Department of Pharmacotherapy, University of Utah.
Chobanian & Avedisian School of Medicine, Boston University.
N C Med J. 2024 Aug;85(6):462-470. doi: 10.18043/001c.125106.
In this study, we aimed to examine postpartum health care utilization and identify gaps in care among a postpartum Medicaid population of patients diagnosed with opioid use disorder (OUD) during pregnancy.
We queried North Carolina Medicaid medical and pharmacy claims to identify individuals with a live delivery and evidence of OUD during pregnancy from 2015 to 2019. We examined any evidence of postpartum health care utilization and evidence of medications for OUD (MOUD) during postpartum. We also determined the impact that 4 factors may have had on these outcomes: type of Medicaid coverage (Medicaid for Pregnant Women as compared to other types of Medicaid coverage), rurality, race, and the prenatal use of MOUD. Descriptive statistics, Kaplan-Meier curves with log-rank tests, and negative binomial regression were used.
Of the 6,186 individuals in the study, 84.5% were White, 29.6% lived in rural areas, and 35.0% had MPW coverage. Of the sample, 77.4% sought health care services during the postpartum period. In the multiple negative binomial regression model, individuals who were MPW beneficiaries, non-White, lived in rural areas, and had no evidence of prenatal MOUD all had significantly lower rates of postpartum health care utilization. Of the sample, 53.6% had evidence of MOUD utilization during the postpartum period. We found that patients with MPW continued MOUD at much lower rates compared to patients with other forms of Medicaid (86% versus 93% at 60 days; 57% versus 78% at 180 days, respectively).
Limitations to this analysis are inherent to administrative claims data, such as misclassification of outcomes and covariates, as well as loss to follow-up.
Significant gaps in health care use remain across type of Medicaid coverage, race, geographic setting, and prenatal care access.
本研究旨在考察产后医疗保健服务的利用情况，并确定患有妊娠期间阿片类药物使用障碍（OUD）的产后 Medicaid 人群在医疗服务方面存在的差距。
我们通过北卡罗来纳州 Medicaid 的医疗和药房数据，确定了在 2015 年至 2019 年期间有活产分娩并在妊娠期间有 OUD 证据的个体。我们检查了任何产后医疗保健服务的利用情况，以及产后阿片类药物使用障碍治疗药物（MOUD）的使用情况。我们还确定了 4 个因素可能对这些结果产生的影响：Medicaid 覆盖类型（与其他类型的 Medicaid 覆盖相比，专为孕妇提供的 Medicaid）、农村或城市、种族以及产前 MOUD 的使用情况。采用描述性统计、对数秩检验的 Kaplan-Meier 曲线和负二项回归。
在研究的 6186 名个体中，84.5%为白人，29.6%居住在农村地区，35.0%的人享有 MPW 覆盖。在样本中，77.4%的人在产后期间寻求医疗保健服务。在多变量负二项回归模型中，MPW 受益、非白人、居住在农村地区和产前无 MOUD 证据的个体，其产后医疗保健服务利用的比率均显著降低。在样本中，53.6%的人在产后期间有 MOUD 利用的证据。我们发现，与其他形式的 Medicaid 相比，MPW 患者继续 MOUD 的比例要低得多（60 天分别为 86%和 93%；180 天分别为 57%和 78%）。
该分析的局限性在于行政索赔数据固有的一些问题，例如结果和协变量的分类错误以及随访丢失。
在 Medicaid 覆盖类型、种族、地理位置和产前护理的获得方面，医疗保健的使用仍存在显著差距。
