1
|
Panagiotakopoulos L, Miele K, Cartwright EJ, Kamili S, Furukawa N, Woodworth K, Tong VT, Kim SY, Wester C, Sandul AL. CDC's New Hepatitis C Virus Testing Recommendations for Perinatally Exposed Infants and Children: A Step Towards Hepatitis C Elimination. J Womens Health (Larchmt) 2024. [PMID: 38476092 DOI: 10.1089/jwh.2023.1114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Abstract
New U.S. Centers for Disease Control and Prevention (CDC) guidelines for hepatitis C virus (HCV) testing of perinatally exposed infants and children released in 2023 recommend a nucleic acid test (NAT) for detection of HCV ribonucleic acid (i.e., NAT for HCV RNA) at 2-6 months of age to facilitate early identification and linkage to care for children with perinatally acquired HCV infection. Untreated hepatitis C can lead to cirrhosis, liver cancer, and premature death and is caused by HCV, a blood-borne virus transmitted most often among adults through injection drug use in the United States. Perinatal exposure from a birth parent with HCV infection is the most frequent mode of HCV transmission among infants and children. New HCV infections have been increasing since 2010, with the highest rates of infection among people aged 20-39 years, leading to an increasing prevalence of HCV infection during pregnancy. In 2020, the CDC recommended one-time HCV screening for all adults aged 18 years and older and for all pregnant persons during each pregnancy. Detecting HCV infection during pregnancy is key for the identification of pregnant persons, linkage to care for postpartum treatment, and identification of infants with perinatal exposure for HCV testing. It was previously recommended that children who were exposed to HCV during pregnancy receive an antibody to HCV (anti-HCV) test at 18 months of age; however, most children were lost to follow-up before testing occurred, leaving children with perinatal infection undiagnosed. The new strategy of testing perinatally exposed children at age 2-6 months was found to be cost-effective in increasing the identification of infants who might develop chronic hepatitis C. This report describes the current perinatal HCV testing recommendations and how they advance national hepatitis C elimination efforts by improving the health of pregnant and postpartum people and their children.
Collapse
Affiliation(s)
| | - Kathryn Miele
- Division of Birth Defects and Infant Disorders, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Emily J Cartwright
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Saleem Kamili
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nathan Furukawa
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kate Woodworth
- Division of Birth Defects and Infant Disorders, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Van T Tong
- Division of Birth Defects and Infant Disorders, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shin Y Kim
- Division of Birth Defects and Infant Disorders, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Carolyn Wester
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amy L Sandul
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
2
|
Chaiyachati BH, Deutsch SA. Improving health and well-being for infants with prenatal substance exposure. Curr Probl Pediatr Adolesc Health Care 2024; 54:101572. [PMID: 38431453 PMCID: PMC11025014 DOI: 10.1016/j.cppeds.2024.101572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Substance use disorders (SUD) among caregiving adults has inexorable linkage to the health and well-being of millions of children in the U.S. This piece provides an overview of such linkages, examples of relevant policies and regulations, and the role of pediatric healthcare within the health trajectories of children and families at this intersection. A commonality throughout this work is need for non-stigmatizing engagement and support to facilitate connections to care and reduce barriers.
Collapse
Affiliation(s)
- Barbara H Chaiyachati
- Department of Pediatrics, Perelman School of Medicine, and Leonard Davis Institute, University of Pennsylvania, Philadelphia, PA, USA; Division of General Pediatrics, Clinical Futures & Policy Lab, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Stephanie A Deutsch
- Department of Pediatrics, Nemours Children's Hospital, Delaware, Wilmington, DE, USA; Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| |
Collapse
|
3
|
Mascarenhas M, Wachman EM, Chandra I, Xue R, Sarathy L, Schiff DM. Advances in the Care of Infants With Prenatal Opioid Exposure and Neonatal Opioid Withdrawal Syndrome. Pediatrics 2024; 153:e2023062871. [PMID: 38178779 PMCID: PMC10827648 DOI: 10.1542/peds.2023-062871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 01/06/2024] Open
Abstract
A significant number of advances have been made in the last 5 years with respect to the identification, diagnosis, assessment, and management of infants with prenatal opioid exposure and neonatal opioid withdrawal syndrome (NOWS) from birth to early childhood. The primary objective of this review is to summarize major advances that will inform the clinical management of opioid-exposed newborns and provide an overview of NOWS care to promote the implementation of best practices. First, advances with respect to standardizing the clinical diagnosis of NOWS will be reviewed. Second, the most commonly used assessment strategies are discussed, with a focus on presenting new quality improvement and clinical trial data surrounding the use of the new function-based assessment Eat, Sleep, and Console approach. Third, both nonpharmacologic and pharmacologic treatment modalities are reviewed, highlighting clinical trials that have compared the use of higher calorie and low lactose formula, vibrating crib mattresses, morphine compared with methadone, buprenorphine compared with morphine or methadone, the use of ondansetron as a medication to prevent the need for NOWS opioid pharmacologic treatment, and the introduction of symptom-triggered dosing compared with scheduled dosing. Fourth, maternal, infant, environmental, and genetic factors that have been found to be associated with NOWS severity are highlighted. Finally, emerging recommendations on postdelivery hospitalization follow-up and developmental surveillance are presented, along with highlighting ongoing and needed areas of research to promote infant and family well-being for families impacted by opioid use.
