妊娠和育儿相关因素对接受阿片类药物使用障碍药物治疗的阻碍：一项对治疗中的女性、终止治疗的女性以及为其提供服务的专业人员进行的多层面定性研究。
Pregnancy- and parenting-related barriers to receiving medication for opioid use disorder: A multi-paneled qualitative study of women in treatment, women who terminated treatment, and the professionals who serve them.
机构信息
Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA.
Department of Agricultural Economics, Sociology, and Education, The Pennsylvania State University, University Park, PA, USA.
出版信息
Womens Health (Lond). 2024 Jan-Dec;20:17455057231224181. doi: 10.1177/17455057231224181.
BACKGROUND
Women face unique barriers when seeking treatment for substance use disorders, often related to pregnancy and parenting.
OBJECTIVES
This study adds to the extant literature by elucidating the pregnancy- and parenting-related barriers women face when initiating or continuing medication for opioid use disorder, specifically.
DESIGN
This study is based on qualitative semi-structured interviews.
METHODS
Three subgroups participated in semi-structured interviews regarding their experiences (N = 42): women with current or past opioid use disorders who have used or were presently using medication for opioid use disorder, professionals working in substance use disorder treatment programs, and criminal justice professionals.
RESULTS
Three parenting-related subthemes were identified: (1) insufficient access to childcare to navigate appointments and meetings, (2) fear of losing custody of, or access to, one's children, and (3) prioritizing one's children's needs before one's own. Three subthemes were identified with regard to pregnancy as a barrier: (1) hesitancy among physicians to prescribe medication for opioid use disorder for pregnant patients, (2) limited access to resources in rural areas, and (3) difficulty navigating a complex, decentralized health system.
CONCLUSION
Systemic changes are needed to reduce pregnant and parenting women's barriers to seeking medication for opioid use disorder. These include improved childcare support at both in-patient and outpatient treatment programs, which would assuage women's barriers related to childcare, as well as their fears of losing access to their children if they spend time away from their children for treatment. An additional systemic improvement that may reduce barriers for these women is access to comprehensive, integrated care for their prenatal care, postpartum care, pediatric appointments, and appropriate substance use disorder treatment.
背景
女性在寻求物质使用障碍治疗时面临独特的障碍，这些障碍通常与怀孕和育儿有关。
目的
本研究通过阐明女性在开始或继续使用阿片类药物使用障碍药物治疗时面临的与怀孕和育儿相关的障碍，进一步丰富了现有文献。
设计
本研究基于定性半结构式访谈。
方法
三个亚组参与了半结构式访谈，讨论了他们的经验（N=42）：目前或过去有阿片类药物使用障碍且使用或目前正在使用阿片类药物使用障碍药物治疗的女性、在物质使用障碍治疗项目中工作的专业人员以及刑事司法专业人员。
结果
确定了三个与育儿相关的子主题：（1）缺乏儿童保育服务，无法安排约会和会议；（2）担心失去对子女的监护权或无法与子女接触；（3）将子女的需求置于自己的需求之前。在怀孕作为障碍方面确定了三个子主题：（1）医生在为孕妇开阿片类药物使用障碍药物处方时犹豫不决；（2）在农村地区获取资源有限；（3）在复杂的、分散的卫生系统中难以导航。
结论
需要进行系统性变革，以减少怀孕和育儿的女性在寻求阿片类药物使用障碍药物治疗方面的障碍。这些变革包括改善住院和门诊治疗计划中的儿童保育支持，这将减轻女性在儿童保育方面的障碍，以及她们因治疗而离开子女时失去对子女的接触的恐惧。另一个可能减少这些女性障碍的系统改进是为她们提供全面、综合的产前护理、产后护理、儿科预约和适当的物质使用障碍治疗服务。
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