Literature Collection

The COVID-19 pandemic has directly impacted integrated substance use and prenatal care delivery in the United States and has driven a rapid transformation from in-person prenatal care to a hybrid telemedicine care model. Additionally, changes in regulations for take home dosing for methadone treatment for opioid use disorder due to COVID-19 have impacted pregnant and postpartum women. We review the literature on prenatal care models and discuss our experience with integrated substance use and prenatal care delivery during COVID-19 at New England's largest safety net hospital and national leader in substance use care. In our patient-centered medical home for pregnant and postpartum patients with substance use disorder, patients' early responses to these changes have been overwhelmingly positive. Should clinicians continue to use these models, thoughtful planning and further research will be necessary to ensure equitable access to the benefits of telemedicine and take home dosing for all pregnant and postpartum patients with substance use disorder.

Mental Health: [Formula: see text] GIM/FP/GP: [Formula: see text] Public Health: [Formula: see text].

BACKGROUND: Integrated treatment programs for pregnant and parenting people seek to provide wrap-around services and supports to overcome the barriers and constraints associated with the gendered contexts of substance use and help-seeking. We investigated retention in outpatient treatment among pregnant people and mothers, comparing integrated treatment programs with standard treatment programs in Ontario, Canada. METHODS: We conducted a population-based retrospective cohort study of females (n = 4440) admitted to 11 integrated treatment programs (cases) and 10 standard treatment programs (controls) between 2008 and 2015. Data sources included linked administrative health data merged with primary data on program characteristics. Exposure was program type and outcomes included days in treatment and number of visits. Multi-level negative binomial regression estimated the effects of program type on retention measures, controlling for individual- and program-level covariates. RESULTS: Relative to standard treatment, integrated treatment programs offered more services in-house or through partnerships, with specific advantages around the availability of prenatal or primary care and child-minding. Controlling for individual- and program-level covariates, individuals in integrated treatment programs spent more days in treatment (adjusted incidence rate ratio [aIRR] = 5.41, 95 % CI 4.10-7.13) and had more visits (aIRR = 5.18, 95 % CI 4.305-6.23) than did controls in standard treatment programs. CONCLUSIONS: This study contributes to a growing body of evidence on the implementation and effectiveness of wrap-around comprehensive service models, or integrated treatment programs, designed for pregnant and parenting people who use substances. Integrated treatment models constitute a promising approach to supporting families affected by substance use.

OBJECTIVES: The multidisciplinary team approach improves adverse drug reaction (ADR) reporting and management. Our study aims to integrate a pharmacovigilance (PV) and Response Team within the general medicine department to improve ADR reporting and management. MATERIALS AND METHODS: We conducted a prospective cross-sectional study for seven months in four general medicine wards. We proposed a PV and response unit team (PRUT), comprising a nursing student, and a Doctor of Pharmacy (intern). After the team received interventional educational training, we integrated them with the physician and head nurse of each general medicine inpatient ward. We then evaluated the effectiveness of the team in ADR reporting and management using a feedback survey. RESULTS: In this study, comorbidities (30.69%) and polypharmacy (≥5 drugs) (26.25%) were major predisposing factors. Among drug-related problems in 125 patients, inappropriate drug use (28.80%) and unclear dose timing (21.60%) were predominant. Gastrointestinal disorders were common (44.73%), with dose adjustment being the top management strategy (36.84%). Over 71% supported the PRUT for improving patient safety and reducing medication errors, noting high effectiveness in consultation (85.92%) and in reducing the ADR reporting burden (87.32%). There is a statistically significant association between the level of agreement on the effectiveness of PRUT among healthcare professionals (p<0.01). Most healthcare professionals agreed on PRUT's effectiveness without any reports of low agreement levels. CONCLUSION: The PRUT effectively reported and managed ADRs. A multidisciplinary approach improves ADR reporting and management.