DESIGN This was a retrospective cohort study of pregnant women delivering at ≥24 weeks' gestation in a large inner-city public hospital system. Maternal and neonatal data were abstracted from the electronic health record and a community-wide data initiative data set, which included socioeconomic and local geographic data from diverse sources. Maternal characteristics and perinatal outcomes were examined among women with and without prenatal care. Prenatal care was defined as at least 1 visit before delivery. Outcomes of interest were (1) preterm delivery at <37 weeks' gestation, (2) preeclampsia or eclampsia, and (3) days in the neonatal intensive care unit after delivery. Barriers to care were analyzed, including public transportation access and location of the nearest county-sponsored prenatal clinic according to block-level location of residence. Statistical analysis included chi-square test and analysis of variance with logistic regression performed for adjustment of demographic features. RESULTS Between January 1, 2019, and October 31, 2019, 9488 women received prenatal care and 326 women did not. Women without prenatal care differed by race and were noted to have higher rates of substance use (P=.004), preterm birth (P<.001), and longer lengths of newborn admission (P<.001). After adjustment for demographic features, higher rates of preterm birth in women without prenatal care persisted (adjusted odds ratio, 2.65; 95% confidence interval, 1.95-3.55). Women without prenatal care resided in areas that relied more on public transportation and required longer transit times (42 minutes vs 30 minutes; P=.005) with more bus stops (29 vs 17; P<.001) to the nearest county-sponsored prenatal clinic. CONCLUSION Women without prenatal care were at a significantly increased risk of adverse pregnancy outcomes. In a large inner city, women without prenatal care resided in areas with significantly higher demands for public transportation. Alternative resources, including telemedicine and ridesharing, should be explored to reduce barriers to prenatal care access.
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Affiliation(s)
- Denisse S Holcomb
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX (Drs Holcomb, Spong, and Nelson); Parkland Center for Clinical Innovation, Dallas, TX (Dr Pengetnze, Ms Steele, and Mr Karam).
| | - Yolande Pengetnze
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX (Drs Holcomb, Spong, and Nelson); Parkland Center for Clinical Innovation, Dallas, TX (Dr Pengetnze, Ms Steele, and Mr Karam)
| | - Ashley Steele
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX (Drs Holcomb, Spong, and Nelson); Parkland Center for Clinical Innovation, Dallas, TX (Dr Pengetnze, Ms Steele, and Mr Karam)
| | - Albert Karam
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX (Drs Holcomb, Spong, and Nelson); Parkland Center for Clinical Innovation, Dallas, TX (Dr Pengetnze, Ms Steele, and Mr Karam)
| | - Catherine Spong
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX (Drs Holcomb, Spong, and Nelson); Parkland Center for Clinical Innovation, Dallas, TX (Dr Pengetnze, Ms Steele, and Mr Karam)
| | - David B Nelson
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX (Drs Holcomb, Spong, and Nelson); Parkland Center for Clinical Innovation, Dallas, TX (Dr Pengetnze, Ms Steele, and Mr Karam)
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Sobel L, Lee YW, White KO, Woodhams E, Patton E. Contraceptive decision making among pregnancy-capable individuals with opioid use disorder at a tertiary care center in Massachusetts. Contraception 2021; 104:355-360. [PMID: 34118268 DOI: 10.1016/j.contraception.2021.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/02/2021] [Accepted: 06/04/2021] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To explore contraceptive decision making among recently pregnant patients with a history of opioid use disorder. STUDY DESIGN We conducted semi-structured qualitative interviews, based on principles of the Ottawa Decision Support Framework, with 20 recently pregnant individuals diagnosed with opioid use disorder at a tertiary care medical center in Massachusetts. We audio-recorded the interviews and they were transcribed verbatim. We analyzed our interview data using inductive and deductive coding. RESULTS Participants value the availability of barrier methods as a means of preventing both sexually transmitted infections and pregnancy. For some participants, housing instability makes storing contraceptive methods and managing personal hygiene related to bleeding patterns difficult. For others, housing instability impacts their overall fertility goals. Side effects including weight gain, interactions with mood stabilizing medications, concern regarding post-operative opioids, or intrinsic aspects of a method that serve as reminders of opioid use may be unacceptable given the risk of relapse. The relapsing and remitting arc of recovery make remembering important aspects of both short- and long-acting contraceptive method use difficult, yet participants offer strategies to aid in doing so. CONCLUSION When choosing a contraceptive method participants in our study exhibit similarities to individuals with other chronic medical conditions as well as motivations specific to opioid use disorder. Their contraceptive decisions are grounded in integrating a method into a chaotic life, preventing relapse, and protecting future fertility. IMPLICATIONS Our data highlight how lived experiences at the intersection of active opioid use disorder and recovery fundamentally shape the lens through which pregnancy-capable individuals with opioid use disorder view their contraceptive decisions.
