An Integrated Care Model for Pregnant and Postpartum Individuals Receiving Medication for Opioid Use Disorder

Abstract

Objectives: Perinatal opioid use disorder is increasing. Integrated obstetric/addiction care models likely optimize parent-infant dyad outcomes, but the ideal combination of services is unknown. This study (1) describes pregnancy-to-postpartum service utilization by people receiving buprenorphine at an integrated Obstetric/Addiction Clinic and (2) explores the association between service utilization and postpartum buprenorphine continuation. Methods: This retrospective medical record review study uses research registry data from an outpatient Obstetric/Addiction Clinic. All patients are invited to participate in the research registry. For patients who consent, monthly medical record abstractions are conducted beginning with their first clinic visit to collect demographic, obstetric, and substance use disorder treatment variables. Present analyses included patients who delivered an infant between June 2019 and June 2021, started buprenorphine during pregnancy, and were receiving buprenorphine at delivery. Overall service utilization was the number of services (range 0-12) used between 28-weeks gestation and 12-weeks postpartum. Bivariate analyses and multivariable logistic regression assessed associations between service utilization and buprenorphine continuation. Results: Participants (n = 42) were primarily non-Latinx White (67%) with comorbid psychiatric diagnoses (95%). On average, participants used 6 services; prenatal care, mental health care, and postpartum contraception were most utilized. Overall, 69% of participants continued buprenorphine at 6 months postpartum. This did not differ by level of service utilization (bivariate [P = 0.07], multivariable [P = 0.16]). Conclusion: Integrated care with a harm reduction focus supports pregnancy-to-postpartum service utilization and buprenorphine continuation in a patient sample at high risk for medication for opioid use disorder discon-tinuation. Further work is needed to identify evidence-based methods to individualize integrated obstetric/addiction care.

Incarceration status at buprenorphine initiation and OUD treatment outcomes during pregnancy

“…The program embedded within the health system from which this study derives provides outpatient substance use disorder treatment integrated with OBGYN care. As part of this program, providers travel to one local jail to provide care on site, and other jails transport pregnant patients on BUP to the health system outpatient OBGYN clinic approximately monthly for OUD treatment follow-up while incarcerated during pregnancy ( 12 ). Recently, due to the COVID-19 pandemic, some jails and prisons have implemented telemedicine to provide further flexibility for MOUD ( 18 ).…”

“…For example, a recent study done in North Carolina highlighted the potential of a prison-academic partnership to bolster MOUD continuity for pregnant and postpartum people with OUD ( 11 ). Likewise, our institution houses an integrated OBGYN-Addiction program consisting of nurses and medical providers with expertise in both OBGYN and Addiction Medicine as well as support staff, behavioral health clinicians and subspecialty consultants who provide robust, recovery-oriented wrap-around services ( 12 ). An integral component of this program includes its partnerships with local jails where pregnant individuals with OUD are referred to our health system for evaluation and initiation of OUD treatment.…”

Beyond opioid prescribing: Evaluation of a substance use disorder curriculum for OBGYN residents

“…After curriculum completion, residents reported improved self-assessed competence in their Motivational Interviewing abilities. Notably, patients seen in the clinical setting of this study vary substantially in their stages of change, as the clinic prioritizes a low-threshold, harm reduction approach [ 37 ]; this represented a unique opportunity for residents to apply their new Motivational Interviewing skills and compassionate, person-centered approaches as role modeled by the clinic providers. Considering these findings and feedback from residents obtained in our qualitative interviews, future adaptations of this pilot SUD curriculum by other institutions should prioritize training in Motivational Interviewing and harm reduction as it relates to substance use that includes both didactic and experiential components.…”

Expanding Medical Education to Include Substance Use Disorders during Pregnancy and Postpartum: Preliminary Effectiveness of a Pilot Curriculum for Medical Students

“…This SUD curriculum was designed and implemented at the OB MOTIVATE clinic at Virginia Commonwealth University, which provides integrated obstetric, gynecologic, and addiction medicine services for pregnant and parenting people with SUD. 7 The curriculum is based on the principles of Kolb's experiential learning. 8 Third-year medical students on their obstetrics and gynecology clerkship rotated 1 full day through the OB MOTIVATE clinic between August 2020 and April 2022 and completed this curriculum.…”