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Satcher MF, Bruce ML, Goodman DJ, Lord SE. Biopsychosocial contexts of timely and adequate prenatal care utilization among women with criminal legal involvement and opioid use disorder. BMC Public Health 2023; 23:729. [PMID: 37085842 PMCID: PMC10119004 DOI: 10.1186/s12889-023-15627-6] [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] [Received: 11/28/2022] [Accepted: 04/07/2023] [Indexed: 04/23/2023] Open
Abstract
OBJECTIVE Pregnant women with criminal legal involvement and opioid use disorder (CL-OUD) living in non-urban regions may be at risk for complex biomedical, psychological, and social barriers to prenatal care and healthy pregnancy. Yet, limited research has explored prenatal care utilization patterns among this subpopulation. This study describes the biopsychosocial factors of pregnant women with a history of criminal legal involvement and opioid use disorder (CL-OUD) associated with timely prenatal care initiation and adequate prenatal care utilization (APNCU). METHODS Analyses were conducted on a subsample of medical record data from an observational comparative effectiveness study of medication treatment models for pregnant women with diagnosed opioid use disorder (OUD) who received prenatal care in Northern New England between 2015 and 2022. The subsample included women aged ≥ 16 years with documented criminal legal involvement. Analyses included χ2, Fisher exact tests, and multiple logistic regression to assess differences in timely prenatal care and APNCU associated with biopsychosocial factors selected by backwards stepwise regression. RESULTS Among 317 women with CL-OUD, 203 (64.0%) received timely prenatal care and 174 (54.9%) received adequate care. Timely prenatal care was associated with having two or three prior pregnancies (aOR 2.37, 95% CI 1.07-5.20), receiving buprenorphine at care initiation (aOR 1.85, 95% CI 1.01-3.41), having stable housing (aOR 2.49, 95% CI 1.41-4.41), and being mandated to court diversion (aOR 4.06, 95% CI 1.54-10.7) or community supervision (aOR 2.05, 95% CI 1.16-3.63). APNCU was associated with having a pregnancy-related medical condition (aOR 2.17, 95% CI 1.27-3.71), receiving MOUD throughout the entire prenatal care period (aOR 3.40, 95% CI 1.45-7.94), having a higher number of psychiatric diagnoses (aOR 1.35, 95% CI 1.07-1.70), attending a rurally-located prenatal care practice (aOR 2.14, 95% CI 1.22-3.76), having stable housing (aOR 1.94, 95% CI 1.06-3.54), and being mandated to court diversion (aOR 3.11, 95% CI 1.19-8.15). CONCLUSION While not causal, results suggest that timely and adequate prenatal care among women with CL-OUD may be supported by OUD treatment, comorbid indications for care, stable access to social resources, and maintained residence in the community (i.e., community-based alternatives to incarceration).
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Affiliation(s)
- Milan F Satcher
- Department of Community and Family Medicine, Dartmouth Health, Lebanon, NH, USA.
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA.
| | - Martha L Bruce
- Department of Community and Family Medicine, Dartmouth Health, Lebanon, NH, USA
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
- Department of Psychiatry, Dartmouth Health, Lebanon, NH, USA
- The Dartmouth Institute, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Daisy J Goodman
- Department of Community and Family Medicine, Dartmouth Health, Lebanon, NH, USA
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
- Department of Obstetrics-Gynecology, Dartmouth Health, Lebanon, NH, USA
| | - Sarah E Lord
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
- Department of Psychiatry, Dartmouth Health, Lebanon, NH, USA
- Department of Pediatrics, Dartmouth Health, Lebanon, NH, USA
- Department of Biomedical Data Sciences, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
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Oluyede L, Cochran AL, Wolfe M, Prunkl L, McDonald N. Addressing transportation barriers to health care during the COVID-19 pandemic: Perspectives of care coordinators. TRANSPORTATION RESEARCH. PART A, POLICY AND PRACTICE 2022. [PMID: 35283561 DOI: 10.1016/j.trip.2022.100565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Prior to the COVID-19 pandemic, transportation barriers prevented millions of Americans from accessing needed medical care. Then the pandemic disrupted medical and transportation systems across the globe. This research explored ways the COVID-19 pandemic changed how people experienced transportation barriers to accessing health care. We conducted in-depth interviews with social workers, nurses, and other care coordinators in North Carolina to identify barriers to traveling for medical care during the pandemic and explore innovative solutions employed to address these barriers. Analyzing these interviews using a flexible coding approach, we found that the pandemic exacerbated existing transportation barriers and created new barriers. Yet, simultaneously, temporary policy responses expanded the utilization of telehealth. The interviews identified specific advantages of expanded telehealth, including increasing access to mental health services in rural areas, reducing COVID-19 exposure for high-risk patients, and offering continuity of care for COVID-19 patients with other health conditions. While telehealth cannot address all medical needs, such as emergency or cancer care, it may be well-suited for preliminary screenings and follow-up visits. The findings provide insights on how post-pandemic telehealth policy changes can benefit individuals facing transportation barriers to accessing health care and support more accommodating and convenient health care for patients and their families.