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Affiliation(s)
- Lauren Sobel
- Department of Obstetrics, Gynecology, Boston Medical Center, Boston, MA.
| | - Yeon Woo Lee
- Department of Obstetrics, Gynecology, Boston Medical Center, Boston, MA
| | | | | | - Elizabeth Patton
- Department of Obstetrics, Gynecology, Boston Medical Center, Boston, MA
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Corr TE, Xing X, Liu G. Longitudinal Health Care Utilization of Medicaid-Insured Children with a History of Neonatal Abstinence Syndrome. J Pediatr 2021; 233:82-89.e1. [PMID: 33545189 DOI: 10.1016/j.jpeds.2021.01.067] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/13/2021] [Accepted: 01/27/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To describe longitudinal health care utilization of Medicaid-insured children with a history of neonatal abstinence syndrome (NAS) compared with similar children without NAS. STUDY DESIGN Retrospective, longitudinal cohort study. Data were extracted from the Medicaid Analytic eXtract files for all available states and DC from 2003-2013. Subjects were followed up to 11 years. In total, 17 229 children with NAS were identified using the International Classification of Diseases, Ninth Revision code 779.5. Children without NAS, matched on demographic and health variables, served as the comparison group. Outcomes were number of claims for inpatient, outpatient, and emergency department encounters, numbers of prescription claims, and costs associated with these services. Linked claims were identified for each subject using a unique, within-state ID. RESULTS Children with NAS had increased claims for inpatient admissions (marginal effect [ME] 0.49; SE 0.01) and emergency department visits (ME 0.30; SE 0.04) through year 1; increased prescriptions (ME 1.45; SE 0.08, age 0) (ME 0.69; SE 0.11, age 1 year) through year 2; and increased outpatient encounters (ME 20.13; SE 0.54, age 0) (ME 3.95; SE 0.62, age 1 year) (ME 2.90; SE 1.11, age 2 years) through year 3 after adjusting for potential confounders (P < .01 for all). Beyond the third year, health care utilization was similar between those with and without NAS. CONCLUSIONS Children with a diagnosis of NAS have greater health care utilization through the third year of life. These differences resolve by the fourth year. Our results suggest resolution of disparities may be due to shifts in developmental health management in school-age children and inability to track relevant diagnoses in a health care database.
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Affiliation(s)
- Tammy E Corr
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA
| | - Xueyi Xing
- Evidence-to-Impact Collaborative, Social Science Research Institute, Penn State University, State College, PA
| | - Guodong Liu
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
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"A good mother": Impact of motherhood identity on women's substance use and engagement in treatment across the lifespan. J Subst Abuse Treat 2021; 130:108474. [PMID: 34118710 PMCID: PMC8478714 DOI: 10.1016/j.jsat.2021.108474] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/22/2020] [Accepted: 05/11/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Women are underrepresented in substance use disorder (SUD) treatment. Interpersonal and structural factors affect women's access to SUD treatment, but limited research evaluates how motherhood is a potential barrier and facilitator to engagement in SUD treatment. We focus on women from young to middle adulthood, and capture women's identities as mothers, caretakers, and grandmothers, outside of pregnancy and the postpartum period. METHODS Study staff conducted twenty qualitative interviews with women in SUD treatment to assess experiences with SUD treatment, in which motherhood emerged as a key theme. Twelve women then participated in four focus groups centered on motherhood. The study audio-recorded and transcribed interviews, and two independent authors analyzed interviews, followed by group consensus. RESULTS Most women identified their children and responsibilities as mothers and caretakers as important motivators to accessing SUD treatment. Motherhood was also a barrier to treatment, in that women feared losing child custody by disclosing substance use and few residential programs accommodate women with children. Multiple women expressed guilt about their substance use, sensing that it contributed to perceived abandonment or separation from their children. Reunification was important to SUD recovery. CONCLUSION Women with SUD who are mothers experience specific barriers to treatment engagement and recovery. Women need SUD treatment programs that address these interpersonal and structural factors across the lifespan.
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Moreland A, Guille C, McCauley JL. Increased availability of telehealth mental health and substance abuse treatment for peripartum and postpartum women: A unique opportunity to increase telehealth treatment. J Subst Abuse Treat 2021; 123:108268. [PMID: 33612199 PMCID: PMC9759701 DOI: 10.1016/j.jsat.2020.108268] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/19/2020] [Accepted: 12/22/2020] [Indexed: 10/22/2022]
Abstract
Since the onset of the COVID-19 pandemic, several federal, state, and payor policy changes have facilitated the uptake of telehealth service delivery. These changes have resulted in a significant uptick in the utilization of maternal mental health and substance use disorder screening and treatment services for pregnant and postpartum women. The Medical University of South Carolina's [MUSC] Women's Reproductive Behavioral Health Program provides outpatient mental health and substance use treatment to pregnant and postpartum women within obstetric practices. With the onset of COVID-19, our program converted all of its screening for and treatment of mental health and substance use disorders to remote platforms. Lessons learned during this time may lay the foundation for transitioning to sustainable telehealth-based referral and delivery of substance use treatment more broadly.
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Affiliation(s)
- Angela Moreland
- Medical University of South Carolina, United States of America.