Collapse
Affiliation(s)
| | - Elisha M. Wachman
- Department of Pediatrics, Boston Medical Center, and Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Iyra Chandra
- Dana Farber Cancer Institute, Boston, Massachusetts
| | - Rachel Xue
- Department of Family Medicine, Boston Medical Center, Boston, Massachusetts
| | - Leela Sarathy
- Newborn Medicine, MassGeneral for Children, Boston, Massachusetts
| | | |
Collapse
|
4
|
Schiff DM, Muftu S, MacMillan KDL, Work EC, Hoeppner BB, Greenfield SF, Schwartz L, Chaiyachati B, Wilens TE, Bernstein JA. Mutual Mistrust: The Multilayered Experiences at the Intersection of Healthcare and Early Parenting Among Mothers With Opioid Use Disorder. J Addict Med 2024; 18:55-61. [PMID: 37994464 PMCID: PMC10872799 DOI: 10.1097/adm.0000000000001242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
OBJECTIVE The aim of the study is to explore the early parenting experiences among a cohort of postpartum individuals with opioid use disorder (OUD) both during and after the delivery hospitalization to identify areas of intervention to strengthen bonding and attachment. METHODS Semistructured qualitative interviews with recently pregnant people with OUD assessed parenting needs, supports, and goals in the context of the demands of addiction treatment and early motherhood. Probes explored the relationship between early parenting experiences, addiction, and recovery, as well as enabling factors and barriers to mother-infant bonding. Interviews were completed between 2019 to 2020. A constant comparative methods approach was used for codebook development and analysis. RESULTS Twenty-six women completed interviews a mean of 10.1 months postpartum. Twenty-four women were receiving methadone or buprenorphine treatment at delivery for OUD. Four interrelated themes emerged. Women experienced the following: (1) increased surveillance from healthcare workers who doubted their parenting ability; (2) a desire for a "normal" early parenting experience that was not disrupted by increased medical monitoring and surveillance; (3) complex and intersecting identities of being both a mother and a person in recovery; and (4) the importance of support from and advocacy by clinicians and peers to developing maternal confidence and connection. CONCLUSIONS Interventions are needed to improve the early parenting experiences of opioid-exposed mother-infant dyads, to address the mutual mistrust between health care providers and parents, and to provide additional supports to families. Promotion of positive attachment and parental self-efficacy should be prioritized over increased surveillance and scrutiny to sustain maternal recovery trajectories into early childhood and foster family well-being.
Collapse
Affiliation(s)
- Davida M. Schiff
- Division of General Academic Pediatrics, MassGeneral Hospital for Children, 125 Nashua St Suite 860, Boston, Massachusetts, 02114
| | - Serra Muftu
- Division of General Academic Pediatrics, MassGeneral Hospital for Children, 125 Nashua St Suite 860, Boston, Massachusetts, 02114
| | | | - Erin C. Work
- Division of General Academic Pediatrics, MassGeneral Hospital for Children, 125 Nashua St Suite 860, Boston, Massachusetts, 02114
| | - Bettina B. Hoeppner
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit St, Boston, Massachusetts, 02114
| | - Shelly F. Greenfield
- Division of Women’s Mental Health and Division of Alcohol, Drugs, and Addiction, McLean Hospital, 115 Mill St, Belmont, MA 02478
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115
| | - Leah Schwartz
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115
| | - Barbara Chaiyachati
- Department of Pediatrics, Perelman School of Medicine, and Leonard Davis Institute, University of Pennsylvania
- Division of General Pediatrics, PolicyLab and Clinical Futures, Children’s Hospital of Philadelphia
| | - Timothy E. Wilens
- Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, 55 Fruit St, Boston, Massachusetts, 02114
| | - Judith A. Bernstein
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA
| |
Collapse
|
5
|
Goyal N, Gannon M, Sood E, Harris G, Franko E, Abatemarco DJ, Hand DJ, Leib S, Short VL. Group Well Child Care for Mothers with Opioid Use Disorder: Framework for Implementation. Matern Child Health J 2023; 27:75-86. [PMID: 37515747 PMCID: PMC10692244 DOI: 10.1007/s10995-023-03762-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2023] [Indexed: 07/31/2023]
Abstract
OBJECTIVE For parents with opioid use disorder (OUD) and their children, group well child care (WCC) is an under-studied intervention that may reduce stigma, increase quality of care, and improve clinical outcomes. We explored barriers and facilitators to this intervention using an implementation science framework. METHODS A qualitative study was conducted from October 2020-March 2021 as part of the planning phase of a cluster-randomized trial of group WCC. Parent participants were recruited from one urban, university-affiliated OUD treatment center to participate in semi-structured telephone interviews. Eligible parents had a child under two years old and were English speaking. Clinician participants were recruited from a nearby pediatric primary care practice. Inductive thematic analysis of interview responses was led by two investigators using open coding procedures. RESULTS Thirty-one parents and thirteen pediatric clinicians participated in the interviews. Most parents (68%) reported that they would be likely or very likely to bring their child to the OUD treatment center for WCC. Six themes emerged describing perceived implementation barriers, including intervention difficulty, complexity, and potential negative outcomes such as loss of privacy. Six themes emerged as implementation facilitators: (1) focus on parental OUD and recovery, (2) peer support, (3) accessibility and coordination of care, (4) clinician skill and expertise in parental OUD, (5) increased time for patient care, and (6) continuity of care. CONCLUSIONS FOR PRACTICE Parents and clinicians expressed multiple perceived benefits of this intervention. Identified barriers and facilitators will inform implementation and evaluation of group WCC within one OUD treatment program.
