Improving Access to Treatment for Women with Opioid Use Disorder

改善患有阿片类药物使用障碍的女性获得治疗的机会

• 批准号: 10442184
• 负责人: Stephen W Patrick
• 金额: $ 13.76万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2023-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10442184
• 关键词: Address; Age; Appointment; Birth Weight; Buprenorphine; Caring; Characteristics; Clinic; Communities; Data; Data Set; Diagnosis; Discipline of obstetrics; Drug usage; Eligibility Determination; Employment; Ensure; Ethnic Origin; Ethnic group; Evidence based treatment; Family Practice; Female of child bearing age; Fetal Development; First Pregnancy Trimester; Funding; Future; Growth; HIV risk; Health; Health Personnel; Health Services Accessibility; Health Services Research; Healthcare; Improve Access; Individual; Infant; Infant Health; Insurance; Insurance Coverage; Location; Maternal Health; Measures; Medicaid; Medicaid eligibility; Medical; Medicine; Methadone; Methods; Mothers; National Institute of Drug Abuse; Neonatal; Opioid Antagonist; Opioid agonist; Outcome; Outpatients; Patient Self-Report; Patients; Pattern; Personal Satisfaction; Pharmaceutical Preparations; Pharmacotherapy; Policies; Pregnancy; Pregnant Women; Privatization; Provider; Race; Randomized; Reporting; Reproducibility; Source; Surveys; Time; Treatment Cost; Uninsured; United States Dept. of Health and Human Services; Visit; Wait Time; Woman; Women Status; addiction; adverse outcome; base; community setting; criminal behavior; drug mechanism; experience; experimental study; flexibility; health care availability; health equity; health inequalities; illicit drug use; improved; in utero; kappa opioid receptors; mu opioid receptors; opioid agonist therapy; opioid exposure; opioid treatment program; opioid use; opioid use disorder; overdose death; overdose risk; pregnant; prescription opioid; prevent; programs; racial and ethnic; relapse risk; reproductive; treatment strategy; waiver

Opioid use, diagnoses of opioid use disorder among pregnant women, and complications from in utero opioid exposure increased dramatically over the past two decades. Despite evidence that medications for opioid use disorder are highly effective for preventing adverse outcomes from opioid use disorder, most patients needing treatment do not receive it with evidence of differential patterns of access for minoritized racial and ethnic groups compared to non-minoritized groups. Disparities in opioid use disorder treatment and medication access may intersect with race and ethnicity and pregnancy status for women seeking treatment for opioid use disorder. Receiving treatment for opioid use disorder during pregnancy is crucial for maternal and infant health and wellbeing; however, issues of equitable treatment access for racial and ethnically minoritized women remains understudied. Extending the ongoing NIDA-funded project (R01DA045729), which conducted a randomized field experiment of pregnant and non-pregnant “secret shoppers” attempting to obtain appointments at opioid treatment programs or with outpatient buprenorphine providers, this health equity supplement seeks to determine if non-white patients identified barriers to obtaining an appointment for opioid use disorder treatment. In addition, we seek to determine if racial concordance was a determining factor in women’s reported experiences based on secret shoppers’ race/ethnicity matching with community setting of clinic locations. Explanations of underlying mechanisms of these barriers will be explored using qualitative data. Leveraging the unique data from the NIDA-funded field experiment, this study will 1) determine if racial concordance between secret shoppers and the communities that surround clinic locations influenced their ability to a) obtain an appointment for treatment, b) wait time for treatment, c) out of pocket costs for treatment, and d) determine if these outcomes varied by pregnancy status and treatment provider type, and 2) explore secret shoppers’ qualitative descriptions of racial discriminatory encounters and experiences when seeking treatment and medication at opioid treatment program, either with opioid treatment programs or outpatient buprenorphine providers, attending to variability based on race/ethnicity and pregnancy status. Data from this study will inform future studies aimed at mitigating health inequities at the confluence of opioid use disorder, pregnancy, and race.