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Shrestha S, Roberts MH, Maxwell JR, Leeman LM, Bakhireva LN. Post-discharge healthcare utilization in infants with neonatal opioid withdrawal syndrome. Neurotoxicol Teratol 2021; 86:106975. [PMID: 33766722 DOI: 10.1016/j.ntt.2021.106975] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/10/2021] [Accepted: 03/15/2021] [Indexed: 12/15/2022]
Abstract
The opioid epidemic in the United States has led to a significant increase in the incidence of neonatal opioid withdrawal syndrome (NOWS); however, the understanding of long-term consequences of NOWS is limited. The objective of this study was to evaluate post-discharge healthcare utilization in infants with NOWS and examine the association between NOWS severity and healthcare utilization. A retrospective cohort design was used to ascertain healthcare utilization in the first year after birth-related discharge using the CERNER Health Facts® database. ICD-9/ICD-10 diagnostic codes were used to identify live births and to classify infants into two study groups: NOWS and uncomplicated births (a 25% random sample). Evaluated outcomes included rehospitalization, emergency department (ED) visits within 30-days and one-year after discharge, and a composite one-year utilization event (either hospitalization or emergency department visit during that year). NOWS severity was operationalized as pharmacologic treatment, length of hospitalization, and medical conditions often associated with NOWS. In 3,526 infants with NOWS (restricted to gestational age ≥ 33 weeks), NOWS severity was associated with an increase in composite one-year utilization (OR: 1.1; 95% CI: 1.04-1.2) after adjusting for prematurity, sepsis, jaundice, use of antibiotics, infant sex, insurance status, race, hospital bed size, year of birth, and census division. In a subset of full-term infants (3008 with NOWS and 88,452 uncomplicated births), having a NOWS diagnosis was associated with higher odds of a 30-day (OR: 1.6; 95% CI: 1.03-2.4) and one-year rehospitalization (OR: 1.6; 95% CI: 1.1-2.4) after adjusting for infant sex, race, type of medical insurance, hospital location, census division, year of primary encounter, hospital bed size, and medical conditions. This study found higher healthcare utilization during the first year of life in infants diagnosed with NOWS, especially those with severe NOWS. Findings suggest a need for closer post-discharge follow-up and management of infants with NOWS.
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Affiliation(s)
- Shikhar Shrestha
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA (Current Affiliation), United States of America; Department of Pharmacy Practice and Administrative Sciences, College of Pharmacy, University of New Mexico, Albuquerque, NM (Institution where the research was carried out), United States of America.
| | - Melissa H Roberts
- Department of Pharmacy Practice and Administrative Sciences, College of Pharmacy, University of New Mexico, Albuquerque, NM (Institution where the research was carried out), United States of America
| | - Jessie R Maxwell
- Department of Pediatrics, University of New Mexico, Albuquerque, NM, United States of America
| | - Lawrence M Leeman
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, United States of America
| | - Ludmila N Bakhireva
- Department of Pharmacy Practice and Administrative Sciences, College of Pharmacy, University of New Mexico, Albuquerque, NM (Institution where the research was carried out), United States of America; Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, United States of America; Division of Epidemiology, Biostatistics and Preventive Medicine, Department of Internal Medicine, University of New Mexico, Albuquerque, NM, United States of America
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Body composition during the first 4 months in infants affected by neonatal abstinence syndrome: a pilot study. J Dev Orig Health Dis 2021; 13:120-127. [PMID: 33650484 DOI: 10.1017/s2040174421000052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Newborns with neonatal abstinence syndrome (NAS) display symptoms related to neurologic excitability and autonomic dysfunction that result in increased metabolic demands. These infants also exhibit feeding difficulties and/or hyperphagia. Because the effects of these symptoms and behaviors on growth are unknown, we sought to measure serial body composition measurements over the first 4 months in infants with NAS requiring pharmacologic treatment using air displacement plethysmography. Fourteen infants of singleton birth with appropriate-for-gestational-age (AGA) weight and a gestational age of ≥35 weeks and <42 weeks were evaluated. In mixed-effects models, per week, infants increased in mean fat percent by 1.1% (95% confidence interval [CI]: 0.85-1.43), fat mass by 90 g (CI: 70-100), and fat-free mass by 140 g (CI: 130-150). The subgroup of infants (N = 5) requiring multidrug therapy for symptom control had lower mean fat percent (-1.2%, CI: -5.2-2.1), fat mass (-60 g, CI: -25-13), and fat-free mass (-270 g, CI: -610-80) across time compared to infants requiring monotherapy. We are the first to report how body composition measures change over time in a small group of patients with NAS. Infants with NAS were smaller and leaner in the first several weeks compared to previously reported body composition measurements in term infants, but grew similarly to their healthy counterparts by 16 weeks. Infants with more severe NAS may be at risk for abnormalities in longer term growth.
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Short VL, Alexander K, Gannon M, Abatemarco DJ, Goyal NK. What aspects of their child's primary care do mothers value? A qualitative analysis of perspectives of women in treatment for opioid use disorder. Child Care Health Dev 2021; 47:40-46. [PMID: 33016377 DOI: 10.1111/cch.12811] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 06/22/2020] [Accepted: 09/08/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Preventive paediatric healthcare is essential for infant and child health. Current research, however, suggests that the delivery of routine well child care (WCC) for children affected by maternal opioid use disorder (OUD) could be improved. How mothers perceive interactions with healthcare providers may help identify ways to modify the experience of WCC, which could ultimately improve healthcare utilization, patient satisfaction and clinical outcomes. The objective of this qualitative study was to assess perceptions of WCC among mothers in treatment for OUD. METHODS Four focus group sessions of 4-8 participants each (N = 22) were conducted. All study participants were receiving comprehensive behavioural and physical health support and care plus pharmacotherapy for OUD from a single outpatient treatment centre. Focus groups were semi-structured, with a standardized set of open-ended questions and follow-up prompts to engage participants in a fluid discussion. Participants were asked to identify and discuss important aspects of their youngest child's WCC and what they liked and disliked about their child's WCC. Grounded theory analysis was used to identify themes. RESULTS Several aspects of WCC were identified as important to the mothers. Main themes identified included (1) mother-provider relationship, (2) communication with healthcare team and (3) support for mother's OUD treatment. Participants discussed their desire to be heard and understood and wanted the entire healthcare team and clinic staff to see them as mothers first and foremost, not merely as individuals with OUD. CONCLUSION Future attempts to refine care may consider healthcare models that highlight open communication and personalized care and offer strong support and ongoing encouragement for the mother's OUD treatment and recovery process.