Collapse
Affiliation(s)
- Neera Goyal
- Nemours Children's Health, Wilmington, DE, USA.
- Sidney Kimmel Medical College of Medicine, Thomas Jefferson University, Philadelphia, PA, USA.
- Nemours Children's Health Philadelphia, 833 Chestnut St, Ste. 300, Philadelphia, PA, 19107, USA.
| | - Meghan Gannon
- Sidney Kimmel Medical College of Nursing, Philadelphia, PA, USA
| | - Erica Sood
- Nemours Children's Health, Wilmington, DE, USA
- Sidney Kimmel Medical College of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Grace Harris
- Sidney Kimmel Medical College of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Elizabeth Franko
- Sidney Kimmel Medical College of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Dennis J Hand
- Sidney Kimmel Medical College of Nursing, Philadelphia, PA, USA
| | - Susan Leib
- Department of Pediatric and Adolescent Medicine, Einstein Medical Center Philadelphia, Philadelphia, PA, USA
| | - Vanessa L Short
- Sidney Kimmel Medical College of Nursing, Philadelphia, PA, USA
| |
Collapse
|
6
|
Panagiotakopoulos L, Sandul AL, Conners EE, Foster MA, Nelson NP, Wester C. CDC Recommendations for Hepatitis C Testing Among Perinatally Exposed Infants and Children - United States, 2023. MMWR Recomm Rep 2023; 72:1-21. [PMID: 37906518 PMCID: PMC10683764 DOI: 10.15585/mmwr.rr7204a1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023] Open
Abstract
The elimination of hepatitis C is a national priority (https://www.hhs.gov/sites/default/files/Viral-Hepatitis-National-Strategic-Plan-2021-2025.pdf). During 2010-2021, hepatitis C virus (HCV) acute and chronic infections (hereinafter referred to as HCV infections) increased in the United States, consequences of which include cirrhosis, liver cancer, and death. Rates of acute infections more than tripled among reproductive-aged persons during this time (from 0.8 to 2.5 per 100,000 population among persons aged 20-29 years and from 0.6 to 3.5 among persons aged 30-39 years). Because acute HCV infection can lead to chronic infection, this has resulted in increasing rates of HCV infections during pregnancy. Approximately 6%-7% of perinatally exposed (i.e., exposed during pregnancy or delivery) infants and children will acquire HCV infection. Curative direct-acting antiviral therapy is approved by the Food and Drug Administration for persons aged ≥3 years. However, many perinatally infected children are not tested or linked to care. In 2020, because of continued increases in HCV infections in the United States, CDC released universal screening recommendations for adults, which included recommendations for screening for pregnant persons during each pregnancy (Schillie S, Wester C, Osborne M, Wesolowski L, Ryerson AB. CDC recommendations for hepatitis C screening among adults-United States, 2020. MMWR Recomm Rep 2020;69[No. RR-2]:1-17). This report introduces four new CDC recommendations: 1) HCV testing of all perinatally exposed infants with a nucleic acid test (NAT) for detection of HCV RNA at age 2-6 months; 2) consultation with a health care provider with expertise in pediatric hepatitis C management for all infants and children with detectable HCV RNA; 3) perinatally exposed infants and children with an undetectable HCV RNA result at or after age 2 months do not require further follow-up unless clinically warranted; and 4) a NAT for HCV RNA is recommended for perinatally exposed infants and children aged 7-17 months who previously have not been tested, and a hepatitis C virus antibody (anti-HCV) test followed by a reflex NAT for HCV RNA (when anti-HCV is reactive) is recommended for perinatally exposed children aged ≥18 months who previously have not been tested. Proper identification of perinatally infected children, referral to care, and curative treatment are critical to achieving the goal of hepatitis C elimination.
