Background: Maternal opioid use disorder (OUD) has serious consequences for maternal and infant health. Analysis of Medicaid enrollee data is critical, since Medicaid bears a disproportionate share of costs. Methods: This study analyzes linked maternal and infant Medicaid claims data and infant birth records in three states in the year before and after a delivery in 2014-2015 (2013-2016) examining health, health care use, treatment, and neonatal outcomes. Diagnosis and procedure codes identify OUD and other substance use disorders (SUDs). Results: In the year before and after delivery, 2.2 percent of the sample had an OUD diagnosis, and 5.9 percent had a SUD diagnosis other than OUD. Of the women with OUD, 72.8% had treatment for a SUD in the year before and after delivery, but most had none in an average enrolled month, and only 8.8% received any methadone treatment in a given month. Pregnant women with OUD had delayed and lower rates of prenatal care compared to women with other substance use disorders (SUDs). Infants of mothers with OUD did not differ from infants of mothers with other SUDs in rate of preterm or low birth weight but had higher NICU admission rates and longer birth hospitalizations. Health care costs for women with an OUD were higher than those with other SUDs. Conclusions: There is an urgent need for comprehensive, evidence-based OUD treatment integrated with maternity care. To fill critical gaps in care, workforce and infrastructure innovations can facilitate delivery of preventive and treatment services coordinated across settings.
The education level of the patient and the number of medications showed direct correlation with patients' ability to report medications accurately. Patients showed improvement in accuracy of reporting medications when given written instructions about their regimen, regardless of their level of education or number of medications.
Sunderland Eye Infirmary serves a patient population marked by a higher-than-average incidence and prevalence of wet age-related macular degeneration (AMD). Over the past years, a graduated multidisciplinary approach has been taken to maximise patient management capacity through implementation of AMD triage clinics, nurse-led wet AMD review clinics and optometrist-led OCT clinics for monitoring and assessment. This team-based approach has created added flexibility in the service to ensure efficient and effective delivery of AMD treatment. To extend capacity and flexibility, further SEI has recently introduced independent nurse-led intravitreal anti-VEGF injection lists enabling consultants to focus increasingly on complex pathology, poor responders and other high-risk patients. This article discusses this process to meet the AMD capacity challenge in a busy eye hospital.
We assert that psychologists have an important role to play in the care of the chronically ill, and that it is possible to construct programs that are workable, useful to patients, and of mutual interest to psychologists and physicians in the health care setting. We describe a program of psychological services in a multiple sclerosis center. These services are built on a theoretical model of coping, directed at education in a broad sense and at peer contact and support. We describe a program of group discussions for patients and family, conceptualized as reference groups for the learning of a new life style with a different set of values. We also discuss factors of critical importance in the success of this particular model of care, and we suggest that psychologists must carefully consider political, financial, and organizational realities in their attempts to structure programs in the primary health care settings.
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