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Affiliation(s)
- Vanessa L Short
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Karen Alexander
- College of Nursing, Thomas Jefferson University, Philadelphia, PA, USA
| | - Meghan Gannon
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Diane J Abatemarco
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Neera K Goyal
- Department of Pediatrics, Sidney Kimmel College of Medicine, Thomas Jefferson University, Philadelphia, PA, USA.,Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
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Abstract
OBJECTIVES To engage community members with opioid use disorder (OUD) and case managers working with pregnant and parenting individuals with OUD in a priority setting process to identify the key priorities for research, policy, and care improvement during pregnancy, birth, and postpartum. METHODS We conducted focus groups across Washington State with pregnant and parenting people with OUD and with case managers working with this community as part of research priority setting using the validated Research Prioritization by Affected Communities protocol. Priorities for research, policy, and service improvement were developed during each focus group by the participants. RESULTS Three focus groups with pregnant and parenting people with OUD and 2 focus groups with case managers were conducted (total N = 24 and 16, respectively). Both prioritized topics such as stigma and bias, housing, access to treatment, and steps toward successful recovery. The community and case manager groups shared similar, complementary strategies for each priority, with differences reflecting their perspectives in relation to OUD. CONCLUSIONS Community-engaged priority setting among those with OUD was an effective and meaningful way to guide future research, policy, and care improvement efforts.
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O’Rourke-Suchoff D, Sobel L, Holland E, Perkins R, Saia K, Bell S. The labor and birth experience of women with opioid use disorder: A qualitative study. Women Birth 2020; 33:592-597. [DOI: 10.1016/j.wombi.2020.01.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 12/18/2019] [Accepted: 01/08/2020] [Indexed: 10/25/2022]
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Young-Wolff KC, Tucker LY, Armstrong MA, Conway A, Weisner C, Goler N. Correlates of Pregnant Women's Participation in a Substance Use Assessment and Counseling Intervention Integrated into Prenatal Care. Matern Child Health J 2020; 24:423-431. [PMID: 32056081 DOI: 10.1007/s10995-020-02897-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Screening and referral for substance use are essential components of prenatal care. However, little is known about barriers to participation in substance use interventions that are integrated within prenatal care. METHODS Our study examines demographic and clinical correlates of participation in an initial assessment and counseling intervention integrated into prenatal care in a large healthcare system. The sample comprised Kaiser Permanente Northern California pregnant women with a live birth in 2014 or 2015 who screened positive for prenatal substance use via a self-reported questionnaire and/or urine toxicology test given as part of standard prenatal care (at ~ 8 weeks gestation). RESULTS Of the 11,843 women who screened positive for prenatal substance use (median age = 30 years; 42% white; 38% screened positive for alcohol only, 20% for cannabis only, 5% nicotine only, 17% other drugs only, and 19% ≥ 2 substance categories), 9836 (83%) completed the initial substance use assessment and counseling intervention. Results from multivariable logistic regression analyses indicated that younger age, lower income, single marital status, and a positive urine toxicology test predicted higher odds of participation, while other/unknown race/ethnicity, greater parity, receiving the screening later in pregnancy, and screening positive for alcohol only or other drugs only predicted lower odds of participation (all Ps < .05). DISCUSSION Findings suggest that integrated substance use interventions can successfully reach vulnerable populations of pregnant women (e.g., younger, lower income, racial/ethnic minorities). Future research should address whether differences in participation are due to patient (e.g., type of substance used, perceived stigma) or provider factors (e.g., working harder to engage traditionally underserved patients).
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Affiliation(s)
- Kelly C Young-Wolff
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA. .,Department of Psychiatry, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA, 94143, USA.
