Dataset Information

Improving Outcomes of Mothers With Opioid Use Disorder Using a Community Collaborative Model.

ABSTRACT:

Context

Increasing rates of Opioid Use Disorder among pregnant women are a significant public health issue. Care for these women is fragmented, and multiple barriers to care have been identified. Program: The Tides, Inc. is attempting to address these needs by providing comprehensive, coordinated care, beginning in pregnancy and extending beyond the birth of their infant.

Implementation

Using a collaborative model, care is coordinated between multiple existing agencies in an effort to reduce barriers and improve access to care. Funding for these services is provided through county funding and existing payor sources (eg, insurance, Medicaid).

Evaluation

Participant and program outcomes were evaluated at the end of each year of the program. In addition, participants who had completed the program at the end of year 1 were asked to complete a survey providing qualitative information about their experience in the program. Of these participants, 73% reported no opiate use and 100% had full custody of their infants.

Discussion

The Tides, Inc. program utilizes existing resources to provide coordinated and comprehensive care for pregnant women with Opioid Use Disorder. In addition to improving outcomes for women and their infants, this program can reduce cost and burden on community entities such as the justice system and foster care networks. This program can serve as a model for other communities to coordinate care for women and their infants.

SUBMITTER: Jones C

PROVIDER: S-EPMC8543638 | biostudies-literature | 2021 Jan-Dec

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Improving Outcomes of Mothers With Opioid Use Disorder Using a Community Collaborative Model.

Jones Carolyn C Duea Stephanie S Griggs Kellie K Johnstone William W Kinsey Debbie D

Journal of primary care & community health 20210101

<h4>Context</h4>Increasing rates of Opioid Use Disorder among pregnant women are a significant public health issue. Care for these women is fragmented, and multiple barriers to care have been identified. Program: The Tides, Inc. is attempting to address these needs by providing comprehensive, coordinated care, beginning in pregnancy and extending beyond the birth of their infant.<h4>Implementation</h4>Using a collaborative model, care is coordinated between multiple existing agencies in an effor ...[more]

PMID: 34686099

Similar Datasets

Project description:ImportanceAgonist medications for opioid use disorder (MOUD), buprenorphine and methadone, in carceral settings might reduce the risk of postrelease opioid overdose but are uncommonly offered. In April 2019, the Massachusetts Department of Correction (MADOC), the state prison system, provided buprenorphine for incarcerated individuals in addition to previously offered injectable naltrexone.ObjectiveTo evaluate postrelease outcomes after buprenorphine implementation.Design, setting, and participantsThis cohort study with interrupted time-series analysis used linked data across multiple statewide data sets in the Massachusetts Public Health Data Warehouse stratified by sex due to differences in carceral systems. Eligible participants were individuals sentenced and released from a MADOC facility to the community. The study period for the male sample was January 2014 to November 2020; for the female sample, January 2015 to October 2019. Data were analyzed between February 2022 and January 2024.ExposureApril 2019 implementation of buprenorphine during incarceration.Main outcomes and measuresReceipt of MOUD within 4 weeks after release, opioid overdose, and all-cause mortality within 8 weeks after release, each measured as a percentage of monthly releases who experienced the outcome. Segmented linear regression analyzed changes in outcome rates after implementation.ResultsA total of 15 225 individuals were included. In the male sample there were 14 582 releases among 12 688 individuals (mean [SD] age, 35.0 [10.8] years; 133 Asian and Pacific Islander [0.9%], 4079 Black [28.0%], 4208 Hispanic [28.9%], 6117 White [41.9%]), a rate of 175.7 releases per month; the female sample included 3269 releases among 2537 individuals (mean [SD] age, 34.9 [9.8] years; 328 Black [10.0%], 225 Hispanic [6.9%], 2545 White [77.9%]), a rate of 56.4 releases per month. Among male participants at 20 months postimplementation, the monthly rate of postrelease buprenorphine receipt was higher than would have been expected under baseline trends (21.2% vs 10.6% of monthly releases; 18.6 additional releases per month). Naltrexone receipt was lower than expected (1.0% vs 6.0%; 8.8 fewer releases per month). Monthly rates of methadone receipt (1.4%) and opioid overdose (1.8%) were not significantly different than expected. All-cause mortality was lower than expected (1.9% vs 2.8%; 1.5 fewer deaths per month). Among female participants at 7 months postimplementation, buprenorphine receipt was higher than expected (31.6% vs 9.5%; 12.4 additional releases per month). Naltrexone receipt was lower than expected (3.4% vs 7.2%) but not statistically significantly different. Monthly rates of methadone receipt (1.1%), opioid overdose (4.8%), and all-cause mortality (1.6%) were not significantly different than expected.Conclusions and relevanceIn this cohort study of state prison releases, postrelease buprenorphine receipt increased and naltrexone receipt decreased after buprenorphine became available during incarceration.

