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Martin CE, Martinez Telleria M, Hostetter K, Thumma L, Edwards C, Thakkar B. Expanding Medical Education to Include Substance Use Disorders During Pregnancy and Postpartum: Preliminary Effectiveness of a Pilot Curriculum for Medical Students. J Addict Med 2024; 18:191-193. [PMID: 38205928 PMCID: PMC10939943 DOI: 10.1097/adm.0000000000001262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
OBJECTIVE To effectively combat the simultaneous overdose and maternal mortality crises, a multimodal approach is needed. The aim of this study is to evaluate the preliminary effectiveness of a pilot, experiential learning, substance use disorder (SUD) curriculum embedded into a third-year medical student obstetrics and gynecology clerkship to improve self-reported confidence in SUD clinical skills. METHODS This SUD curriculum was designed and implemented in an outpatient clinic, which provides integrated obstetric, gynecologic, and addiction medicine services for pregnant and parenting people with SUD. Third-year medical students on their obstetrics and gynecology clerkship rotated 1 full day through the OB MOTIVATE clinic between August 2020 and April 2022 and completed this curriculum. Students completed preclinic assignments and in-clinic tasks (eg, practicing SBIRT under supervision: screening, brief intervention, referral to treatment). Paired t tests assessed changes in outcomes, with increasing scores (range 1-5) demonstrating improvement. RESULTS Sixty-three students rotated through the OB MOTIVATE clinic; 57 completed the curriculum and surveys. Results from the self-assessment tools demonstrated significant improvements in confidence in SUD clinical skills, including performing SBIRT (2.46 ± 0.80 vs 4.07 ± 0.59, P < 0.01), motivational interviewing (2.98 ± 0.86 vs 4.16 ± 0.65, P < 0.01), using evidence-based medicine (2.91 ± 1.09 vs 4.23 ± 0.66, P < 0.01), and collecting an SUD history (3.25 ± 1.04 vs 4.35 ± 0.55, P = 0.01). CONCLUSIONS The integration of interventional curriculums into medical school and residency programs could be an effective avenue to reinforce addiction knowledge and teach new skills. This practical 1-day pilot curriculum demonstrated preliminary effectiveness at introducing third-year medical students to the complexities of SUD in pregnancy and postpartum. Further investigations of feasible and acceptable SUD educational interventions are warranted.
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Affiliation(s)
- Caitlin E Martin
- From the Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, VA (CEM, MMT, LT, BT); School of Medicine, Virginia Commonwealth University, Richmond, VA (CEM, KH); Office of Assessment, Evaluation and Scholarship, Virginia Commonwealth University, Richmond, VA (CE); and Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA (CEM, LT)
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Ellick KL, Kroelinger CD, Chang K, McGown M, McReynolds M, Velonis AJ, Bronson E, Riehle-Colarusso T, Pliska E, Akbarali S, Mueller T, Dronamraju R, Cox S, Barfield WD. Increasing access to quality care for pregnant and postpartum people with opioid use disorder: Coordination of services, provider awareness and training, extended postpartum coverage, and perinatal quality collaboratives. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 156:209208. [PMID: 37939904 PMCID: PMC10711679 DOI: 10.1016/j.josat.2023.209208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 08/02/2023] [Accepted: 10/24/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION Fifteen states participating in the Opioid Use Disorder, Maternal Outcomes, and Neonatal Abstinence Syndrome Initiative Learning Community (OMNI LC) developed action plan goals and activities to address the rise in opioid use disorder (OUD) among birthing persons. In a separate initiative, Perinatal Quality Collaboratives (PQCs) from 12 states participating in Centers for Disease Control and Prevention (CDC)-supported activities hosted trainings to improve the provision of OUD services and implement protocols for screening and treatment in delivery facilities. METHODS This descriptive study synthesizes qualitative data extracted from 15 OMNI LC state action plans, excerpts from qualitative interviews conducted with OMNI LC state teams, and quantitative data from quarterly project performance monitoring reports from 12 CDC-funded PQCs implementing quality improvement activities to address clinical service gaps for pregnant and postpartum people with OUD. Qualitative data were deidentified, coded as barriers or facilitators, then aggregated into emergent themes. Count data are presented for quantitative results. RESULTS The OMNI LC states identified a lack of coordinated care among providers, stigma toward people with OUD, discontinued insurance coverage, and inconsistencies in screening and treating birthing people with OUD as barriers to accessing quality care. State-identified facilitators for access to quality care included: 1) improving engagement and communication between providers and other partners to integrate medical and behavioral health services post-discharge, and facilitate improved patient care postpartum; 2) training providers to prescribe medications for OUD, and to address bias and reduce patient stigma; 3) extending Medicaid coverage up to one year postpartum to increase access to and continuity of services; and 4) implementing screening, brief intervention, and referral to treatment (SBIRT) in clinical practice. PQCs demonstrated that increased provider trainings to treat OUD, improvements in implementation of standardized protocols, and use of evidence-based tools can facilitate access to and coordination of services in delivery facilities. CONCLUSION State-identified facilitators for increasing access to care include coordinating integrated services, extending postpartum coverage, and provider trainings to improve screening and treatment. PQCs provide a platform for identifying emerging areas for quality improvement initiatives and implementing clinical best practices to provide comprehensive, quality perinatal care for birthing populations.