| | - Lue-Yen Tucker
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
| | - Mary Anne Armstrong
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
| | - Amy Conway
- Early Start Program, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Constance Weisner
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA.,Department of Psychiatry, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Nancy Goler
- Regional Offices, Kaiser Permanente Northern California, Oakland, CA, USA
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Drake C, Donohue JM, Nagy D, Mair C, Kraemer KL, Wallace DJ. Geographic access to buprenorphine prescribers for patients who use public transit. J Subst Abuse Treat 2020; 117:108093. [PMID: 32811632 DOI: 10.1016/j.jsat.2020.108093] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/03/2020] [Accepted: 07/29/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Urban Medicaid enrollees with opioid use disorder often rely on public transit to reach buprenorphine prescribers. Research has not shown whether public transit provides this population with adequate geographic access to buprenorphine prescribers. We examined travel times to buprenorphine prescribers by car and public transit in urban areas, and determined whether car-based Medicaid regulatory standards produce their intended geographic coverage. METHODS We obtained data for this study from the Substance Abuse and Mental Health Services Administration's Buprenorphine Practitioner Locator, Microsoft Bing Maps, and the American Community Survey. We examined four urban counties at the centers of the metropolitan statistical areas with the highest 2017 accidental drug poisoning death rates: Kanawha, WV; Montgomery, OH; Philadelphia, PA; and St. Louis City, MO. These counties comprised 696 census tracts representing 1,038,564 households. We calculated travel times from each census tract center to the nearest buprenorphine prescribers by car and public transit, and compared that to 30-min regulatory standards and by whether census tracts had below median levels of car access. We calculated Global Moran's I statistics to determine whether spatial clustering was present among census tracts with limited access to buprenorphine prescribers. RESULTS Households in all but two census tracts could access a buprenorphine prescriber within 30 min by car. However, households in 12.1% (84) of census tracts could not do so by public transit. The correlation between car- and public transit-based travel times to the nearest buprenorphine prescriber was 0.11 (95% CI = 0.07-0.22). More than 15% (47,918) of households in the two less densely populated counties could not travel to the nearest prescriber in 30 min and resided in census tracts where access to cars was relatively low. There was no evidence of spatial clustering among census tracts with public transit travel times exceeding 30 min, or among census tracts with public transit travel times exceeding 30 min and below median values of access to cars. CONCLUSIONS Geographic access to buprenorphine prescribers is overestimated by regulatory standards that apply car-based travel time estimates, which are a weak proxy for public transit-based travel times. Since geographic areas with limited access to buprenorphine prescribers do not tend to cluster near one another, individually targeted interventions may be necessary to improve buprenorphine access and utilization.
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Affiliation(s)
- C Drake
- Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, United States of America.
| | - J M Donohue
- Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, United States of America
| | - D Nagy
- Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, United States of America
| | - C Mair
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, United States of America
| | - K L Kraemer
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, United States of America
| | - D J Wallace
- Department of Critical Care Medicine and Emergency Medicine, University of Pittsburgh School of Medicine, United States of America
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Preis H, Garry DJ, Herrera K, Garretto DJ, Lobel M. Improving Assessment, Treatment, and Understanding of Pregnant Women With Opioid Use Disorder: The Importance of Life Context. ACTA ACUST UNITED AC 2020. [DOI: 10.1080/23293691.2020.1780395] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Heidi Preis
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
| | - David J. Garry
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York, USA
| | - Kimberly Herrera
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York, USA
| | - Diana J. Garretto
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York, USA
| | - Marci Lobel
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
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Eckardt P, Bailey D, DeVon HA, Dougherty C, Ginex P, Krause-Parello CA, Pickler RH, Richmond TS, Rivera E, Roye CF, Redeker N. Opioid use disorder research and the Council for the Advancement of Nursing Science priority areas. Nurs Outlook 2020; 68:406-416. [PMID: 32279897 DOI: 10.1016/j.outlook.2020.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 02/03/2020] [Accepted: 02/21/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Chronic diseases, such as opioid use disorder (OUD) require a multifaceted scientific approach to address their evolving complexity. The Council for the Advancement of Nursing Science's (Council) four nursing science priority areas (precision health; global health, determinants of health, and big data/data analytics) were established to provide a framework to address current complex health problems. PURPOSE To examine OUD research through the nursing science priority areas and evaluate the appropriateness of the priority areas as a framework for research on complex health conditions. METHOD OUD was used as an exemplar to explore the relevance of the nursing science priorities for future research. FINDINGS Research in the four priority areas is advancing knowledge in OUD identification, prevention, and treatment. Intersection of OUD research population focus and methodological approach was identified among the priority areas. DISCUSSION The Council priorities provide a relevant framework for nurse scientists to address complex health problems like OUD.
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Affiliation(s)
| | | | - Holli A DeVon
- University of California Los Angeles School of Nursing, Los Angeles, CA
| | - Cynthia Dougherty
- Dept of Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, Seattle, WA
| | | | | | - Rita H Pickler
- The Ohio State University College of Nursing, Columbus, OH
| | | | - Eleanor Rivera
- New Courtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Colonial Penn Center, Philadelphia, PA
| | - Carol F Roye
- Pace University, College of Health Professions, Pleasantville, NY
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40
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Goyal NK, Rohde JF, Short V, Patrick SW, Abatemarco D, Chung EK. Well-Child Care Adherence After Intrauterine Opioid Exposure. Pediatrics 2020; 145:e20191275. [PMID: 31896548 PMCID: PMC6993495 DOI: 10.1542/peds.2019-1275] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/13/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES For children with intrauterine opioid exposure (IOE), well-child care (WCC) provides an important opportunity to address medical, developmental, and psychosocial needs. We evaluated WCC adherence for this population. METHODS In this retrospective cohort study, we used PEDSnet data from a pediatric primary care network spanning 3 states from 2011 to 2016. IOE was ascertained by using physician diagnosis codes. WCC adherence in the first year was defined as a postnatal or 1-month visit and completed 2-, 4-, 6-, 9-, and 12-month visits. WCC adherence in the second year was defined as completed 15- and 18-month visits. Gaps in WCC, defined as ≥2 missed consecutive WCC visits, were also evaluated. We used multivariable regression to test the independent effect of IOE status. RESULTS Among 11 334 children, 236 (2.1%) had a diagnosis of IOE. Children with IOE had a median of 6 WCC visits (interquartile range 5-7), vs 8 (interquartile range 6-8) among children who were not exposed (P < .001). IOE was associated with decreased WCC adherence over the first and second years of life (adjusted relative risk 0.54 [P < .001] and 0.74 [P < .001]). WCC gaps were more likely in this population (adjusted relative risk 1.43; P < .001). There were no significant adjusted differences in nonroutine primary care visits, immunizations by age 2, or lead screening. CONCLUSIONS Children <2 years of age with IOE are less likely to adhere to recommended WCC, despite receiving on-time immunizations and lead screening. Further research should be focused on the role of WCC visits to support the complex needs of this population.