Collapse
Affiliation(s)
| | - Amy L Sandul
- Division
of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB
prevention, CDC; Division of Global Health Protection, Center for Global
Health, CDC
| | - DHSc1
- Division
of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB
prevention, CDC; Division of Global Health Protection, Center for Global
Health, CDC
| | | | | | | | | | - Collaborators
- Division
of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB
prevention, CDC; Division of Global Health Protection, Center for Global
Health, CDC
| |
Collapse
|
7
|
Camden A, To T, Gomes T, Ray J, Bai L, Guttmann A. Prenatal opioid exposure and well-child care in the first 2 years of life: population-based cohort study. Arch Dis Child 2023; 108:754-761. [PMID: 37308290 PMCID: PMC10447387 DOI: 10.1136/archdischild-2022-325029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 05/26/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To quantify well-child visits by age 2 years and developmental screening at the 18-month enhanced well-child visit among children with prenatal opioid exposure (POE) and to identify factors associated with study outcomes. DESIGN Population-based cohort study. SETTING Ontario, Canada. PARTICIPANTS 22 276 children with POE born 2014-2018 were classified as (1) 1-29 days of prescribed opioid analgesia, (2) 30+ days of prescribed opioid analgesia, (3) medication for opioid use disorder (MOUD), (4) MOUD and opioid analgesia, or (5) unregulated opioids. MAIN OUTCOME MEASURES Attending ≥5 well-child visits by age 2 years and the 18-month enhanced well-child visit. Modified Poisson regression was used to examine factors associated with outcomes. RESULTS Children with POE to 1-29 days of analgesics were most likely to attend ≥5 well-child visits (61.2%). Compared with these children, adjusted relative risks (aRRs) for ≥5 well-child visits were lower among those exposed to 30+ days of opioid analgesics (0.95, 95% CI 0.91 to 0.99), MOUD (0.83, 95% CI 0.79 to 0.88), MOUD and opioid analgesics (0.78 95% CI 0.68 to 0.90) and unregulated opioids (0.89, 95% CI 0.83 to 0.95). Relative to children with POE to 1-29 days of analgesics (58.5%), respective aRRs for the 18-month enhanced well-child visit were 0.92 (95% CI 0.88 to 0.96), 0.76 (95% CI 0.72 to 0.81), 0.76 (95% CI 0.66 to 0.87) and 0.82 (95% CI 0.76 to 0.88). Having a regular primary care provider was positively associated with study outcomes; socioeconomic disadvantage, rurality and maternal mental health were negatively associated. CONCLUSION Well-child visits are low in children following POE, especially among offspring of mothers receiving MOUD or unregulated opioids. Strategies to improve attendance will be important for child outcomes.
Collapse
Affiliation(s)
- Andi Camden
- Dalla Lana School of Public Health, Division of Epidemiology, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Teresa To
- Dalla Lana School of Public Health, Division of Epidemiology, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tara Gomes
- ICES, Toronto, Ontario, Canada
- Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, and Edwin SH Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
| | - Joel Ray
- ICES, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Li Bai
- ICES, Toronto, Ontario, Canada
| | - Astrid Guttmann
- Dalla Lana School of Public Health, Division of Epidemiology, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Obstetrics and Gynaecology, St. Michaels Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
8
|
Ettinger de Cuba S, Miller DP, Raifman J, Cutts DB, Bovell-Ammon A, Frank DA, Jones DK. Reduced health care utilization among young children of immigrants after Donald Trump's election and proposed public charge rule. Health Aff Sch 2023; 1:qxad023. [PMID: 38756243 PMCID: PMC10986243 DOI: 10.1093/haschl/qxad023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 05/31/2023] [Accepted: 06/10/2023] [Indexed: 05/18/2024]
Abstract
Widespread fear among immigrants from hostile 2016 presidential campaign rhetoric decreased social and health care service enrollment (chilling effect). Health care utilization effects among immigrant families with young children are unknown. We examined whether former President Trump's election had chilling effects on well-child visit (WCV) schedule adherence, hospitalizations, and emergency department (ED) visits among children of immigrant vs US-born mothers in 3 US cities. Cross-sectional surveys of children <4 years receiving care in hospitals were linked to 2015-2018 electronic health records. We applied difference-in-difference analysis with a 12-month pre/post-election study period. Trump's election was associated with a 5-percentage-point decrease (-0.05; 95% CI: -0.08, -0.02) in WCV adherence for children of immigrant vs US-born mothers with no difference in hospitalizations or ED visits. Secondary analyses extending the treatment period to a leaked draft of proposed changes to public charge rules also showed significantly decreased WCV adherence among children of immigrant vs US-born mothers. Findings indicate likely missed opportunities for American Academy of Pediatrics-recommended early childhood vaccinations, health and developmental screenings, and family support. Policies and rhetoric promoting immigrant inclusion create a more just and equitable society for all US children.
Collapse
Affiliation(s)
- Stephanie Ettinger de Cuba
- Health Law, Policy & Management, Boston University School of Public Health and Boston University Chobanian and Avedisian School of Medicine, Boston, MA 02118, United States
| | - Daniel P Miller
- Human Behavior, Research, and Policy, Boston University School of Social Work, Boston, MA, United States
| | - Julia Raifman
- Health Law, Policy & Management, Boston University School of Public Health, Boston, MA 02118, United States
| | - Diana B Cutts
- Pediatrics, Hennepin Healthcare and University of Minnesota School of Medicine, MN, United States
| | - Allison Bovell-Ammon
- Pediatrics, Boston Medical Center and Boston University Chobanian and Avedisian School of Medicine, Boston, MA, United States
| | - Deborah A Frank
- Pediatrics, Boston Medical Center and Boston University Chobanian and Avedisian School of Medicine, Boston, MA, United States
| | - David K Jones
- Health Law, Policy & Management, Boston University School of Public Health, Boston, MA 02118, United States
| |
Collapse
|
9
|
Short VL, Abatemarco DJ, Sood E, Hand DJ, Gannon M, Hossain J, Goyal NK. The Child Healthcare at MATER Pediatric Study (CHAMPS): a 2-arm cluster randomized control trial of group well child care for mothers in treatment for opioid use disorder and their children. Trials 2023; 24:333. [PMID: 37194074 PMCID: PMC10189945 DOI: 10.1186/s13063-023-07357-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 05/05/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Studies suggest that group-based well child care-a shared medical appointment where families come together as a group to receive pediatric primary care-increases patient-reported satisfaction and adherence to recommended care. Evidence supporting the use of group well child care for mothers with opioid use disorder, however, is lacking. The overall objective of the Child Healthcare at MATER Pediatric Study (CHAMPS) trial is to evaluate a group model of well child care for mothers with opioid use disorder and their children. METHODS CHAMPS is a single-site 2-arm cluster randomized controlled trial. A total of 108 mother-child dyads will be enrolled into the study. Twenty-six clusters of approximately 4 mother-infant dyads each will be randomized 1:1 to one of two study arms (intervention or control). Clustering will be based on child's month of birth. In the intervention arm, group well child care will be provided on-site at a maternal substance use disorder treatment program. Mother-child dyads in the control arm will receive individual well child care from one nearby pediatric primary care clinic. Dyads in both study arms will be followed prospectively for 18 months, and data will be compared between the two study arms. Primary outcomes include well child care quality and utilization, child health knowledge, and parenting quality. DISCUSSION The CHAMPS trial will provide evidence to determine if a group well child care offered on-site at an opioid treatment program for pregnant and parenting women is beneficial over individual well child care for families impacted by maternal opioid use disorder. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT05488379. Registered on Aug. 04, 2022.
