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: 10215452
• 负责人: Marian Patricia Jarlenski
• 金额: $ 76.74万
• 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 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10215452
• 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，怀孕期间阿片类药物使用障碍(OUD)的流行率增加了一倍多，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。自阿片类药物流行开始以来，可归因于药物过量的孕产妇死亡人数增加了近5倍。2012年，美国平均每30分钟就有一名婴儿出生时患有新生儿禁欲综合征(NAS)，据估计，NAS在医疗支出中占了15亿美元。在临床试验中，怀孕期间使用药物辅助治疗(MAT)与减少产妇和新生儿的不良结局有关。尽管如此，许多患有OUD的妇女在怀孕期间没有接受治疗，大多数人在产后停止治疗。因此，R01提案的目标是了解提供妇幼保健服务的三个不同的可修改组成部分(即可获得性、可获得性和结构)如何对孕产妇和儿童的健康结果产生不同的影响。为了实现这一目标，我们将利用行政医疗数据，包括2008年至2017年宾夕法尼亚州所有医疗补助受益人的申领、遭遇和药房数据，其中包括13,000名患有OUD的孕妇及其婴儿。数据将与出生证明和早期干预数据合并，以确定母婴治疗参与度的改善是否影响儿科健康结果。我们将创建患者级别的OUD治疗可用性(与医疗补助OUD治疗提供者的地理位置接近)、可获得性(医疗补助登记持续时间)和治疗结构(指南一致性)的衡量标准。主要研究目标是：1)评估孕期可获得医疗垫治疗的可能性(地理位置靠近医疗补助和医疗补助提供者)对产妇垫的使用及分娩和新生儿健康结局的影响；;2)评估可及性治疗(孕产妇参加医疗补助的持续时间)对孕期和产后垫的使用及儿科健康结局的影响；;3)确定垫的使用与妇幼健康结局之间的关系是否由保健垫治疗结构调节(与妊娠期保健垫治疗指南一致)。深受阿片类药物流行的影响，宾夕法尼亚州有第四大医疗补助计划，农村和城市人口以及人口和社会经济概况与全国平均水平一致，这将提供高度概括的结果。目标1将量化与医疗补助治疗提供者的最小地理距离，以改善怀孕期间和随后的分娩结果。目标2将确定孕前和产后医疗补助登记与头三年妊娠垫使用和儿科健康结果的相关性，这将为医疗补助登记标准提供信息。目标3将量化建议的OUD治疗结构的组成部分在多大程度上与孕产妇和儿童的健康结果相关，而不是使用垫子。总而言之，我们的发现将提供高质量的证据，证明医疗补助政策可能如何减轻OUD的相当大负担。