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Affiliation(s)
| | - Jessica F Rohde
- Departments of Pediatrics and
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Vanessa Short
- Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Stephen W Patrick
- Division of Neonatology, Departments of Pediatrics and Health Policy and Vanderbilt Center for Child Health Policy, School of Medicine, Vanderbilt University, Nashville, Tennessee; and
| | - Diane Abatemarco
- Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Esther K Chung
- Department of Pediatrics, School of Medicine, University of Washington and Seattle Children's Hospital, Seattle, Washington
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41
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One-Year Postpartum Mental Health Outcomes of Mothers of Infants with Neonatal Abstinence Syndrome. Matern Child Health J 2020; 24:283-290. [DOI: 10.1007/s10995-019-02839-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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42
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Rizk AH, Simonsen SE, Roberts L, Taylor-Swanson L, Lemoine JB, Smid M. Maternity Care for Pregnant Women with Opioid Use Disorder: A Review. J Midwifery Womens Health 2019; 64:532-544. [PMID: 31407485 DOI: 10.1111/jmwh.13019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 06/06/2019] [Accepted: 06/07/2019] [Indexed: 01/04/2023]
Abstract
Opioid misuse is a problem that is complex and widespread. Opioid misuse rates are rising across all US demographics, including among pregnant women. The opioid epidemic brings a unique set of challenges for maternity health care providers, ranging from ethical considerations to the complex health needs and risks for both woman and fetus. This article addresses care for pregnant women during the antepartum, intrapartum, and postpartum periods through the lens of the opioid epidemic, including screening and counseling, an interprofessional approach to prenatal care, legal considerations, and considerations for care during labor and birth and postpartum. Providers can be trained to identify at-risk women through the evidence-based process of Screening, Brief Intervention, and Referral to Treatment (SBIRT) and connect them with the appropriate care to optimize outcomes. Women at moderate risk of opioid use disorder can be engaged in a brief conversation with their provider to discuss risks and enhance motivation for healthy behaviors. Women with risky opioid use can be given a warm referral to pharmacologic treatment programs, ideally comprehensive prenatal treatment programs where available (a warm referral is a term used when a provider, with the patient's permission, contacts another provider or another service him or herself rather than providing a phone number and referral number). Evidence regarding care for the pregnant woman with opioid use disorder and practical clinical recommendations are provided.
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Affiliation(s)
- Abigail H Rizk
- Birthcare Healthcare, University of Utah, Salt Lake City, Utah.,College of Nursing, University of Utah, Salt Lake City, Utah
| | - Sara E Simonsen
- College of Nursing, University of Utah, Salt Lake City, Utah
| | - Leissa Roberts
- College of Nursing, University of Utah, Salt Lake City, Utah
| | | | - Jennifer Berkowicz Lemoine
- College of Nursing, University of Utah, Salt Lake City, Utah.,College of Nursing and Allied Health Professions, University of Louisiana at Lafayette, Lafayette, Louisiana
| | - Marcela Smid
- Division of Maternal-Fetal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah.,Substance Use in Pregnancy - Recovery Addiction Dependence (SUPeRAD) Clinic, University of Utah Health, Salt Lake City, Utah
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43
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Perceptions of Pediatric Primary Care Among Mothers in Treatment for Opioid Use Disorder. J Community Health 2019; 44:1127-1134. [DOI: 10.1007/s10900-019-00701-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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44
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Crane D, Marcotte M, Applegate M, Massatti R, Hurst M, Menegay M, Mauk R, Williams S. A statewide quality improvement (QI) initiative for better health outcomes and family stability among pregnant women with opioid use disorder (OUD) and their infants. J Subst Abuse Treat 2019; 102:53-59. [PMID: 31202289 DOI: 10.1016/j.jsat.2019.04.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 03/12/2019] [Accepted: 04/25/2019] [Indexed: 12/12/2022]
Abstract
A collaborative led by state health and human service agencies, academic leaders, and stakeholders tested interventions to expand use of medication assisted treatment (MAT) through a maternal medical home (MMH) model that coordinated behavioral health and prenatal care with social supports for pregnant women with opioid use disorder (OUD) enrolled in Medicaid. The program was anchored in four clinical organizations with distinct models of care: community behavioral health, residential behavioral health, hospital-based obstetrical practice, and co-located obstetrical and behavioral health. A modified version of the Institute for Healthcare Improvement Breakthrough Series Model for Improvement was implemented using monthly performance data feedback to conduct small tests of change and improve care. Administrative data from the state's Medicaid, vital statistics, and child welfare systems were linked to evaluate the impact of MOMS on 252 mother-infant dyads compared to a sample of 846 Medicaid beneficiaries with OUD in the third trimester of pregnancy. MOMS participation was associated with increased likelihood of MAT in trimesters one, two and three (AOR = 2.30, 4.40, 2.75, respectively), behavioral health counseling during trimesters two and three (AOR = 3.75 and 2.07, respectively), retention in MAT during postpartum months one through three and four through six (AOR = 2.86, 2.40, respectively), and marginally lower out-of-home placement of infants born to mothers with OUD (AOR = 0.66). Within the MOMS program, greater participation in behavioral health treatment and MAT (χ2(3) ≥ 12.09) was observed in the co-located behavioral health/obstetrical care practice site compared to behavioral health-led and obstetrical provider-led sites.