Collapse
Affiliation(s)
- Vanessa L. Short
- Thomas Jefferson University, 1233 Locust Street Suite 401, Philadelphia, PA USA
| | - Diane J. Abatemarco
- Thomas Jefferson University, 1233 Locust Street Suite 401, Philadelphia, PA USA
| | - Erica Sood
- Nemours Children’s Health, 1600 Rockland Rd, Wilmington, DE USA
| | - Dennis J. Hand
- Thomas Jefferson University, 1233 Locust Street Suite 401, Philadelphia, PA USA
| | - Meghan Gannon
- Thomas Jefferson University, 1233 Locust Street Suite 401, Philadelphia, PA USA
| | - Jobayer Hossain
- Nemours Children’s Health, 1600 Rockland Rd, Wilmington, DE USA
| | - Neera K. Goyal
- Nemours Children’s Health, 1600 Rockland Rd, Wilmington, DE USA
- Department of Pediatrics, Thomas Jefferson University, 833 Chestnut Street, Philadelphia, PA USA
| |
Collapse
|
10
|
Short VL, Gannon M, Sood E, Harris G, Kale A, Abatemarco DJ, Hand DJ, Goyal N. Opportunities to Increase Well-Child Care Engagement for Families Affected by Maternal Opioid Use Disorder: Perceptions of Mothers and Clinicians. Acad Pediatr 2023; 23:425-433. [PMID: 35878748 PMCID: PMC9867779 DOI: 10.1016/j.acap.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 07/15/2022] [Accepted: 07/16/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Previous research suggests gaps in well-child care (WCC) adherence, quality, and effectiveness for children impacted by parental opioid use disorder (OUD). The objective of this study was to gather in-depth information regarding maternal and clinician-reported factors that enhance ("facilitators") or hinder ("barriers") WCC engagement as well as mothers' experiences during WCC visits. METHODS Thirty mothers who were in treatment for OUD and 13 clinicians working at a pediatric primary care clinic participated in this qualitative study. All participants completed one data collection telephone session which involved a brief questionnaire followed by a semi-structured interview. Thematic analyses of the interview transcripts were conducted using an inductive approach. RESULTS Three broad themes were identified as facilitators of WCC by mothers and clinicians, including: 1) continuity in care, 2) addressing material needs, and 3) clinician OUD training and knowledge. Themes identified as barriers to WCC included: 1) stigma toward mothers with OUD, 2) gaps in basic parenting knowledge, 3) competing specialized health care needs, and 4) insufficient time to address all concerns. CONCLUSION WCC programs or clinical pathways designed for families affected by maternal OUD should consider these barriers and facilitators of WCC engagement and affect experiences of WCC for mothers and clinicians.
Collapse
Affiliation(s)
- Vanessa L Short
- Thomas Jefferson University (VL Short, M Gannon, G Harris, A Kale, DJ Abatemarco, and DJ Hand), Philadelphia, PA.
