Availability, accessibility, and structure of opioid use disorder treatment and maternal and child health outcomes

阿片类药物使用障碍治疗的可用性、可及性和结构以及孕产妇和儿童健康结果

• 批准号: 10463553
• 负责人: Marian Patricia Jarlenski
• 金额: $ 61.39万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-30 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10463553
• 关键词: Address; Affect; Behavior Therapy; Birth; Birth Certificates; Buprenorphine; Caring; Child; Child Care; Child Health; Child health care; Clinical; Clinical Trials; Data; Dose; Early Intervention; Enrollment; First Pregnancy Trimester; Frequencies; Geography; Goals; Guidelines; HCV screening; HIV/HCV; Health; Health Expenditures; Health Personnel; Health Policy; Healthcare; Healthcare Systems; Individual; Infant; Knowledge; Length of Stay; Longitudinal Studies; Low Birth Weight Infant; Maternal Mortality; Maternal and Child Health; Measures; Mediating; Medicaid; Medicaid eligibility; Methadone; Neonatal; Neonatal Abstinence Syndrome; Neonatal Mortality; Outcome; Overdose; Patients; Pennsylvania; Pharmaceutical Preparations; Pharmacy facility; Policies; Postpartum Period; Postpartum Women; Pregnancy; Pregnant Women; Premature Birth; Prevalence; Provider; Relapse; Research; Resources; Rural Population; Structure; United States; Urban Population; Variant; Visit; Woman; addiction; adverse maternal outcomes; attributable mortality; beneficiary; care outcomes; complex chronic conditions; improved; maternal morbidity; maternal opioid use; medication-assisted treatment; neonatal health; neonatal morbidity; neonatal outcome; obstetric care; opioid epidemic; opioid use disorder; pediatric health outcomes; postpartum health; pregnancy health; prepregnancy; programs; service intervention; socioeconomics; substance abuse treatment; substance use; treatment guidelines; treatment services

The prevalence of opioid use disorder (OUD) during pregnancy has more than doubled in the past decade, as has maternal and neonatal morbidity and mortality related to OUD. Since the beginning of the opioid epidemic, maternal deaths attributable to drug overdose have increased by nearly 5-­fold. In 2012, one infant, on average, was born every 30 minutes in the United States with neonatal abstinence syndrome (NAS), which has accounted for an estimated $1.5 billion in healthcare expenditures. In clinical trials, medication-­assisted treatment (MAT) use during pregnancy has been associated with reductions in adverse maternal and neonatal outcomes. Despite this, many women with OUD do not receive treatment during pregnancy and the majority discontinue treatment in the postpartum period. Therefore, the goal of this R01 proposal is to understand how three different modifiable components of the delivery of OUD treatment services (i.e. availability, accessibility and structure) differentially impact maternal and child health outcomes. To accomplish this goal, we will utilize administrative healthcare data including claims, encounters, and pharmacy data for all Medicaid beneficiaries in Pennsylvania including >13,000 pregnant women with OUD and their infants, from 2008 to 2017. Data will be merged with birth certificate and early intervention data to determine if improvements in maternal OUD treatment engagement impact pediatric health outcomes. We will create patient-­level measures of OUD treatment availability (geographic proximity to Medicaid OUD treatment providers), accessibility (duration of Medicaid enrollment) and treatment structure (guideline concordance). The primary research aims are to 1) assess the impact of OUD treatment availability during pregnancy (geographic proximity to Medicaid OUD treatment providers) on maternal MAT use and birth and neonatal health outcomes;; 2) assess the impact of OUD treatment accessibility (duration of maternal Medicaid enrollment) on MAT use during pregnancy and postpartum and pediatric health outcomes;; 3) determine if the relationships between MAT use and maternal and child health outcomes are mediated by OUD treatment structure (concordance with OUD treatment guidelines in pregnancy). Deeply affected by the opioid epidemic, Pennsylvania has the fourth-­largest Medicaid program, rural and urban populations and demographic and socioeconomic profiles consistent with national averages which will provide highly generalizable findings. Aim 1 will quantify the minimum geographic proximity to Medicaid OUD treatment providers necessary to improve MAT use during pregnancy and subsequent birth outcomes. Aim 2 will determine the relevance of pre-­pregnancy and postpartum Medicaid enrollment to first trimester MAT use and pediatric health outcomes for the first three years, which will inform Medicaid enrollment criteria. Aim 3 will quantify the extent to which recommended components of OUD treatment structure, beyond MAT use, are associated with maternal and child health outcomes. Together, our findings will provide high-­quality evidence about how Medicaid policies may lessen the considerable burden of OUD.

