Literature Collection

Optimizing the overall health of individuals prior to pregnancy can improve both pregnancy and lifelong health outcomes. Despite extremely high financial expenditure on birth in the United States, maternal and infant mortality rates continue to rise. Moreover, significant racial and ethnic disparities persist in perinatal health outcomes. Preconception care, or health care provided before or between pregnancies, has the capacity to meet these challenges. Preconception care can be integrated into every health care visit, including visits with primary care, reproductive health, and mental health care clinicians. Increasing awareness among clinicians of the benefits of preconception care and equipping them with innovative strategies to implement this care into practice, the number of people receiving optimal care could be increased. Recent innovations in preconception care include group care, health applications (apps), reminders in electronic health records, social marketing campaigns, social media movements, community-based partnerships, health care policy and access, and improving public and clinician education on preconception health topics. Ultimately, improving preconception health is best done in partnership between the consumer and clinician. Midwives, whose care is person-centered and partnership-focused, are well positioned to champion the innovation and implementation of equitable preconception care. The purpose of this State of the Science review, therefore, is to synthesize the literature on recent evidence-based innovations that may be used to improve preconception health and counseling.

People who have behavioral health disorders are disproportionately represented among people with HIV and those likely to be diagnosed with HIV. Despite repeated calls for the past decade for the integration of behavioral health into the HIV Care Continuum, findings from priority jurisdictions show these efforts lag. We present 5 examples of efforts to integrate behavioral health services into the HIV Care Continuum, across regions and populations in Ending the HIV Epidemic priority regions. Across diverse settings, care provision-screening, assessment, referrals, and treatments-remains insufficient. Consistent, ongoing actions are needed to address the compounded consequences of the HIV and behavioral health synergistic epidemics, or syndemic. The studies in this article involved local communities, provider groups, and people with lived experience of trauma, serious mental illness, neuropsychological disorder, substance use disorder, and HIV. These example studies reveal significant unmet needs for behavioral health care and/or HIV prevention and treatment in these priority communities. A common finding among these examples was that the success of interventions hinges on the extent to which interventions are tailored to local contexts and the specific needs of historically underserved populations, including Black women, the socioeconomically disadvantaged, LGBTQIA+ individuals, and people with serious mental illness and/or substance use disorders. We suggest recommendations for how Ending the HIV Epidemic efforts can be optimized to adapt and implement integrated HIV and behavioral health care to advance national goals.

High-income countries face the challenge of providing effective and efficient care to the relatively small proportion of their populations with high health and social care needs. Recent reports suggest that integrated health and social care programs target specific high-needs population segments, coordinate health and social care services to meet their clients' needs, and engage clients and their caregivers. We identified thirty health and social care programs in eleven high-income countries that delivered care in new ways. We used a structured survey to characterize the strategies and activities used by these programs to identify and recruit clients, coordinate care, and engage clients and caregivers. We found that there were some common features in the implementation of these innovations across the eleven countries and some variation related to local context or the clients served by these programs. Researchers could use this structured approach to better characterize the core components of innovative integrated care programs. Policy makers could use this approach to provide a common language for international policy exchange, and this structured characterization of successful programs could play an important role in spreading them and scaling them up.

OBJECTIVE: To educate health care professionals and nurses on buprenorphine initiations in pregnancy, establish a mutual care agreement to promote therapeutic partnership, and standardize buprenorphine initiation using the Epic electronic health record (EHR) order set. PROJECT SUMMARY: This project provides resources that can be adapted and implemented at other institutions to perform inpatient buprenorphine initiations for pregnant patients with opioid use disorder (OUD). The toolkit includes educational PowerPoint presentations, a mutual care agreement template, and a comprehensive order set. This project begins by addressing the gap in health care professional knowledge about medications for opioid use disorder (MOUD) in pregnancy. We supply educational resources in PowerPoint format. The presentations cover the role of buprenorphine in pregnancy, micro-dose initiation pharmacology, and the use of ancillary supportive medications to manage withdrawal symptoms. Clear expectations and goals help facilitate smooth integration of buprenorphine initiation into inpatient care. The toolkit includes a templated "Mutual Care Agreement" for patients and health care professionals to sign on admission. Lastly, this toolkit addresses the technical barrier of prescribing by providing an order set. The Epic EHR order set, which can be replicated or adapted for other systems, includes dosing and timing for buprenorphine micro-dosing initiation, supportive medications, and comprehensive care considerations. These considerations include treatments for co-occurring substance use, consultations with social workers and psychiatrists, infectious disease screening, and vaccinations. OUTCOME: Disseminating this program will improve pregnant patients' access to MOUD and empower clinicians to provide for patients with OUD. RELEVANCE TO WOMENS HEALTH AND PHYSICIANS IN PRACTICE: Due to the opioid epidemic, pregnancy-related overdose deaths have risen significantly and are becoming a leading cause of maternal mortality. Medications for opioid use disorder decrease mortality. Despite the American College of Obstetricians and Gynecologists' recommendation to treat OUD with MOUD during pregnancy, many health care professionals lack the education and tools to initiate MOUD for pregnant patients with active substance use.