From the School of Medicine, Virginia Commonwealth University, Richmond, VA (LPE); Department of Psychology, Virginia Commonwealth University, Richmond, VA (ABP-A); Department of Obstetrics and Gynecology and Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA (MS); and Department of Obstetrics and Gynecology and Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA (CEM).
J Addict Med. 2023;17(2):131-139. doi: 10.1097/ADM.0000000000001052. Epub 2022 Aug 17.
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.
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.
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]).
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 discontinuation. Further work is needed to identify evidence-based methods to individualize integrated obstetric/addiction care.
围产期阿片类药物使用障碍正在增加。综合产科/成瘾护理模式可能会优化母婴二人组的结局，但服务的理想组合尚不清楚。本研究（1）描述了在综合产科/成瘾诊所接受丁丙诺啡治疗的人群在妊娠至产后期间的服务利用情况，（2）探讨了服务利用与产后丁丙诺啡续用之间的关联。
本回顾性病历审查研究使用了门诊产科/成瘾诊所的研究登记数据。所有患者都被邀请参与研究登记。对于同意的患者，从他们的第一次就诊开始，每月进行病历摘录，以收集人口统计学、产科和物质使用障碍治疗变量。目前的分析包括在 2019 年 6 月至 2021 年 6 月期间分娩婴儿、在妊娠期间开始使用丁丙诺啡且在分娩时正在接受丁丙诺啡治疗的患者。总体服务利用是指在 28 周妊娠至产后 12 周期间使用的服务数量（范围 0-12）。采用单变量分析和多变量逻辑回归评估了服务利用与丁丙诺啡续用之间的关联。
参与者（n=42）主要是非拉丁裔白人（67%），伴有共病精神诊断（95%）。平均而言，参与者使用了 6 项服务；产前保健、精神保健和产后避孕的利用率最高。总体而言，69%的参与者在产后 6 个月时继续使用丁丙诺啡。这在服务利用率方面没有差异（单变量[P=0.07]，多变量[P=0.16]）。
以减少伤害为重点的综合护理支持了高危药物使用障碍患者在妊娠至产后期间的服务利用和丁丙诺啡续用。需要进一步努力确定个性化综合产科/成瘾护理的循证方法。