在过去十年中，妊娠期阿片类药物使用障碍（OUD）的患病率增加了一倍以上，与OUD相关的孕产妇和新生儿发病率和死亡率也增加了一倍以上。自类阿片开始流行以来，因药物过量造成的孕产妇死亡增加了近5/10倍。2012年，美国平均每30分钟就有一名新生儿出生，患有新生儿戒断综合征（NAS），估计造成15亿美元的医疗支出。在临床试验中，妊娠期间使用药物辅助治疗（MAT）与不良孕产妇和新生儿结局的减少相关。尽管如此，许多患有OUD的妇女在怀孕期间没有接受治疗，大多数在产后期间停止治疗。因此，本R 01提案的目标是了解OUD治疗服务提供的三个不同的可修改组成部分（即可用性、可及性和结构）如何对孕产妇和儿童健康结果产生差异性影响。为了实现这一目标，我们将利用行政医疗保健数据，包括2008年至2017年宾夕法尼亚州所有医疗补助受益人的索赔，遭遇和药房数据，包括> 13，000名OUD孕妇及其婴儿。数据将与出生证明和早期干预数据合并，以确定母亲OUD治疗参与的改善是否会影响儿科健康结果。我们将创建OUD治疗可用性（与Medicaid OUD治疗提供者的地理接近度）、可及性（Medicaid登记的持续时间）和治疗结构（指南一致性）的患者级别措施。主要研究目的是1）评估妊娠期间OUD治疗可用性的影响（地理上接近Medicaid OUD治疗提供者）对产妇MAT使用以及出生和新生儿健康结果的影响; 102）评估OUD治疗可及性的影响（母亲参加医疗补助的持续时间）对怀孕期间使用MAT以及产后和儿科健康结果的影响; 3）确定MAT使用与母婴健康结果之间的关系是否由OUD治疗结构介导（与妊娠期OUD治疗指南一致）。宾夕法尼亚州深受阿片类药物流行病的影响，拥有第四大医疗补助计划，农村和城市人口以及与全国平均水平一致的人口和社会经济概况，这将提供高度概括的发现。目标1将量化与医疗补助OUD治疗提供者的最小地理接近度，以改善妊娠期间MAT的使用和随后的分娩结果。目标2将确定怀孕前和产后医疗补助登记与前三个月MAT使用和前三年儿科健康结果的相关性，这将告知医疗补助登记标准。目标3将量化OUD治疗结构的建议组成部分（除MAT使用外）与孕产妇和儿童健康结果的相关程度。总之，我们的研究结果将提供高质量的证据，说明医疗补助政策如何减轻OUD的巨大负担。

项目成果

Outcomes associated with the use of medications for opioid use disorder during pregnancy.

• DOI: 10.1111/add.15582
• 发表时间: 2021-12
• 期刊: Addiction (Abingdon, England)
• 作者: Krans EE;Kim JY;Chen Q;Rothenberger SD;James AE 3rd;Kelley D;Jarlenski MP
• 通讯作者: Jarlenski MP

Co-occurring Substance Use Disorders Identified Among Delivery Hospitalizations in the United States.

• DOI: 10.1097/adm.0000000000000792
• 发表时间: 2021-11-01
• 期刊: Journal of addiction medicine
• 影响因子: 5.5
• 作者: Jarlenski M;Krans EE
• 通讯作者: Krans EE

Association of Duration of Methadone or Buprenorphine Use During Pregnancy With Risk of Nonfatal Drug Overdose Among Pregnant Persons With Opioid Use Disorder in the US.

• DOI: 10.1001/jamanetworkopen.2022.7964
• 发表时间: 2022-04-01
• 期刊: JAMA NETWORK OPEN
• 影响因子: 13.8
• 作者: Jarlenski, Marian;Chen, Qingwen;Gao, Alice;Rothenberger, Scott D.;Krans, Elizabeth E.
• 通讯作者: Krans, Elizabeth E.

Duration of medication for opioid use disorder during pregnancy and postpartum by race/ethnicity: Results from 6 state Medicaid programs.

按种族/民族划分的怀孕期间和产后阿片类药物使用障碍的药物治疗持续时间：来自 6 个州医疗补助计划的结果。

• DOI: 10.1016/j.drugalcdep.2023.109868
• 发表时间: 2023
• 期刊: Drug and alcohol dependence
• 影响因子: 4.2
• 作者: Austin,AnnaE;Durrance,ChristinePiette;Ahrens,KatherineA;Chen,Qingwen;Hammerslag,Lindsey;McDuffie,MaryJoan;Talbert,Jeffery;Lanier,Paul;Donohue,JulieM;Jarlenski,Marian
• 通讯作者: Jarlenski,Marian

Substance use disorders and risk of severe maternal morbidity in the United States.

• DOI: 10.1016/j.drugalcdep.2020.108236
• 发表时间: 2020-11-01
• 期刊: Drug and alcohol dependence
• 影响因子: 4.2
• 作者: Jarlenski M;Krans EE;Chen Q;Rothenberger SD;Cartus A;Zivin K;Bodnar LM
• 通讯作者: Bodnar LM