Division of General Academic Pediatrics (JF Rohde and C Dorrian), Nemours Children's Health, Wilmington, Del; Sidney Kimmel Medical College (JF Rohde, C Dorrian, and NK Goyal), Thomas Jefferson University, Philadelphia, Pa; Value-Based Service Organization (NK Goyal, JF Rohde and C Dorrian), Nemours Children's Health, Philadelphia, Pa.
Policy Lab (BH Chaiyachati and EF Gregory), Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pa; Department of Pediatrics (BH Chaiyachati and EF Gregory), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.
Acad Pediatr. 2024 Nov-Dec;24(8):1304-1313. doi: 10.1016/j.acap.2024.06.007. Epub 2024 Jun 15.
Intrauterine opioid exposure (IOE) has increased over the last 2 decades and is associated with additional needs after birth. To date, no clinical guidelines address the primary care of children with IOE. We aimed to characterize clinician-reported screening and referral practices, barriers to effective primary care for children with IOE, and clinician- and practice-level characteristics associated with perceived barriers.
We conducted a cross-sectional survey of pediatric residents, pediatricians, and advanced practitioners at 28 primary care clinics affiliated with 7 pediatric residency programs (April-June 2022). We assessed screening and other clinical practices related to IOE and perceived barriers to addressing parental opioid use disorder (OUD). We used descriptive statistics to analyze survey responses, assessed the distribution of reported barriers, and applied a 2-stage cluster analysis to assess response patterns.
Of 1004 invited clinicians, 329 (32.8%) responses were returned, and 325 pediatric residents and pediatricians were included in the final analytic sample. Almost all (99.3%) reported parental substance use screening as important, but only 11.6% screened routinely. Half of the respondents routinely refer children with IOE to early intervention services and social work. Lack of standard screening for substance use was the most frequently selected barrier to addressing parental OUD. Participants reporting fewer barriers to addressing parental OUD identified having greater access to OUD treatment programs and home visiting programs.
Pediatricians report variations in primary care screenings and referrals for children with IOE. Access to parental OUD treatment programs may mitigate perceived barriers to addressing parental OUD in the pediatric office.
在过去的 20 年中，宫内阿片类药物暴露（IOE）有所增加，并且与出生后的额外需求相关。迄今为止，尚无临床指南涉及 IOE 儿童的初级保健。我们旨在描述临床医生报告的筛查和转介实践、IOE 儿童有效初级保健的障碍，以及与感知障碍相关的临床医生和实践特征。
我们对 28 家隶属于 7 个儿科住院医师实习计划的初级保健诊所的儿科住院医师、儿科医生和高级从业者进行了横断面调查（2022 年 4 月至 6 月）。我们评估了与 IOE 相关的筛查和其他临床实践以及解决父母阿片类药物使用障碍（OUD）的感知障碍。我们使用描述性统计分析来分析调查结果，评估报告障碍的分布，并应用两阶段聚类分析来评估反应模式。
在 1004 名受邀临床医生中，有 329 名（32.8%）做出了回应，最终分析样本包括 325 名儿科住院医师和儿科医生。几乎所有（99.3%）人报告父母物质使用筛查很重要，但只有 11.6%人常规筛查。一半的受访者常规将 IOE 儿童转介到早期干预服务和社会工作。缺乏针对物质使用的标准筛查是解决父母 OUD 最常被选中的障碍。报告解决父母 OUD 的障碍较少的参与者表示，他们更有机会获得 OUD 治疗计划和家访计划。
儿科医生报告了对 IOE 儿童进行初级保健筛查和转介的差异。获得父母 OUD 治疗计划可能会减轻在儿科诊室解决父母 OUD 的感知障碍。