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Affiliation(s)
- Dushka Crane
- Ohio Colleges of Medicine Government Resource Center, Ohio State University Medical Center, United States of America.
| | - Michael Marcotte
- Tri-State Maternal-Fetal Medicine Associates, United States of America.
| | - Mary Applegate
- FACP - NASHP, Ohio Department of Medicaid, United States of America.
| | - Richard Massatti
- Ohio Department of Mental Health and Addiction Services, United States of America.
| | - Mark Hurst
- Ohio Department of Mental Health and Addiction Services, United States of America.
| | - Michelle Menegay
- Ohio Colleges of Medicine Government Resource Center, Ohio State University Medical Center, United States of America.
| | - Rachel Mauk
- Ohio Colleges of Medicine Government Resource Center, Ohio State University Medical Center, United States of America.
| | - Susan Williams
- Ohio Department of Job and Family Services, United States of America.
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Abstract
Substance use during pregnancy is common, costly and associated with maternal and newborn health consequences. Assessment of substance use should be integrated into prenatal care. Substance use identification methods include patient interview, screening instruments, and biological testing. In this review, we critically evaluate screening and testing for substance use during pregnancy, highlighting the benefits and barriers of integrated assessment into prenatal care. We also discuss the limitations and negative consequences that should be considered when implementing screening and/or testing procedures. Lastly, we provide recommendations for the ethical implementation of screening and testing for substance use in the context of prenatal care.
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46
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Jackson HJ, Lopez C, Miller S, Engelhardt B. A Scoping Review of Acupuncture as a Potential Intervention for Neonatal Abstinence Syndrome. Med Acupunct 2019; 31:69-84. [PMID: 31031873 PMCID: PMC6484350 DOI: 10.1089/acu.2018.1323] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective: Neonatal abstinence syndrome (NAS) has risen drastically over the past decade. Infants with NAS experience extreme discomfort and developmental delays when going into withdrawal. Management includes multiple supportive and nonpharmacologic therapies as first-line treatments in an effort to reduce or prevent the need for medication management. Acupuncture has demonstrated efficacy in adults experiencing withdrawal from addictions, as well as for treating many other conditions in pediatric patients who have similar symptoms to withdrawal. The purpose of this review is to evaluate the safety and efficacy of acupuncture for neonates in withdrawal. Materials and Methods: This review was guided by the Arksey and O'Malley methodological framework, and analysis was performed based on a social ecological model. The PRISMA [Preferred Reporting Items for Systematic Reviews and Meta-Analyses] statement was used to organize selected publications, and a flow chart was created to display the search process. PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Databases were searched for relevant publications. Results: Acupuncture appears to be safe and effective for reducing withdrawal symptoms in infants, and, thus, should be considered as an additional nonpharmacologic treatment option for NAS.
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Affiliation(s)
- Heather J. Jackson
- Department of Anesthesiology and Office of Advanced Practice, Vanderbilt University Medical Center, Nashville, TN
| | - Cristina Lopez
- College of Nursing, Medical University of South Carolina, Charleston, SC
| | - Sarah Miller
- College of Nursing, Medical University of South Carolina, Charleston, SC
| | - Barbara Engelhardt
- Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN
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Abstract
Pregnancy presents a window of opportunity for effecting positive change in the lives of women with opioid use disorder (OUD). Care should be empathetic and nonjudgmental with a focus on counseling for initiation and maintenance of beneficial health behaviors as well as development of a strong patient-provider relationship.1 These include adherence to treatment of OUD through pharmacotherapy and behavioral counseling, smoking cessation, healthy nutrition, treatment of coexisting medical and psychosocial conditions, as well as preparation for the postpartum period through breastfeeding education and antenatal discussion of contraception. Women will also benefit from anticipatory guidance with regard to neonatal abstinence syndrome (see Chapter 7). This may include a consultation with pediatric or neonatal providers who will be caring for their infants. In the absence of other obstetric indications, minimal additional fetal assessment outside that of standard prenatal care is recommended for OUD.
