Literature Collection

Background: Opioid dependence during pregnancy is associated with increased risk of low birthweight, neonatal mortality, and maternal complications. Methadone or buprenorphine maintenance therapy can prevent the effects of repeated withdrawals on the fetus and improve outcomes for infants and mothers. Method: This report uses the combined 2007 to 2012 National Surveys on Drug Use and Health (NSDUHs), the 2012 Treatment Episode Data Set (TEDS), and the 2012 National Survey of Substance Abuse Treatment Services (N-SSATS) to examine opioid misuse and treatment among women of childbearing age (aged 15 to 44). Results: An annual average of 21,000 pregnant women aged 15 to 44 misused opioids in the past month. Among pregnant women aged 15 to 44, those who were younger and those living below the federal poverty level were more likely than other pregnant women to be past month opioid misusers. Of the pregnant female treatment admissions, 22.9 percent reported heroin use and 28.1 percent reported nonheroin opioid misuse. About half of pregnant female admissions with heroin use had methadone or buprenorphine as a part of their treatment plan compared with less than one-quarter of nonpregnant female admissions with heroin use. For female admissions aged 15 to 44 reporting nonheroin opioid misuse, rates for having methadone or buprenorphine as a part of their treatment plan were comparatively lower. About 13 percent of outpatient-only substance use treatment facilities and residential treatment facilities offered a special program or group for pregnant/postpartum women. Between 61 and 79 percent of facilities that offered specialized programs or groups to pregnant or postpartum women accepted Medicaid as a form of payment. Conclusion: The findings suggest that outreach and educational resources targeting younger pregnant women and women living below the federal poverty level about the dangers of misusing prescription pain relievers may be especially beneficial. The health insurance gap among pregnant treatment admissions suggests that these women may need assistance in navigating the health insurance and health service opportunities provided by the Affordable Care Act to ensure critical access to the health care system.

BACKGROUND: Miscarriage is a traumatic event for women and their families. Australian healthcare is fragmented, with evidence that healthcare approaches may adversely impact women's care during a miscarriage. There is limited evidence that describes women's psychological needs to support post-miscarriage recovery. AIM: The aim of this review was to explore the reported psychological support needs of women receiving care after miscarriage in Australia, as understood through their experiences of health care provision. METHODS: Five databases (CINAHL, MEDLINE, Scopus, Web of Science, PubMed) were searched in January 2024 for key terms related to women's experiences of psychological follow-up post-miscarriage in Australia. The review followed the JBI framework and was reported in line with PRISMA-ScR. RESULTS: Of 101 articles retrieved, 28 duplicates were removed. Seventy-three were screened by title and abstract, 39 underwent full-text review, and 8 were included. Eight studies with data on 1,581 Australian women were analysed. Women frequently reported an absence of structured or routine psychological follow-up, despite reporting significant anguish, sadness, and grief post-miscarriage. The thematic synthesis identified 3 themes on psychological follow-up for post-miscarriage care: (1) the necessity for clear, accessible information about miscarriage; (2) the importance of emotionally sensitive care; and (3) the need for effective follow-up care. CONCLUSIONS: The absence of structured psychological follow-up care after miscarriage often leaves women unsupported in their grief. Further research is needed to address women's needs within an integrated care model for psychological care.

BACKGROUND AND OBJECTIVES: The purpose of the study was to use a best practice quality improvement process to identify and eliminate barriers to Screening, Brief Intervention, and Referral to Treatment (SBIRT) integration in a Federally Qualified Health Center. SBIRT provides an initial method for addressing mental health and substance abuse concerns of patients. The method is very useful in integration of behavioral health screening in primary care. METHODS: A Process Improvement Team used 4 Plan-Do-Study-Act cycles during a 10-week time frame to (1) reduce the reported frequency of barriers to the SBIRT process, (2) reduce non-value-added activities in the SBIRT workflow, (3) reduce bottlenecks, and (4) increase patient receipt of SBIRT. A modified Referral Barriers Questionnaire, a swim lane diagram, non-value-added versus value-added analysis, and a Shewhart control chart (P-chart) were used to evaluate process and outcome measures. RESULTS: Nurses reported a 23.82% reduction in referral barrier frequency and a 21.12% increase in the helpfulness of SBIRT. Providers reported a 7.60% reduction in referral barrier frequency and a decrease in the helpfulness of SBIRT. The P-chart indicated that the process changes resulted in a positive shift in behaviors and an increase in patient receipt of SBIRT. CONCLUSION: The use of a best practice quality improvement process resulted in improvements in workflow related to SBIRT, greater communication about SBIRT, and identification of barriers that blocked successful receipt of SBIRT.

BACKGROUND: While the overdose crisis has impacted all ages, overdose-related deaths among adolescents have been increasing more rapidly than any other age group, doubling between 2019 and 2020. Identifying and treating substance use disorders (SUDs) among adolescents is critical to preventing adolescent overdose deaths. While evidence-based interventions for adolescents with SUDs exist, they remain underutilized. Implementing SUD interventions in primary care settings through integrated behavioral health (IBH) is one approach for increasing access to evidence-based SUD services for adolescents. METHODS: This is a Hybrid Type 2, cluster-randomized, stepped-wedge trial comparing SUD IBH to standard primary care treatment. In our open cohort stepped-wedge design, primary care clinics will be randomly designated to one of three cohorts. We will use a mixed-methods approach to evaluate both implementation and effectiveness outcomes, with a focus on assessing the impact of IBH on primary care provider behaviors around SUD interventions. All cohorts will complete baseline surveys during the control condition and then every 6 months. At each time point, we will also collect and analyze patient administrative data to assess patient engagement and outcomes. In addition, we will conduct qualitative interviews at pre-, mid-, and post-implementation during sustainment of the intervention. CONCLUSION: Addressing the overdose crisis is a national priority. IBH has the potential to reduce overdose rates by enhancing primary care provider willingness to deliver SUD services for adolescents.