TY - JOUR
KW - Adult
KW - Analgesics, Opioid/therapeutic use
KW - Buprenorphine/therapeutic use
KW - Female
KW - Humans
KW - Non-Randomized Controlled Trials as Topic
KW - Opiate Substitution Treatment/standards
KW - Opioid-Related Disorders/drug therapy
KW - Practice Guidelines as Topic
KW - Pregnancy
KW - pregnant women
KW - Telemedicine/standards
AU - C. Guille
AU - A. N. Simpson
AU - E. Douglas
AU - L. Boyars
AU - K. Cristaldi
AU - J. McElligott
AU - D. Johnson
AU - K. Brady
A1 - 
AB - IMPORTANCE: There are high rates of maternal and newborn morbidity and mortality associated with opioid use disorder (OUD). Integrating OUD treatment in obstetric practices for pregnant and postpartum women via telemedicine can increase access to care and reduce the consequences of OUD. Evaluation of this care delivery model, however, is needed before widespread adoption. OBJECTIVE: To compare maternal and newborn outcomes among pregnant women with OUD receiving care via telemedicine vs in person. DESIGN, SETTING, AND PARTICIPANTS: A nonrandomized controlled trial including 98 women receiving perinatal OUD treatment in 4 outpatient obstetric practices by telemedicine or in person and followed up until 6 to 8 weeks post partum was conducted from September 4, 2017, to December 31, 2018. Logistic regression with propensity score adjustment was applied to reduce group selection bias and control for potentially confounding variables. INTERVENTIONS: Participants were seen weekly for 4 weeks, every 2 weeks for 4 weeks, and monthly thereafter and provided relapse prevention therapy and buprenorphine. MAIN OUTCOMES AND MEASURES: The outcomes were retention in treatment, defined as uninterrupted addiction treatment during pregnancy through 6 to 8 weeks post partum; urine drug screen results at delivery and 6 to 8 weeks post partum; and a neonatal abstinence syndrome (NAS) diagnosis collected via electronic health records. RESULTS: The mean (SD) age of the 98 pregnant women was 30.23 (5.12) years. Of these, 41 of 44 women (93.2%) in the telemedicine group and 48 of 54 women (88.9%) in the in-person group chose to continue treatment in the program after an initial evaluation. After propensity score weighting and doubly robust estimation, no significant differences were found between groups in retention in treatment at 6 to 8 weeks post partum (telemedicine: 80.4% vs in person: 92.7%; treatment effect, -12.2%; 95% CI, -32.3% to -4.4%). Similarly, after propensity score weighting and doubly robust estimation, there were no significant group differences in rates of NAS (telemedicine: 45.4% vs in person: 63.2%; treatment effect, -17.8%; 95% CI, -41.0% to 8.9%). CONCLUSIONS AND RELEVANCE: In this nonrandomized controlled trial, virtually integrated OUD care in obstetric practices produced similar maternal and newborn outcomes compared with in-person care. These findings may have important public health implications for combatting the opioid crisis and its consequences on pregnant women and their families. Future large randomized clinical trials are needed. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT04049032.
AD - Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston.; Obstetrics and Gynecology, Medical University of South Carolina, Charleston.; Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston.; Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston.; Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston.; Department of Pediatrics, Medical University of South Carolina, Charleston.; Department of Pediatrics, Medical University of South Carolina, Charleston.; Obstetrics and Gynecology, Medical University of South Carolina, Charleston.; Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston.
BT - JAMA network open
C5 - Education & Workforce; Healthcare Disparities; HIT & Telehealth; Opioids & Substance Use
CP - 1
DO - 10.1001/jamanetworkopen.2019.20177
IS - 1
JF - JAMA network open
LA - eng
M1 - Journal Article
N2 - IMPORTANCE: There are high rates of maternal and newborn morbidity and mortality associated with opioid use disorder (OUD). Integrating OUD treatment in obstetric practices for pregnant and postpartum women via telemedicine can increase access to care and reduce the consequences of OUD. Evaluation of this care delivery model, however, is needed before widespread adoption. OBJECTIVE: To compare maternal and newborn outcomes among pregnant women with OUD receiving care via telemedicine vs in person. DESIGN, SETTING, AND PARTICIPANTS: A nonrandomized controlled trial including 98 women receiving perinatal OUD treatment in 4 outpatient obstetric practices by telemedicine or in person and followed up until 6 to 8 weeks post partum was conducted from September 4, 2017, to December 31, 2018. Logistic regression with propensity score adjustment was applied to reduce group selection bias and control for potentially confounding variables. INTERVENTIONS: Participants were seen weekly for 4 weeks, every 2 weeks for 4 weeks, and monthly thereafter and provided relapse prevention therapy and buprenorphine. MAIN OUTCOMES AND MEASURES: The outcomes were retention in treatment, defined as uninterrupted addiction treatment during pregnancy through 6 to 8 weeks post partum; urine drug screen results at delivery and 6 to 8 weeks post partum; and a neonatal abstinence syndrome (NAS) diagnosis collected via electronic health records. RESULTS: The mean (SD) age of the 98 pregnant women was 30.23 (5.12) years. Of these, 41 of 44 women (93.2%) in the telemedicine group and 48 of 54 women (88.9%) in the in-person group chose to continue treatment in the program after an initial evaluation. After propensity score weighting and doubly robust estimation, no significant differences were found between groups in retention in treatment at 6 to 8 weeks post partum (telemedicine: 80.4% vs in person: 92.7%; treatment effect, -12.2%; 95% CI, -32.3% to -4.4%). Similarly, after propensity score weighting and doubly robust estimation, there were no significant group differences in rates of NAS (telemedicine: 45.4% vs in person: 63.2%; treatment effect, -17.8%; 95% CI, -41.0% to 8.9%). CONCLUSIONS AND RELEVANCE: In this nonrandomized controlled trial, virtually integrated OUD care in obstetric practices produced similar maternal and newborn outcomes compared with in-person care. These findings may have important public health implications for combatting the opioid crisis and its consequences on pregnant women and their families. Future large randomized clinical trials are needed. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT04049032.
PY - 2020
SN - 2574-3805; 2574-3805
T1 - Treatment of Opioid Use Disorder in Pregnant Women via Telemedicine: A Nonrandomized Controlled Trial
T2 - JAMA network open
TI - Treatment of Opioid Use Disorder in Pregnant Women via Telemedicine: A Nonrandomized Controlled Trial
U1 - Education & Workforce; Healthcare Disparities; HIT & Telehealth; Opioids & Substance Use
U2 - 32003816
U3 - 10.1001/jamanetworkopen.2019.20177
VL - 3
VO - 2574-3805; 2574-3805
Y1 - 2020
Y2 - Jan 3
ER -