US Survey of factors associated with adherence to standard of care in treating pregnant women with opioid use disorder
US Survey of factors associated with adherence to standard of care in treating pregnant women with opioid use disorder
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DOI：
10.1080/0167482x.2019.1634048
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发表时间：
2020-01-02
影响因子：
3.1
通讯作者：
Freeman，Katherine
中科院分区：
文献类型：
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作者：
Howard，Heather Grimshaw;Freeman，Katherine
目的：确定产科医生对阿片类药物使用障碍（PWOUD）孕妇的治疗建议的相关因素，并确定医生放弃丁丙诺啡作为药物辅助治疗（MAT）的患病率。方法：我们对全国代表性的565名产科医生进行了结构化的在线调查，回复率为38%。我们建立了Logistic回归模型，以确定影响pwd治疗建议的因素。采用Clopper-Pearson方法推导出放弃丁丙诺啡的医生人数的置信区间（CI）。结果：大约77%的受访者在过去一年内为残疾妇女提供过护理。医生报告说，至少75%的孕妇接受了医疗补助的产前护理。患者就诊时最常用的阿片类药物是处方阿片类药物，第二常见的是美沙酮。共有14.0%的患者有丁丙诺啡豁免（95% CI: 11.6-16.7%），在这些豁免的患者中，47%的患者给PWOUD开了丁丙诺啡。与丁丙诺啡放弃相关的因素包括转介到社区支持服务。与遵守标准护理相关的三个最重要因素是：就诊时阿片类药物的类型、患者的选择和医生的经验。阿片类药物类型与美沙酮表现、社会经济地位、共同决策和实践环境有关。患者的选择与医生的准备和执业时间有关。医生的经验与转介到康复服务有关。结论：需要新的干预措施：(1)通过继续医学教育促进阿片类药物使用障碍的办公室治疗，(2)为医生提供以康复为导向的资源，(3)增加患者在医疗保健决策中的自主权。这些拟议的循证干预措施将促进妇女及其婴儿的最佳做法，并使更多的人获得标准护理。
Objective:To identify, factors associated with obstetricians’ treatment recommendations for pregnant women with an opioid use disorder (PWOUD), and to determine the prevalence of physicians waivered for buprenorphine as a medication-assisted treatment (MAT).Methods:We conducted a structured online survey of a nationally representative sample of 565 obstetrical physicians, with a response rate of 38%. Logistic regression models were derived to identify factors that influence treatment recommendations for PWOUD. The Clopper–Pearson method was used to derive the confidence interval (CI) for the number of physicians waivered for buprenorphine.Results:Approximately 77% of respondents had provided care for a PWOUD within the last year. Physicians reported that at least 75% of their PWOUD received Medicaid for prenatal care. The most common opioids used at patient presentation were prescription opioids, with the second most common being methadone. A total of 14.0% had buprenorphine waivers (95% CI: 11.6–16.7%), and among those waivered, 47% prescribed buprenorphine to PWOUD. Factors associated with buprenorphine waiver encompass referrals to community support services. The three most prominent factors associated with adherence to standard of care were: type of opioid at presentation, patient’s choice, and physician’s experience. Type of opioid was associated with methadone presentation, socioeconomic status, shared decision making and practice setting. Patient’s choice was associated with physician preparedness and practice duration. Physician’s experience was associated with referral to recovery-oriented services.Conclusions:Novel interventions are needed to (1) promote office-based treatment for opioid use disorder through continuing medical education, (2) provide physicians with access to recovery-oriented resources and (3) increase patient autonomy in healthcare decision making. These proposed evidence-based interventions will promote best practices for women and their infants and greater accessibility to standard of care.