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Affiliation(s)
- Lindsay Oluyede
- Department of City and Regional Planning, New East Building, CB# 3140, 223 E Cameron Ave, Chapel Hill, NC 27599-3140, USA
| | - Abigail L Cochran
- Department of City and Regional Planning, New East Building, CB# 3140, 223 E Cameron Ave, Chapel Hill, NC 27599-3140, USA
| | - Mary Wolfe
- UNC Center for Health Equity Research, 323 MacNider Hall, 333 South Columbia Street, Chapel Hill, NC 27599-7240, USA
| | - Lauren Prunkl
- Department of City and Regional Planning, New East Building, CB# 3140, 223 E Cameron Ave, Chapel Hill, NC 27599-3140, USA
| | - Noreen McDonald
- Department of City and Regional Planning, New East Building, CB# 3140, 223 E Cameron Ave, Chapel Hill, NC 27599-3140, USA
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Oluyede L, Cochran AL, Wolfe M, Prunkl L, McDonald N. Addressing transportation barriers to health care during the COVID-19 pandemic: Perspectives of care coordinators. TRANSPORTATION RESEARCH. PART A, POLICY AND PRACTICE 2022; 159:157-168. [PMID: 35283561 PMCID: PMC8898700 DOI: 10.1016/j.tra.2022.03.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Prior to the COVID-19 pandemic, transportation barriers prevented millions of Americans from accessing needed medical care. Then the pandemic disrupted medical and transportation systems across the globe. This research explored ways the COVID-19 pandemic changed how people experienced transportation barriers to accessing health care. We conducted in-depth interviews with social workers, nurses, and other care coordinators in North Carolina to identify barriers to traveling for medical care during the pandemic and explore innovative solutions employed to address these barriers. Analyzing these interviews using a flexible coding approach, we found that the pandemic exacerbated existing transportation barriers and created new barriers. Yet, simultaneously, temporary policy responses expanded the utilization of telehealth. The interviews identified specific advantages of expanded telehealth, including increasing access to mental health services in rural areas, reducing COVID-19 exposure for high-risk patients, and offering continuity of care for COVID-19 patients with other health conditions. While telehealth cannot address all medical needs, such as emergency or cancer care, it may be well-suited for preliminary screenings and follow-up visits. The findings provide insights on how post-pandemic telehealth policy changes can benefit individuals facing transportation barriers to accessing health care and support more accommodating and convenient health care for patients and their families.
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Affiliation(s)
- Lindsay Oluyede
- Department of City and Regional Planning, New East Building, CB# 3140, 223 E Cameron Ave, Chapel Hill, NC 27599-3140, USA
| | - Abigail L Cochran
- Department of City and Regional Planning, New East Building, CB# 3140, 223 E Cameron Ave, Chapel Hill, NC 27599-3140, USA
| | - Mary Wolfe
- UNC Center for Health Equity Research, 323 MacNider Hall, 333 South Columbia Street, Chapel Hill, NC 27599-7240, USA
| | - Lauren Prunkl
- Department of City and Regional Planning, New East Building, CB# 3140, 223 E Cameron Ave, Chapel Hill, NC 27599-3140, USA
| | - Noreen McDonald
- Department of City and Regional Planning, New East Building, CB# 3140, 223 E Cameron Ave, Chapel Hill, NC 27599-3140, USA
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Stuebe AM, Tucker C, Ferrari RM, McClain E, Jonsson-Funk M, Pate V, Bryant K, Charles N, Verbiest S. Perinatal morbidity and health utilization among mothers of medically fragile infants. J Perinatol 2022; 42:169-176. [PMID: 34376790 PMCID: PMC8858647 DOI: 10.1038/s41372-021-01171-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/29/2021] [Accepted: 07/14/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine the burden of perinatal morbidity among mothers of medically fragile infants. STUDY DESIGN We conducted a retrospective cohort study of 6849 mothers who delivered liveborn infants at a quaternary care hospital during a two-year period. We compared mothers of well babies with mothers of infants admitted to the Neonatal Intensive Care Unit (NICU), and we used logistic regression to model predictors of postpartum acute care utilization among NICU mothers. RESULTS Rates of obstetric morbidity were highest for mothers of infants staying ≥72 h in the NICU; 54.2% underwent cesarean birth, 7.5% experienced severe maternal morbidity, and 6.6% required a blood transfusion. Factors independently associated with postpartum acute care use included gestational age <28 weeks, ever smoking, non-Hispanic Black race, temperature >38 °C and receiving psychiatric medication during the birth hospitalization. CONCLUSION Focused support for mothers of NICU infants has the potential to reduce maternal morbidity and improve health.
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Affiliation(s)
- Alison M. Stuebe
- School of Medicine, University of North Carolina at Chapel Hill,Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Christine Tucker
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Renée M. Ferrari
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Erin McClain
- School of Medicine, University of North Carolina at Chapel Hill
| | - Michele Jonsson-Funk
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Virginia Pate
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | | | - Nkechi Charles
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Sarah Verbiest
- School of Medicine, University of North Carolina at Chapel Hill,School of Social Work, University of North Carolina at Chapel Hill
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