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Affiliation(s)
- Emily W Rosenthal
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, 833 Chestnut Street, Philadelphia, PA, United States.
| | - Jason K Baxter
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, 833 Chestnut Street, Philadelphia, PA, United States
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Abstract
As the opioid crisis continues to exist in the United States, opioid use in pregnancy is becoming a more common occurrence. Left untreated, it may result in an increased risk for adverse outcomes for both the mother and her unborn child. Unfortunately, women with opioid use disorders often face numerous barriers when trying to access prenatal care services including limited availability or treatment options, stigma, legal consequences, co-morbid psychiatric disorders, and trauma exposure. A care model that integrates prenatal care, medication assisted treatment and behavioral health services delivered in a trauma-informed environment can improve prenatal care attendance and thus have far-reaching positive implications for both the woman and her newborn child.
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Affiliation(s)
- Elisabeth Johnson
- UNC Horizons Program, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, 410 North Greensboro St, Suite 220, Carrboro, NC, 27510, USA.
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49
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Sutter MB, Watson H, Bauers A, Johnson K, Hatley M, Yonke N, Leeman L. Group Prenatal Care for Women Receiving Medication-Assisted Treatment for Opioid Use Disorder in Pregnancy: An Interprofessional Approach. J Midwifery Womens Health 2019; 64:217-224. [PMID: 30864287 DOI: 10.1111/jmwh.12960] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 12/05/2018] [Accepted: 12/06/2018] [Indexed: 01/06/2023]
Abstract
Opioid use disorder among pregnant women is common and rapidly increasing nationwide. Group prenatal care is an innovative alternative to individual care for pregnant women and has been shown to improve women's and health care providers' satisfaction and adherence to care. We describe a novel group prenatal care program colocated in an opioid treatment program that integrates prenatal care, substance use disorder counseling, and medication-assisted treatment. Our interprofessional model draws on the unique contributions of physicians, midwives, nurses, and mental health professionals to address the complex needs of pregnant women with opioid use disorder. Participants reported increased trust and engagement with health care providers and peers, improved prenatal care and birth experience, and increased resilience for relapse prevention. Group prenatal care is an accepted and promising model for women with opioid use disorder in pregnancy and has the potential to improve outcomes for women and newborns.
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Affiliation(s)
- Mary Beth Sutter
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | | | - Kate Johnson
- University of New Mexico, Albuquerque, New Mexico
| | - Mandy Hatley
- University of New Mexico, Albuquerque, New Mexico
| | - Nicole Yonke
- Health Sciences Center, University of New Mexico, Albuquerque, New Mexico.,Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Lawrence Leeman
- Health Sciences Center, University of New Mexico, Albuquerque, New Mexico.,Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico.,Department of Obstetrics, University of New Mexico, Albuquerque, New Mexico
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50
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Chen CY, Wang IA, Fang SY, Huang N, Tsay JH, Chang SH. Inadequate prenatal care utilization among women with and without methadone-treated opioid use disorders in Taiwan. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 67:1-8. [PMID: 30771732 DOI: 10.1016/j.drugpo.2019.01.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 12/30/2018] [Accepted: 01/24/2019] [Indexed: 12/25/2022]
Abstract
AIMS The present study aims to investigate the utilization pattern of prenatal care and correlates for women with opioid use disorders (OUD) in Taiwan. METHOD Using the data linkage between the Methadone Maintenance Treatment (MMT) register with national health insurance, national birth notification system, and birth registration system, we identified 1712 pregnancies with 20 or more gestational weeks from women enrolled in the MMT (heroin-exposed: receiving no methadone treatment during pregnancy, n = 1053 by 882 women; methadone-treated: receiving methadone for at least one day during pregnancy, n = 659 by 574 women) and their 1:10 matched pregnancies from 17,060 women without substance use disorder in the period of 2004-2013. The generalized linear mixed models with negative binomial and logit distributions were performed to evaluate the relationship between individual sociodemographic, health, and addiction treatment characteristics with the number of prenatal visits and receiving prenatal care in the first trimester (i.e., early entry). FINDINGS Eighteen percent of pregnancies by women with OUD received no prenatal services and 21% had started prenatal care in the first trimester as compared with 1% and 46% in pregnancies by women without substance use disorders. For pregnancies by women with OUD, methadone treatment was not linked associated with prenatal care visits (adjusted relative risk [aRR] = 1.02; 95% = 0.92, 1.12). For methadone-treated pregnancies, treatment enrollment before pregnancy and spousal methadone treatment elevated prenatal visits by 8% and 18% (0.48 and 1.08 visits, respectively). Additionally, HIV infection (adjusted odds ratio [aOR] = 0.30, 95% CI = 0.10, 0.83) and prior delivery (aOR = 0.05, 95% CI = 0.01, 0.19) significantly reduced the odds of early entry into prenatal care. CONCLUSION Integrating addiction treatment programs with prenatal care is urgently needed to increase adequate prenatal care for pregnant women with OUD, especially the multiparous ones.
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Affiliation(s)
- Chuan-Yu Chen
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan; Center of Neuropsychiatric Research, National Health Research Institutes, Miaoli County, Taiwan; School of Social Work, University of Maryland, Baltimore, MD, USA.
| | - I-An Wang
- Center of Neuropsychiatric Research, National Health Research Institutes, Miaoli County, Taiwan
| | - Shao-You Fang
- Children and Family Research Center, National Taiwan University, Taipei, Taiwan
| | - Nicole Huang
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Jen-Huoy Tsay
- Department of Social Work, National Taiwan University, Taipei, Taiwan
| | - Su-Hui Chang
- Children and Family Research Center, National Taiwan University, Taipei, Taiwan
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