Project STEPuP: A prenatal provider education and training program to improve medication-assisted treatment use during pregnancy and maternal and child health outcomes

主题DAT18-06：怀孕期间阿片类药物使用障碍(OUD)的患病率在过去几年中翻了两番 在过去十年中，与药物使用有关的孕产妇和新生儿发病率和死亡率也是如此。药物治疗- 妊娠期使用辅助治疗(MAT)可减少不良后果，是推荐的治疗方法， 孕期OUD治疗的循证实践(EBP)。尽管如此，40%的孕妇 用乌德不收垫子。目前，没有有效的战略来扩大垫子的获取和 孕妇的可获得性，特别是在母亲使用阿片类药物的农村低资源环境中 高得不成比例。作为解决这一差距的第一步，我们与广泛的关键利益相关者进行了接触 宾夕法尼亚州卫生系统确定障碍和促进者扩大高血压病治疗服务 需要低资源的产科设置。我们的利益相关者发现，迫切需要一个以妇女为中心、低成本的 资源、可持续、提供者级别的干预，以促进在产科环境中采用MAT。 因此，我们在此应用程序中的目标是测试产前提供者教育和 旨在促进在怀孕期间采用EBP的培训计划，称为Stepup计划 (孕期和产后药物滥用治疗和教育)。Stepup项目，扎根于 我们的研究团队进行的初步和试点工作有4个组成部分，旨在解决以下障碍 MAT和EBP的采用：1)远程支持的提供商教育和培训计划，2) 成瘾远程咨询支持，3)病例管理和心灵感应支持，以及4)与 卫生系统管理员和付款人，以满足与行政和报销相关的需求。至 为了达到这一目标，我们将在12个产科地点进行整群随机临床试验。 宾夕法尼亚州和纽约。870名患者的结局将在怀孕期间、分娩时进行评估 产后1年。我们的中心假设是，Stepup项目将促进EBP的采用， 提高胎垫使用率，改善妊娠和产后妇女的健康状况 他们的孩子。具体地说，我们的目标是：1)创建组织就绪状态，以促进项目逐步实施 实施；2)评估Stepup项目对供应商在OUD期间采用EBP的影响 3)评估提供者采用EBP对母婴健康结局的影响。我们的 这项研究具有重大意义，因为它解决了如何在怀孕期间增加垫子使用的实质性知识差距 并通过审查产前提供者在扩大治疗机会方面可以发挥的作用来进行创新。

Topic DAT18-06: The prevalence of opioid use disorder (OUD) during pregnancy has quadrupled over the past decade, as have maternal and neonatal morbidity and mortality related to substance use. Medication- assisted treatment (MAT) use during pregnancy reduces adverse outcomes and is the recommended, evidence-based practice (EBP) for OUD treatment during pregnancy. Despite this, 40% of pregnant women with OUD do not receive MAT. Currently, there are no effective strategies to expand MAT access and availability for pregnant women, especially in rural, low-resource settings where maternal opioid use is disproportionately high. As an initial step to address this gap, we engaged key stakeholders across a large health system in Pennsylvania to determine barriers and facilitators to expanding treatment services in high need, low-resource obstetric settings. Our stakeholders identified a critical need for a women-centered, low- resource, sustainable, provider-level intervention to facilitate the adoption of MAT in obstetric settings. Therefore, our objective in this application is to test the effectiveness of a prenatal provider education and training program designed to facilitate the adoption of EBP for OUD during pregnancy called Project STEPuP (Substance abuse Treatment and Education during Pregnancy and Postpartum). Project STEPuP, grounded in preliminary and pilot work conducted by our research team, has 4 components designed to address barriers to MAT and EBP adoption: 1) a “hub and spoke,” remotely-supported provider education and training program, 2) addiction teleconsultation support, 3) case management and telepsychiatry support, and 4) a partnership with health system administrators and payers to address administrative and reimbursement related needs. To achieve this objective, we will conduct a cluster-randomized clinical trial across 12 obstetric sites in Pennsylvania and New York. Outcomes among 870 patients will be assessed during pregnancy, at delivery and through 1 year postpartum. Our central hypothesis is that Project STEPuP will facilitate EBP adoption, increase MAT utilization and improve health outcomes among pregnant and postpartum women with OUD and their children. Specifically, we aim to: 1) create organizational readiness to facilitate Project STEPuP implementation; 2) assess the effect of Project STEPuP on provider adoption of EBP for OUD during pregnancy; and 3) evaluate the effect of provider adoption of EBP on maternal and child health outcomes. Our research is significant by addressing the substantial knowledge gap of how to increase MAT use in pregnancy and innovative by examining the role that prenatal providers can play in expanding treatment access.