阿片类药物使用，孕妇中阿片类药物使用障碍的诊断以及阿片类药物的并发症 在过去的二十年中，暴露量急剧增加。尽管有证据表明使用阿片类药物的药物 疾病对于预防阿片类药物使用障碍的不良结果非常有效，大多数患者需要 治疗没有收到它的证据，表明少数赛车和种族的访问方式不同 组与非最小化组相比。卵毒素使用障碍治疗和药物的差异 访问可能与寻求阿片类药物治疗的妇女的种族，种族和怀孕状况相交 紊乱。怀孕期间接受阿片类药物使用障碍的治疗对于材料和婴儿健康至关重要 和幸福；但是，种族和种族少数妇女的公平治疗机会的问题 仍然被理解。扩展了正在进行的NIDA资助项目（R01DA045729），该项目进行了 试图获得的孕妇和非怀孕的“秘密购物者”的随机现场实验 在阿片类药物治疗计划或门诊丁丙诺啡提供者的任命，该健康公平 补充剂旨在确定非白人患者是否确定了获得阿片类药物预约的障碍 使用障碍治疗。此外，我们试图确定种族一致性是否是决定因素 妇女根据秘密购物者的种族/种族与社区环境相匹配的经验 诊所地点。将使用定性探索这些障碍的基本机制的解释 数据。利用NIDA资助的现场实验中的独特数据，本研究将确定种族是否 秘密购物者与周围诊所地点的社区之间的一致性影响了他们 a）获得治疗约会的能力，b）等待治疗时间，c）不需要零花钱的治疗费用， d）确定这些结果是否因怀孕状况和治疗提供者的类型而变化，2）探索 秘密购物者在寻求种族歧视性相遇和经验的定性描述 阿片类药物治疗计划的治疗和药物治疗，无论是阿片类药物治疗计划还是门诊 基于种族/种族和怀孕状况的变异性，丁丙诺啡提供者参加。来自此的数据 研究将为未来的研究提供旨在减轻阿片类药物使用障碍融合的健康不平等的研究， 怀孕和种族。

项目成果

Association between punitive policies and neonatal abstinence syndrome among Medicaid-insured infants in complex policy environments.

• DOI: 10.1111/add.15602
• 发表时间: 2022-01
• 期刊: Addiction (Abingdon, England)
• 作者: Faherty LJ;Heins S;Kranz AM;Patrick SW;Stein BD
• 通讯作者: Stein BD

Neonatal Opioid Withdrawal Syndrome Is Associated With Infant Foster Care Entry At The County Level.

• DOI: 10.1377/hlthaff.2021.00460
• 发表时间: 2021-11
• 期刊: Health affairs (Project Hope)
• 作者: Loch SF;Stein BD;Ghertner R;McNeer E;Dupont WD;Smart R;Patrick SW
• 通讯作者: Patrick SW

Opioid Litigation and Maternal-Child Health-Investing in the Future.

阿片类药物诉讼和未来母婴健康投资。

• DOI: 10.1001/jamapediatrics.2019.5009
• 发表时间: 2020
• 期刊: JAMA pediatrics
• 影响因子: 26.1
• 作者: Patrick,StephenW;Davis,CoreyS;Stein,BradleyD
• 通讯作者: Stein,BradleyD

Improving the Child Welfare System to Respond to the Needs of Substance-Exposed Infants.

• DOI: 10.1542/hpeds.2019-0106
• 发表时间: 2019-08-01
• 期刊: Hospital pediatrics
• 作者: Patrick, Stephen W;Frank, Richard G;Stein, Bradley D
• 通讯作者: Stein, Bradley D

Medications for opioid use disorder among pregnant women referred by criminal justice agencies before and after Medicaid expansion: A retrospective study of admissions to treatment centers in the United States.

医疗补助扩大前后刑事司法机构转介的孕妇阿片类药物使用障碍药物：对美国治疗中心入院情况的回顾性研究。

• DOI: 10.1371/journal.pmed.1003119
• 发表时间: 2020
• 期刊: PLoS medicine
• 影响因子: 15.8
• 作者: Winkelman,TylerNA;Ford,BeckyR;Shlafer,RebeccaJ;McWilliams,Anna;Admon,LindsayK;Patrick,StephenW
• 通讯作者: Patrick,StephenW