| | - Meghan Gannon
- Thomas Jefferson University (VL Short, M Gannon, G Harris, A Kale, DJ Abatemarco, and DJ Hand), Philadelphia, PA
| | - Erica Sood
- Nemours Children's Health (E Sood and N Goyal), Wilmington, Del; Department of Pediatrics, Thomas Jefferson University (E Sood and N Goyal), Philadelphia, PA
| | - Grace Harris
- Thomas Jefferson University (VL Short, M Gannon, G Harris, A Kale, DJ Abatemarco, and DJ Hand), Philadelphia, PA
| | - Aditi Kale
- Thomas Jefferson University (VL Short, M Gannon, G Harris, A Kale, DJ Abatemarco, and DJ Hand), Philadelphia, PA
| | - Diane J Abatemarco
- Thomas Jefferson University (VL Short, M Gannon, G Harris, A Kale, DJ Abatemarco, and DJ Hand), Philadelphia, PA
| | - Dennis J Hand
- Thomas Jefferson University (VL Short, M Gannon, G Harris, A Kale, DJ Abatemarco, and DJ Hand), Philadelphia, PA
| | - Neera Goyal
- Nemours Children's Health (E Sood and N Goyal), Wilmington, Del; Department of Pediatrics, Thomas Jefferson University (E Sood and N Goyal), Philadelphia, PA
| |
Collapse
|
11
|
Beldick SR, Rohde JF, Short VL, Abatemarco D, Goyal NK. Pediatric Primary Care Diagnoses Among Children with Intrauterine Opioid Exposure. J Health Care Poor Underserved 2023; 34:161-179. [PMID: 37464487 PMCID: PMC10483573 DOI: 10.1353/hpu.2023.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
BACKGROUND AND OBJECTIVES Characterizing common concerns for children with intrauterine opioid exposure (IOE) can inform tailored primary care. METHODS Retrospective analysis of primary care data of children with IOE from birth to age two years within one multi-state pediatric health system. Well child care (WCC) and problem-based visit diagnoses were categorized, and descriptive statistics were tabulated. RESULTS Three hundred and eighty-five (385) children with IOE had 3,622 primary care visits, of which 51.4% were WCC and 48.6% were problem-based. Most frequent visit diagnoses were upper respiratory complaints (14.8% of visits), feeding difficulties (12.2%), and perinatal viral exposure (9.8%). Although visit type (WCC vs. problem-based) varied across diagnostic category, frequent utilization of both visit types were documented for several diagnoses in infancy (e.g., fussiness/colic, feeding difficulties). CONCLUSIONS Well child care visits for children with IOE are key opportunities for anticipatory guidance with an emphasis on problems that may contribute to acute health care utilization, particularly in early infancy.
Collapse
Affiliation(s)
| | | | - Vanessa L. Short
- Department of Obstetrics & Gynecology, Thomas Jefferson University, Philadelphia PA
| | - Diane Abatemarco
- Department of Obstetrics & Gynecology, Thomas Jefferson University, Philadelphia PA
| | - Neera K. Goyal
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia PA
- Nemours Children’s Health, Philadelphia, PA
| |
Collapse
|
12
|
Benninger KL, Richard C, Conroy S, Newton J, Taylor HG, Sayed A, Pietruszewski L, Nelin MA, Batterson N, Maitre NL. One-Year Neurodevelopmental Outcomes After Neonatal Opioid Withdrawal Syndrome: A Prospective Cohort Study. Perspect ASHA Spec Interest Groups 2022; 7:1019-1032. [PMID: 36211832 PMCID: PMC9539823 DOI: 10.1044/2022_persp-21-00270] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE The aims of this study were, in a cohort of children with neonatal opioid withdrawal syndrome (NOWS), (a) to report 1-year neurodevelopmental outcomes and specifically characterize speech, language, and hearing outcomes and (b) to report the prevalence of cleft lip and/or cleft palate. METHOD This prospective observational cohort study includes newborns with confirmed in utero opioid exposure who received pharmacological treatment for NOWS. During 1-year-old developmental visits, we administered standardized assessments (Bayley Scales of Infant and Toddler Development-Third Edition [Bayley-III] or Developmental Assessment of Young Children-Second Edition [DAYC-2]-due to COVID-19 restrictions). We compared Bayley-III scores to standardized population means using one-sample z tests. We report estimates, 95% confidence intervals, and two-sided p values. RESULTS We enrolled 202 infants (October 2018 to March 2020). Follow-up at 1-year was 80%. Infants with NOWS had lower Bayley-III scores at 1 year compared to published norms for cognitive, language, and motor domains. One infant with NOWS was diagnosed with isolated cleft palate and Pierre Robin sequence. All infants passed the newborn hearing screen, and 7.5% had a formal hearing evaluation after neonatal intensive care unit discharge, with 40% having abnormal or inconclusive results; middle ear effusion was the leading cause of abnormal hearing (66.7%). Ten percent of children received a speech-language pathology referral prior to 2 years of age. Infants born to mothers with mental health conditions were more likely to have Bayley-III or DAYC-2 scores below 95 in language or motor domains. CONCLUSIONS Infants with pharmacologically treated NOWS have significantly lower cognitive, language, and motor scores on standardized developmental testing compared to population means at 1 year of age. Early speech-language pathology referral is frequently necessary to promote optimal development in this population. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.20044403.
