Addressing opioid use disorder among rural pregnant and postpartum women: a study protocol

Addiction Science & Clinical Practice

Katherine T. Fortenberry¹  Melissa Cheng¹  Bhanu Muniyappa²  Danielle Pendergrass³  M. Aryana Bryan⁴  Amy Kenney⁴  Marcela C. Smid⁵  Gerald Cochran⁶  Adam J. Gordon⁷ 

[1] Department of Family and Preventive Medicine, University of Utah School of Medicine, 375 Chipeta Way Ste. A, 84108, Salt Lake City, UT, USA;Department of Pediatrics, University of Utah School of Medicine, Division of General Pediatrics, 295 Chipeta Way, 84108, Salt Lake City, UT, USA;Eastern Utah Women’s Health, LLC, 77 S 600 E, 84501, Price, UT, USA;Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, University of Utah School of Medicine, 295 Chipeta Way, 84132, Salt Lake City, UT, USA;Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, University of Utah School of Medicine, 295 Chipeta Way, 84132, Salt Lake City, UT, USA;Department of Obstetrics and Gynecology, University of Utah School of Medicine, Division of Maternal Fetal Medicine, 84132, Salt Lake City, UT, USA;Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, University of Utah School of Medicine, 295 Chipeta Way, 84132, Salt Lake City, UT, USA;Greater Intermountain Node (GIN), NIH NIDA Clinical Trials Network, University of Utah, Salt Lake City, UT, USA;Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, University of Utah School of Medicine, 295 Chipeta Way, 84132, Salt Lake City, UT, USA;Greater Intermountain Node (GIN), NIH NIDA Clinical Trials Network, University of Utah, Salt Lake City, UT, USA;Informatics, Decision-Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA;

关键词: Perinatal addiction;    Medication-assisted treatment;    Medication for opioid use disorder;    Rural;    Opioid use disorder;    Provider education;   

DOI  :  10.1186/s13722-020-00206-6

来源: Springer

【 摘 要 】

BackgroundOpioid use disorder (OUD) among women delivering at a hospital has increased 400% from 1999–2014 in the United States. From the years 2007 to 2016, opioid-related mortality during pregnancy increased over 200%, and drug-overdose deaths made up nearly 10% of all pregnancy-associated mortality in 2016 in the US. Disproportionately higher rates of neonatal opioid withdrawal syndrome (NOWS) have been reported in rural areas of the country, suggesting that perinatal OUD is a pressing issue among these communities. There is an urgent need for comprehensive, evidence-based treatment services for pregnant women experiencing OUD. The purpose of this article is to describe a study protocol aimed at developing and evaluating a perinatal OUD curriculum, enhancing evidence-based perinatal OUD treatment in a rural setting, and evaluating the implementation of such collaborative care for perinatal OUD.MethodsThis two-year study employed a one group, repeated measures, hybrid type-1 effectiveness-implementation design. This study delivered interventions at 2 levels, both targeting improvement of care for pregnant women with OUD. The first area of focus was at the community healthcare provider-level, which aimed to evaluate the acceptability and feasibility of perinatal OUD education across time and to improve provider education by increasing knowledge specific to: MOUD provision; screening, brief intervention, and referral to treatment (SBIRT) utilization; and NOWS treatment. The second area of intervention focus was at the patient-level, which assessed the preliminary effect of perinatal OUD provider education in promoting illicit opioid abstinence and treatment engagement among pregnant women with OUD. We adopted constructs from the Consolidated Framework for Implementation Research (CFIR) to assess contextual factors that may influence implementation, and the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) model to comprehensively evaluate implementation outcomes.DiscussionThis article presents the protocol of an implementation study that is employing the CFIR and RE-AIM frameworks to implement and evaluate a perinatal OUD education and service coordination program in two rural counties. This protocol could serve as a model for clinicians and researchers seeking to implement improvements in perinatal care for women with OUD in other rural communities.Trial registration NCT04448015 clinicaltrials.gov.

【 授权许可】

CC BY