TY - JOUR
KW - American Indians or Alaska Natives
KW - Buprenorphine/therapeutic use
KW - Female
KW - Humans
KW - Opiate Substitution Treatment
KW - Opioid-Related Disorders/drug therapy/therapy
KW - Pregnancy
KW - Rural Population
KW - access to care
KW - opioid use disorder
KW - Quality of Care
KW - rural health care
KW - Unannounced standardized patients
AU - A. T. Kelley
AU - M. C. Smid
AU - J. D. Baylis
AU - E. Charron
AU - A. E. Binns-Calvey
AU - S. Archer
AU - S. J. Weiner
AU - L. J. Begaye
AU - G. Cochran
A1 - 
AB - BACKGROUND: Opioid use disorder (OUD) disproportionately impacts rural and American Indian communities and has quadrupled among pregnant individuals nationwide in the past two decades. Yet, limited data are available about access and quality of care available to pregnant individuals in rural areas, particularly among American Indians (AIs). Unannounced standardized patients (USPs), or "secret shoppers" with standardized characteristics, have been used to assess healthcare access and quality when outcomes cannot be measured by conventional methods or when differences may exist between actual versus reported care. While the USP approach has shown benefit in evaluating primary care and select specialties, its use to date for OUD and pregnancy is very limited. METHODS: We used literature review, current practice guidelines for perinatal OUD management, and stakeholder engagement to design a novel USP protocol to assess healthcare access and quality for OUD in pregnancy. We developed two USP profiles-one white and one AI-to reflect our target study area consisting of three rural, predominantly white and AI US counties. We partnered with a local community health center network providing care to a large AI population to define six priority outcomes for evaluation: (1) OUD treatment knowledge among clinical staff answering telephones; (2) primary care clinic facilitation and provision of prenatal care and buprenorphine treatment; (3) appropriate completion of evidence-based screening, symptom assessment, and initial steps in management; (4) appropriate completion of risk factor screening/probing about individual circumstances that may affect care; (5) patient-directed tone, stigma, and professionalism by clinic staff; and (6) disparities in care between whites and American Indians. DISCUSSION: The development of this USP protocol tailored to a specific environment and high-risk patient population establishes an innovative approach to evaluate healthcare access and quality for pregnant individuals with OUD. It is intended to serve as a roadmap for our own study and for future related work within the context of substance use disorders and pregnancy.
AD - Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, 500 Foothill Drive, Building 2, Salt Lake City, UT, 84148, USA. Alan.Kelley@hsc.utah.edu.; Program of Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, 84132, USA. Alan.Kelley@hsc.utah.edu.; Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, 30 N 1900 E 5R341, Salt Lake City, UT, 84132, USA. Alan.Kelley@hsc.utah.edu.; Program of Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, 84132, USA.; Department of Obstetrics and Gynecology, University of Utah School of Medicine, 30 N 1900 E 2B300, Salt Lake City, UT, 84132, USA.; Program of Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, 84132, USA.; Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, 30 N 1900 E 5R341, Salt Lake City, UT, 84132, USA.; Program of Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, 84132, USA.; Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, 30 N 1900 E 5R341, Salt Lake City, UT, 84132, USA.; Jesse Brown VA Medical Center, Medical Services, 820 S Damen Ave, Chicago, IL, 60612, USA.; Division of Academic Internal Medicine and Geriatrics, Department of Medicine, University of Illinois At Chicag(TRUNCATED)
BT - Addiction science & clinical practice
C5 - Education & Workforce; Healthcare Disparities; Measures; Opioids & Substance Use
CP - 1
DO - 10.1186/s13722-021-00246-6
IS - 1
JF - Addiction science & clinical practice
LA - eng
M1 - Journal Article
N2 - BACKGROUND: Opioid use disorder (OUD) disproportionately impacts rural and American Indian communities and has quadrupled among pregnant individuals nationwide in the past two decades. Yet, limited data are available about access and quality of care available to pregnant individuals in rural areas, particularly among American Indians (AIs). Unannounced standardized patients (USPs), or "secret shoppers" with standardized characteristics, have been used to assess healthcare access and quality when outcomes cannot be measured by conventional methods or when differences may exist between actual versus reported care. While the USP approach has shown benefit in evaluating primary care and select specialties, its use to date for OUD and pregnancy is very limited. METHODS: We used literature review, current practice guidelines for perinatal OUD management, and stakeholder engagement to design a novel USP protocol to assess healthcare access and quality for OUD in pregnancy. We developed two USP profiles-one white and one AI-to reflect our target study area consisting of three rural, predominantly white and AI US counties. We partnered with a local community health center network providing care to a large AI population to define six priority outcomes for evaluation: (1) OUD treatment knowledge among clinical staff answering telephones; (2) primary care clinic facilitation and provision of prenatal care and buprenorphine treatment; (3) appropriate completion of evidence-based screening, symptom assessment, and initial steps in management; (4) appropriate completion of risk factor screening/probing about individual circumstances that may affect care; (5) patient-directed tone, stigma, and professionalism by clinic staff; and (6) disparities in care between whites and American Indians. DISCUSSION: The development of this USP protocol tailored to a specific environment and high-risk patient population establishes an innovative approach to evaluate healthcare access and quality for pregnant individuals with OUD. It is intended to serve as a roadmap for our own study and for future related work within the context of substance use disorders and pregnancy.
PY - 2021
SN - 1940-0640; 1940-0632; 1940-0632
SP - 40
T1 - Development of an unannounced standardized patient protocol to evaluate opioid use disorder treatment in pregnancy for American Indian and rural communities
T2 - Addiction science & clinical practice
TI - Development of an unannounced standardized patient protocol to evaluate opioid use disorder treatment in pregnancy for American Indian and rural communities
U1 - Education & Workforce; Healthcare Disparities; Measures; Opioids & Substance Use
U2 - 34172081
U3 - 10.1186/s13722-021-00246-6
VL - 16
VO - 1940-0640; 1940-0632; 1940-0632
Y1 - 2021
Y2 - Jun 25
ER -