Doula Support Engagement in a Population of Pregnant and Parenting Women in Drug Treatment

项目摘要 美国目前的阿片类药物危机有据可查， 阿片类药物使用障碍孕妇的孕产妇结局。使用阿片类药物的女性 疾病（OUD）的产前保健利用率较低， 急诊室使用此外，在这一人群中， 这些因素包括：条件、普遍存在的社会人口和健康不利因素以及养育子女的差异。 患有OUD的妇女报告说，在治疗期间， 过渡到父母。目前的医疗模式不能满足这些弱势群体的需求。 在围产期需要新的方法，如导乐参与。 导乐干预这一人口的养育妇女OUD没有得到很好的研究。这 该项目旨在评估导乐参与妇女与OUD在围产期， 研究其对保健利用、产妇临床分娩结局和产后影响 心理健康和育儿领域。所有研究程序将在孕产妇中心进行。 托马斯杰斐逊大学的成瘾治疗教育与研究（MATER）项目， 美国最古老，最大，最全面的OUD治疗计划之一， 孕妇和育儿妇女。在两年的项目期间， 在MATER接受OUD治疗的患者将入组导乐或非导乐队列， 在围产期进行随访。将比较两者之间的结果差异 组将从电子健康记录中收集定量和定性数据， 有效的研究评估，半结构化访谈，人口统计调查，以及 观察性育儿评估在目标1中，我们将评估导乐护理参与如何 影响妇女在围产期治疗OUD时的医疗保健利用。在Aim中 2，我们将评估导乐护理参与如何影响分娩结果和心理健康 女性在治疗OUD。最后，在目标3中，我们将评估导乐参与如何 影响父母域的母亲儿童的二元体，对于那些二元体受OUD。这 项目响应AHRQ的特别强调对卫生服务研究感兴趣的通知， 阿片类药物危机（NOT-HS-18-015），并讨论了妇女的经验和结果， 居住在城市地区的个人，AHRQ优先人群。鉴于OUD的流行程度 在美国各地的医疗保健利用和孕产妇围产期结果的差异， 对于患有OUD的孕妇，我们预计这项研究将产生重大影响。

PROJECT SUMMARY The current opioid crisis in the United States is well documented, with prevailing disparities in maternal outcomes for pregnant women with opioid use disorder. Women with opioid use disorder (OUD) experience lower rates of prenatal healthcare utilization and increased rates of emergency room utilization. Further, in this population there are higher rates of comorbid conditions, prevailing sociodemographic and health disadvantages, and parenting disparities. Women with OUD report fewer social supports and relationships to help them during the transition to parenthood. Current healthcare models do not meet the needs of this vulnerable population, requiring novel approaches in the perinatal period such as doula engagement. Doula intervention in this population of parenting women with OUD is not well studied. This project seeks to evaluate doula engagement in women with OUD during the perinatal period to study its effect on healthcare utilization, maternal clinical birth outcomes and post-partum psychosocial health, and parenting domains. All study procedures will occur at the Maternal Addiction Treatment Education & Research (MATER) program at Thomas Jefferson University, one of the oldest, largest, and most comprehensive OUD treatment programs in the U.S. for pregnant and parenting women. Over the 2-year project period, up to 100 pregnant women in treatment for OUD at MATER will be enrolled into either a doula or non-doula cohort to be followed over their perinatal period. Differences in outcomes will be compared between the two groups. Quantitative and qualitative data will be collected from electronic health records, validated study assessments, semi-structured interviews, a demographic survey, and an observational parenting assessment. In Aim 1, we will evaluate how doula care engagement affects healthcare utilization of women in treatment for OUD during the perinatal period. In Aim 2, we will evaluate how doula care engagement affects birth outcomes and psychosocial health of women in treatment for OUD. Finally, in Aim 3, we will evaluate how doula engagement affects parenting domains in the mother child dyad, for those dyads affected by OUD. This project responds to AHRQ's special emphasis notice of interest for health services research on the opioid crisis (NOT-HS-18-015) and addresses the experience and outcomes of women and individuals living in an urban area, AHRQ priority populations. Given the prevalence of OUD across the U.S. and the disparities in healthcare utilization and maternal perinatal outcomes for pregnant women with OUD, we anticipate this research will be of significant impact.