Collapse
Affiliation(s)
- Kristen L. Benninger
- Department of Pediatrics, Nationwide Children’s Hospital and The Ohio State University Wexner Medical Center, Columbus
- Center for Perinatal Research, The Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH
| | - Celine Richard
- Department of Otolaryngology, The University of Tennessee Health Science Center College of Medicine, Memphis
- Department of Otolaryngology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Sara Conroy
- Biostatistics Core, The Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH
- Center for Biostatistics, The Ohio State University Wexner Medical Center, Columbus
| | - Julia Newton
- Center for Perinatal Research, The Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH
| | - H. Gerry Taylor
- Department of Pediatrics, Nationwide Children’s Hospital and The Ohio State University Wexner Medical Center, Columbus
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH
| | - Alaisha Sayed
- Department of Pediatrics, Nationwide Children’s Hospital and The Ohio State University Wexner Medical Center, Columbus
- Center for Perinatal Research, The Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH
| | - Lindsay Pietruszewski
- Center for Perinatal Research, The Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH
| | - Mary Ann Nelin
- Department of Pediatrics, Nationwide Children’s Hospital and The Ohio State University Wexner Medical Center, Columbus
| | - Nancy Batterson
- Department of Pediatrics, Nationwide Children’s Hospital and The Ohio State University Wexner Medical Center, Columbus
- Center for Perinatal Research, The Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH
| | - Nathalie L. Maitre
- Department of Pediatrics, Emory University and Children’s Healthcare of Atlanta, GA
| |
Collapse
|
13
|
Hand DJ, Fischer AC, Gannon ML, McLaughlin KA, Short VL, Abatemarco DJ. Comprehensive and compassionate responses for opioid use disorder among pregnant and parenting women. Int Rev Psychiatry 2021; 33:514-527. [PMID: 34176410 DOI: 10.1080/09540261.2021.1908966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Pregnant and parenting women with opioid use disorder face multiple challenges to recovery. Trauma histories, poverty, stigma and discrimination, and lack of access to treatment intersect to marginalise this population. It is important that pregnant and parenting women with opioid use disorder receive comprehensive care to improve their health, the health of their child(ren), and prevent the intergenerational transmission of opioid and other substance use disorders. For nearly 50 years the Maternal Addiction Treatment, Education, and Research program has provided an evolving and expanding range of comprehensive services for treating opioid and other substance use disorders in this population. In this review the rationale for, and processes by which, key components of a comprehensive approach are discussed. These components include patient navigation for access to care, low-barrier medications for opioid use disorder, effective trauma-responsive therapy, prenatal and well-child healthcare, and other support services that make it possible for pregnant and parenting women to engage in treatment and improve the health of the entire family. Additionally, a method for supporting staff to build resilience and reduce fatigue and burnout is discussed. These components comprise an effective model of care for pregnant and parenting women with opioid and other substance use disorders.
Collapse
Affiliation(s)
- Dennis J Hand
- Department of Obstetrics & Gynecology, Thomas Jefferson University, Philadelphia, PA, USA.,Department of Psychiatry & Human Behavior, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alice C Fischer
- Department of Obstetrics & Gynecology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Meghan L Gannon
- Department of Obstetrics & Gynecology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Kimberly A McLaughlin
- Department of Obstetrics & Gynecology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Vanessa L Short
- Department of Obstetrics & Gynecology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Diane J Abatemarco
- Department of Obstetrics & Gynecology, Thomas Jefferson University, Philadelphia, PA, USA.,Department of Pediatrics, Thomas Jefferson University, Philadelphia, PA, USA
| |
Collapse
|
14
|
Corr TE, Xing X, Liu G. Longitudinal Health Care Utilization of Medicaid-Insured Children with a History of Neonatal Abstinence Syndrome. J Pediatr 2021; 233:82-89.e1. [PMID: 33545189 DOI: 10.1016/j.jpeds.2021.01.067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/13/2021] [Accepted: 01/27/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To describe longitudinal health care utilization of Medicaid-insured children with a history of neonatal abstinence syndrome (NAS) compared with similar children without NAS. STUDY DESIGN Retrospective, longitudinal cohort study. Data were extracted from the Medicaid Analytic eXtract files for all available states and DC from 2003-2013. Subjects were followed up to 11 years. In total, 17 229 children with NAS were identified using the International Classification of Diseases, Ninth Revision code 779.5. Children without NAS, matched on demographic and health variables, served as the comparison group. Outcomes were number of claims for inpatient, outpatient, and emergency department encounters, numbers of prescription claims, and costs associated with these services. Linked claims were identified for each subject using a unique, within-state ID. RESULTS Children with NAS had increased claims for inpatient admissions (marginal effect [ME] 0.49; SE 0.01) and emergency department visits (ME 0.30; SE 0.04) through year 1; increased prescriptions (ME 1.45; SE 0.08, age 0) (ME 0.69; SE 0.11, age 1 year) through year 2; and increased outpatient encounters (ME 20.13; SE 0.54, age 0) (ME 3.95; SE 0.62, age 1 year) (ME 2.90; SE 1.11, age 2 years) through year 3 after adjusting for potential confounders (P < .01 for all). Beyond the third year, health care utilization was similar between those with and without NAS. CONCLUSIONS Children with a diagnosis of NAS have greater health care utilization through the third year of life. These differences resolve by the fourth year. Our results suggest resolution of disparities may be due to shifts in developmental health management in school-age children and inability to track relevant diagnoses in a health care database.
