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.
Matern Child Health J. 2020 Apr;24(4):423-431. doi: 10.1007/s10995-020-02897-4.
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.
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).
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).
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).
筛查和转介物质使用是产前护理的重要组成部分。然而，对于整合在产前护理中的物质使用干预措施的参与障碍知之甚少。
我们的研究考察了参与大型医疗保健系统中整合在产前护理中的初步评估和咨询干预的人口统计学和临床相关性。该样本包括 Kaiser Permanente 北加州在 2014 年或 2015 年有活产的孕妇，她们通过自我报告的问卷和/或尿液毒理学测试筛查出产前物质使用阳性，这些测试是标准产前护理的一部分（在~8 周妊娠时进行）。
在 11843 名筛查出产前物质使用阳性的女性中（中位数年龄为 30 岁；42%为白人；38%仅筛查出酒精阳性，20%仅筛查出大麻阳性，5%仅尼古丁阳性，17%仅其他药物阳性，19%≥2 种药物阳性），9836 名（83%）完成了初始物质使用评估和咨询干预。多变量逻辑回归分析的结果表明，年龄较小、收入较低、单身婚姻状况和尿液毒理学检测阳性预测参与的可能性更高，而其他/未知种族/民族、更高的生育次数、在妊娠后期接受筛查以及仅筛查出酒精阳性或其他药物阳性预测参与的可能性较低（均 P<.05）。
研究结果表明，整合的物质使用干预措施可以成功地接触到脆弱的孕妇群体（例如，年轻、低收入、少数族裔）。未来的研究应该解决参与差异是否是由于患者（例如，使用的物质类型、感知的耻辱感）还是提供者因素（例如，更努力地接触传统上服务不足的患者）。
