University of Pittsburgh, School of Social Work, Pittsburgh, PA (GC, VH, RF); University of Pittsburgh, School of Medicine, Pittsburgh, PA (GC); UPMC, Magee-Womens Hospital, Pittsburgh, PA (WA); University of Pittsburgh, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Research Institute, Pittsburgh, PA (EK); University of Pittsburgh, School of Medicine, Pittsburgh, PA (ABD); Pregnancy Recovery Center, UPMC, Magee-Womens Hospital, Pittsburgh, PA (SB); University of Pittsburgh, School of Pharmacy, Pittsburgh, PA (RT).
J Addict Med. 2018 Jan/Feb;12(1):72-79. doi: 10.1097/ADM.0000000000000370.
The public health burden of opioid use disorder (OUD) among pregnant women has significantly increased in recent years. The Optimizing Pregnancy Treatment Interventions for Moms study was a pilot project that examined the feasibility of a patient navigation (PN) intervention model to reduce substance use and improve mental health, quality of life, and to increase engagement with treatment services among pregnant women with OUD.
A 1-group repeated-measures pilot study was conducted with treatment-seeking pregnant women with opioid dependence initiating buprenorphine maintenance treatment. Participants received the PN intervention delivered as 10 sessions before delivery and 4 sessions postpartum. Participants completed assessments at baseline and after the prenatal and postnatal portions of the intervention. Demographics were assessed using descriptive statistics, and general estimating equation analyses were employed to examine changes in health and service engagement across time.
in all, 21 women were enrolled and completed the PN intervention and follow-up assessments. Participants reported improvements in abstinence from illicit opioids (B = 0.15, 95% confidence interval [CI] 0.1-0.2), drug use (odds ratio [OR] 5.25, 95% CI 2.1-13.0), and depression (OR 7.70, 95% CI 2.4-25.1). Results also showed nonsignificant trends suggesting enhancements in general health (B = 0.17, 95% CI 0.0-0.3, P = 0.06) and increases in substance use treatment attendance (B = 2.15, 95% CI -0.2 to 4.5, P = 0.07). Most study participants achieved adequate or better prenatal care.
These findings provide support that PN is a feasible adjunctive intervention that shows promise for health improvements and service engagement among treatment-seeking pregnant women with opioid dependence initiating buprenorphine.
近年来,孕妇阿片类药物使用障碍(OUD)的公共卫生负担显著增加。“优化孕产妇治疗干预措施研究”是一个试点项目,旨在检验患者导航(PN)干预模式的可行性,以减少物质使用,改善心理健康、生活质量,并提高阿片类药物依赖孕妇对治疗服务的参与度。
对接受丁丙诺啡维持治疗的有药物依赖的孕妇进行了 1 组重复测量的试点研究。参与者在分娩前接受了 10 次 PN 干预,产后接受了 4 次。参与者在基线和产前及产后干预部分完成评估。使用描述性统计评估人口统计学特征,并采用一般估计方程分析评估随时间变化的健康和服务参与情况。
共有 21 名妇女入组并完成了 PN 干预和随访评估。参与者报告在戒断非法阿片类药物(B=0.15,95%置信区间 [CI] 0.1-0.2)、药物使用(比值比 [OR] 5.25,95% CI 2.1-13.0)和抑郁(OR 7.70,95% CI 2.4-25.1)方面有所改善。结果还显示,在一般健康方面有增强的趋势(B=0.17,95%CI 0.0-0.3,P=0.06),在物质使用治疗出勤率方面有增加的趋势(B=2.15,95%CI -0.2-4.5,P=0.07)。大多数研究参与者获得了足够或更好的产前保健。
这些发现提供了支持,即 PN 是一种可行的辅助干预措施,有望改善寻求丁丙诺啡治疗的阿片类药物依赖孕妇的健康和服务参与度。