Literature Collection

Background: Postpartum is a highly vulnerable time for women with opioid use disorder (OUD). Our primary objective was to identify patient and provider reported aspects of the pregnancy to postpartum transition that impact recovery progress for postpartum women receiving medication for opioid use disorder (MOUD). Methods: This qualitative study consisted of semi-structured interviews with postpartum women in OUD treatment (n = 12) and providers (n = 9) at an outpatient addiction clinic. Interviews were transcribed and analyzed using an editing style approach to report themes and quotes. Results: Patients and providers identified different themes that both promote and challenge recovery during the postpartum transition. These comprised of clinical factors, including MOUD, neonatal opioid withdrawal syndrome (NOWS) and pain associated with labor and delivery as well as psychosocial factors, such as role of a support system, mental health aspects of anxiety and depression causing mood changes, stigma and mistrust among healthcare providers and child welfare. Conclusions: Patients receiving MOUD and their providers identified multiple aspects unique to the postpartum transition that substantially strengthen and/or oppose OUD recovery. These aspects impacting recovery include factors specific to the receipt of MOUD treatment and those not specific to MOUD, yet tied to the postpartum state. Overall, these findings provide insight into areas for future research focused on identifying opportunities to promote recovery-oriented care for families affected by OUD.

OBJECTIVE:  This study aimed to describe opioid prescribing patterns for pregnant patients with a history of or active opioid use to inform postpartum pain management strategies. STUDY DESIGN:  We conducted a retrospective cohort analysis of all patients with a history of opioid use disorder (OUD) or chronic pain seen at a single outpatient clinic specializing in opioid use and OUD in pregnancy from January 2019 to August 2021. Patient characteristics, delivery outcomes, and opioid prescribing information were collected through electronic health record fields. We used descriptive statistics to characterize differences in receipt of an opioid prescription, prescription size, and receipt of a prescription refill across three patient groups: patients with OUD on medication, patients with OUD maintaining abstinence, and patients with chronic pain using opioids. In the study period, the institutional average rate of opioid prescribing after cesarean and vaginal birth were 80.0 and 2.8%, respectively. RESULTS:  Of the 69 patients included in this study, 46 (66.7%) had a history of OUD on medication, 14 (20.3%) had a history of OUD maintaining abstinence, and 9 (13.0%) had a history of chronic pain. Receipt of an opioid prescription after childbirth was more common after cesarean birth (12/23, 52.2%) than vaginal birth (3/46, 6.5%). Refills were common in patients who received an opioid proscription (cesarean: 5/12, 41.7%; vaginal: 1/3, 33.3%). CONCLUSION:  Compared with institutional averages, postpartum opioid prescribing rates for people with a history of OUD or chronic pain were 50 to 60% lower for cesarean birth and three times higher for vaginal birth. Future work is needed to balance opioid stewardship and harm reduction with adequate pain control in these high-risk populations. KEY POINTS: · Opioid prescribing rates for patients with OUD/chronic pain were 60% lower for cesarean birth than institutional averages.. · Opioid prescribing rates for patients with OUD/chronic pain were three times higher for vaginal birth than institutional averages.. · Refill rates following birth were high overall for cesarean (40%) and vaginal (33%) birth.. · More work is needed to balance opioid prescribing with adequate pain control in high-risk patients..

Background: The United States is experiencing a maternal health crisis that continues to worsen in the face of racial/ethnic disparities, rising chronic disease burden among birthing patients, and policy barriers to health care access. Longitudinal postpartum primary care is critical to mitigating these trends, but current rates of use are low, and evidence-based interventions are limited. This scoping review aims to understand the current literature and components of the Chronic Care Model (CCM) used in postpartum primary care and its impact on maternal health outcomes. Methods: We identified 74 studies published between 2000 and 2023 through comprehensive searches of four databases. Extracted data was synthesized for their impact on maternal health, including equity considerations and the primary CCM element. Results: The studies were collated based on their primary maternal health priority (general health n = 13, depression and anxiety n = 34, diabetes n = 3, hypertension n = 5, adolescent parents n = 6, and substance use disorder n = 13). The most common CCM elements were Delivery System Design and Self-Management Support. The least common CCM element was Clinical Information Systems, with electronic health record challenges noted as a barrier. We identified successful interventions that increased depression screening, postpartum hypertension follow-up via telehealth, and integrated contraceptive education within shared parent-child medical homes for adolescent parents. Interventions were largely feasible and acceptable for both patients and clinicians. Conclusions: This review highlights several potential strategies to improve and scale longitudinal postpartum primary care. Further work is needed to ensure equitable delivery, improved connection with community resources, and to expand informatics in postpartum care.

BACKGROUND AND OBJECTIVES: Factors associated with physician practice choice include residency location, training experiences, and financial incentives. How length of training affects practice setting and clinical care features postgraduation is unknown. METHODS: In this Length of Training Pilot (LoTP) study, we surveyed 366 graduates of 3-year (3YR) and 434 graduates of 4-year (4YR) programs 1 year after completion of training between 2013 and 2021. Variables assessed included reasons for practice setting choice, practice type, location, practice and community size, specialty mix, and clinical care delivery features (eg, integrated behavioral health, risk stratified care management). We compared different length of training models using χ2 or Fisher's exact tests for categorical variables and independent samples, and t test (unequal variances) for continuous variables. RESULTS: Response rates ranged from 50% to 88% for 3YR graduates and 68% to 95% for 4YR graduates. Scope of practice was a predominant reason for graduates choosing their eventual practice, and salary was a less likely reason for those completing 4 years versus 3 years of training (scope, 72% vs 55%, P=.001; salary, 15% vs 22%, P=.028). Community size, practice size, practice type, specialty mix, and practice in a federally designated underserved site did not differ between the two groups. We found no differences in patient-centered medical home features when comparing the practices of 3YR to 4YR graduates. CONCLUSIONS: Training length did not affect practice setting or practice features for graduates of LoTP programs. Future LoTP analyses will examine how length of training affects scope of practice and clinical preparedness, which may elucidate other elements associated with practice choice.