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Affiliation(s)
- Kecia L Ellick
- CDC Foundation (CDCF), 600 Peachtree St. NE #1000, Atlanta, GA 30308, United States of America
| | - Charlan D Kroelinger
- Centers for Disease Control and Prevention (CDC), 4770 Buford Hwy NE, MS S107-2, Atlanta, GA 30341, United States of America.
| | - Karen Chang
- Centers for Disease Control and Prevention (CDC), 4770 Buford Hwy NE, MS S107-2, Atlanta, GA 30341, United States of America
| | - Molly McGown
- University of Illinois Chicago (UIC), School of Public Health, 1603 W. Taylor St., Chicago, IL 60612, United States of America; Access Community Health Network, 600 W. Fulton St., Chicago, IL 60661, United States of America
| | - Matthew McReynolds
- University of Illinois Chicago (UIC), School of Public Health, 1603 W. Taylor St., Chicago, IL 60612, United States of America
| | - Alisa J Velonis
- University of Illinois Chicago (UIC), School of Public Health, 1603 W. Taylor St., Chicago, IL 60612, United States of America
| | - Emily Bronson
- CDC Foundation (CDCF), 600 Peachtree St. NE #1000, Atlanta, GA 30308, United States of America
| | - Tiffany Riehle-Colarusso
- Centers for Disease Control and Prevention (CDC), 4770 Buford Hwy NE, MS S107-2, Atlanta, GA 30341, United States of America
| | - Ellen Pliska
- Association of State and Territorial Health Officials (ASTHO), 2231 Crystal Dr. Ste. 450, Arlington, VA 22202, United States of America
| | - Sanaa Akbarali
- Association of State and Territorial Health Officials (ASTHO), 2231 Crystal Dr. Ste. 450, Arlington, VA 22202, United States of America
| | - Trish Mueller
- Centers for Disease Control and Prevention (CDC), 4770 Buford Hwy NE, MS S107-2, Atlanta, GA 30341, United States of America
| | - Ramya Dronamraju
- Association of State and Territorial Health Officials (ASTHO), 2231 Crystal Dr. Ste. 450, Arlington, VA 22202, United States of America
| | - Shanna Cox
- Centers for Disease Control and Prevention (CDC), 4770 Buford Hwy NE, MS S107-2, Atlanta, GA 30341, United States of America
| | - Wanda D Barfield
- Centers for Disease Control and Prevention (CDC), 4770 Buford Hwy NE, MS S107-2, Atlanta, GA 30341, United States of America
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Braverman A, Lin T, Messmer S, Wollner K, Taylor R, Williams AA, Class QA. Survey of stigma across healthcare workers in an urban, academic medical center regarding perinatal patients using opioids. Am J Addict 2023; 32:510-514. [PMID: 37337748 DOI: 10.1111/ajad.13446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 04/01/2023] [Accepted: 06/05/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVES To examine healthcare workers' attitudes towards pregnant woman using opioids across provider type, specialty, and years of service. METHODS Cross-sectional, anonymous survey of healthcare workers at an urban, academic medical center regarding attitudes towards pregnant women using opioids. RESULTS One hundred and nineteen surveys were completed. Nurses were less likely to feel sympathetic towards pregnant women that use opioids (p = .016). DISCUSSION AND CONCLUSIONS Differences in attitudes towards pregnant women using opioids were found between clinicians and nurses. SCIENTIFIC SIGNIFICANCE Training and experience may contribute to attitude differences towards pregnant women using opioids.
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Affiliation(s)
- Alexis Braverman
- Department of Obstetrics and Gynecology, University of Illinois, Chicago, Illinois, USA
| | - Tiffany Lin
- Department of Occupational Therapy, Neuroscience Institute, Cleveland Clinic, London, UK
| | - Sarah Messmer
- Department of Academic Internal Medicine, University of Illinois, Chicago, Illinois, USA
| | - Kathy Wollner
- Department of Family and Community Medicine, University of Illinois, Chicago, Illinois, USA
| | - Renee Taylor
- Division of Occupational Therapy, College of Applied Health Sciences, University of Illinois, Chicago, Illinois, USA
| | - Adrienne A Williams
- Department of Family and Community Medicine, University of Illinois, Chicago, Illinois, USA
| | - Quetzal A Class
- Department of Obstetrics and Gynecology, University of Illinois, Chicago, Illinois, USA
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