Project description:BackgroundPharmacists remain an underutilized resource in the treatment of opioid use disorder (OUD). Although studies have engaged pharmacists in dispensing medications for OUD (MOUD), few studies have evaluated collaborative care models in which pharmacists are an active, integrated part of a primary care team offering OUD care.MethodsThis study seeks to implement a pharmacist integrated MOUD clinical model (called PrIMO) and evaluate its feasibility, acceptability, and impact across four diverse primary care sites. The Consolidated Framework for Implementation Research is used as an organizing framework for study development and interpretation of findings. Implementation Facilitation is used to support PrIMO adoption. We assess the primary outcome, the feasibility of implementing PrIMO, using the Stages of Implementation Completion (SIC). We evaluate the acceptability and impact of the PrIMO model at the sites using mixed-methods and combine survey and interview data from providers, pharmacists, pharmacy technicians, administrators, and patients receiving MOUD at the primary care sites with patient electronic health record data. We hypothesize that it is feasible to launch delivery of the PrIMO model (reach SIC Stage 6), and that it is acceptable, will positively impact patient outcomes 1 year post model launch (e.g., increased MOUD treatment retention, medication regimen adherence, service utilization for co-morbid conditions, and decreased substance use), and will increase each site's capacity to care for patients with MOUD (e.g., increased number of patients, number of prescribers, and rate of patients per prescriber).DiscussionThis study will provide data on a pharmacist-integrated collaborative model of care for the treatment of OUD that may be feasible, acceptable to both site staff and patients and may favorably impact patients' access to MOUD and treatment outcomes.Trial registrationThe study was registered on Clinicaltrials.gov (NCT05310786) on April 5, 2022, https://www.Clinicaltrialsgov/study/NCT05310786?id=NCT05310786&rank=1.

Project description:AimTo test the effect of the duration of medication for opioid use disorder (MOUD) use during pregnancy on maternal, perinatal and neonatal outcomes.DesignRetrospective cohort analysis of claims, encounter and pharmacy data.SettingPennsylvania, USA.ParticipantsWe analyzed 13 320 pregnancies among 10 741 women with opioid use disorder aged 15-44 years enrolled in Pennsylvania Medicaid between 2009 and 2017.MeasurementsWe examined five outcomes during pregnancy and for 12 weeks postpartum: (1) overdose, (2) postpartum MOUD continuation, (3) preterm birth (< 37 weeks gestation), (4) term low birth weight (< 2500 g at ≥ 37 weeks) and (5) neonatal abstinence syndrome (NAS). Our primary exposure was the duration (count of weeks) of any MOUD use, including methadone or buprenorphine, during pregnancy.FindingsAmong 13 320 pregnancies, 306 (2.3%) were complicated by an overdose, 1753 (13.2%) resulted in a preterm birth and 6787 (50.9%) continued MOUD postpartum. Among infants, 874 (7.6%) were low birth weight at term and 7706 (57.9%) were diagnosed with NAS. As the duration of MOUD use increased, we found a statistically significant decrease in the rate of overdose and preterm birth, a statistically significant increase in the rate of postpartum MOUD continuation and NAS and a decline in term low birth weight. Specifically, for each additional week of MOUD, the adjusted odds of overdose decreased by 2% [adjusted odds ratio (aOR) = 0.98; 95% confidence interval (CI) = 0.97, 0.99], preterm birth decreased by 1% (aOR = 0.99; 95% CI = 0.99, 1.00), postpartum MOUD continuation increased by 95% (aOR = 1.95; 95% CI = 1.87, 2.04) and NAS increased by 41% (aOR = 1.41; 95% CI = 1.35, 1.47). The odds of term low birth weight did not change (aOR = 1.00; 95% CI = 0.99, 1.00), although the rate declined with a longer duration of MOUD use during pregnancy.ConclusionsLonger duration of medication for opioid use disorder use during pregnancy appears to be associated with improved maternal and perinatal outcomes.

Dataset Information

Improving Outcomes of Mothers With Opioid Use Disorder Using a Community Collaborative Model.

Context

Implementation

Evaluation

Discussion

Publications

Improving Outcomes of Mothers With Opioid Use Disorder Using a Community Collaborative Model.

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