Collapse
Affiliation(s)
- Tammy E Corr
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA
| | - Xueyi Xing
- Evidence-to-Impact Collaborative, Social Science Research Institute, Penn State University, State College, PA
| | - Guodong Liu
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| |
Collapse
|
15
|
Ko JY, Yoon J, Tong VT, Haight SC, Patel R, Rockhill KM, Luck J, Shapiro-Mendoza C. Maternal opioid exposure, neonatal abstinence syndrome, and infant healthcare utilization: A retrospective cohort analysis. Drug Alcohol Depend 2021; 223:108704. [PMID: 33894458 PMCID: PMC8893024 DOI: 10.1016/j.drugalcdep.2021.108704] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/03/2021] [Accepted: 03/06/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND We sought to describe healthcare utilization of infants by maternal opioid exposure and neonatal abstinence syndrome (NAS) status. METHODS A longitudinal cohort of 81,833 maternal-infant dyads were identified from Oregon's 2008-2012 linked birth certificate and Medicaid eligibility and claims data. Chi-square tests compared term infants (≥37 weeks of gestational age) by maternal opioid exposure, defined using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes or prescription fills, and NAS, defined using ICD-9-CM codes, such that infants were categorized as Opioid+/ NAS+, Opioid+/NAS-, Opioid-/NAS+, and Opioid-/NAS-. Modified Poisson regression was used to calculate adjusted risk ratios (aRR) and 95 % confidence intervals (CI) for healthcare utilization for each infant group compared to Opioid-/NAS- infants. RESULTS The prevalence of documented maternal opioid exposure was 123.1 per 1000 dyads and NAS incidence was 5.8 per 1000 dyads. Compared to Opioid-/NAS- infants, infants with maternal opioid exposures were more likely to be hospitalized within 4 weeks (Opioid+/ NAS+: [aRR: 4.7; 95 % CI: 4.3-5.1]; Opioid+/ NAS-: [aRR: 3.7; 95 %CI: 3.1-4.5]) and a year after birth (Opioid+/ NAS+: [aRR: 3.7; 95 %CI: 3.4-4.0]; Opioid+/ NAS-: [aRR: 2.8; 95 %CI: 2.3-3.4]). Infants with maternal opioid exposure and/or NAS were more likely than Opioid-/NAS- infants to have ≥2 sick visits and any ED visits in the year after birth. CONCLUSIONS Infants with NAS and/or maternal opioid exposure had greater healthcare utilization than infants without NAS or opioid exposure. Efforts to mitigate future hospitalization risk and encourage participation in preventative services within the first year of life may improve outcomes.
Collapse
Affiliation(s)
- Jean Y. Ko
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, USA,United States Public Health Service, Commissioned Corps, Rockville, MD, USA,Corresponding author at: Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, Mailstop, S107-2, Atlanta, GA, 30341, USA. (J.Y. Ko)
| | - Jangho Yoon
- College of Public Health and Human Sciences, Oregon State University, USA
| | - Van T. Tong
- Division of Congenital and Developmental Disorders, National Center for Birth Defects and Developmental Disorders, Centers for Disease Control and Prevention, USA
| | - Sarah C. Haight
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, USA
| | - Roshni Patel
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, USA,DB Consulting Group, Atlanta, GA, USA
| | - Karilynn M. Rockhill
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, USA,Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Jeff Luck
- College of Public Health and Human Sciences, Oregon State University, USA
| | - Carrie Shapiro-Mendoza
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, USA
| |
Collapse
|
16
|
Kemper EW, Davis E, Bui AL, DeChalus A, Martos M, McDade JE, Seimears TL, Olszewski AE. The "War on Drugs" Affects Children Too: Racial Inequities in Pediatric Populations. Am J Bioeth 2021; 21:49-51. [PMID: 33825642 DOI: 10.1080/15265161.2021.1891336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Emily W Kemper
- University of Washington and Seattle Children's Hospital
| | - Emily Davis
- University of Washington and Seattle Children's Hospital
| | - Anthony L Bui
- University of Washington and Seattle Children's Hospital
| | | | - Melissa Martos
- University of Washington and Seattle Children's Hospital
| | | | | | | |
Collapse
|
17
|
Short VL, Alexander K, Gannon M, Abatemarco DJ, Goyal NK. What aspects of their child's primary care do mothers value? A qualitative analysis of perspectives of women in treatment for opioid use disorder. Child Care Health Dev 2021; 47:40-46. [PMID: 33016377 DOI: 10.1111/cch.12811] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 06/22/2020] [Accepted: 09/08/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Preventive paediatric healthcare is essential for infant and child health. Current research, however, suggests that the delivery of routine well child care (WCC) for children affected by maternal opioid use disorder (OUD) could be improved. How mothers perceive interactions with healthcare providers may help identify ways to modify the experience of WCC, which could ultimately improve healthcare utilization, patient satisfaction and clinical outcomes. The objective of this qualitative study was to assess perceptions of WCC among mothers in treatment for OUD. METHODS Four focus group sessions of 4-8 participants each (N = 22) were conducted. All study participants were receiving comprehensive behavioural and physical health support and care plus pharmacotherapy for OUD from a single outpatient treatment centre. Focus groups were semi-structured, with a standardized set of open-ended questions and follow-up prompts to engage participants in a fluid discussion. Participants were asked to identify and discuss important aspects of their youngest child's WCC and what they liked and disliked about their child's WCC. Grounded theory analysis was used to identify themes. RESULTS Several aspects of WCC were identified as important to the mothers. Main themes identified included (1) mother-provider relationship, (2) communication with healthcare team and (3) support for mother's OUD treatment. Participants discussed their desire to be heard and understood and wanted the entire healthcare team and clinic staff to see them as mothers first and foremost, not merely as individuals with OUD. CONCLUSION Future attempts to refine care may consider healthcare models that highlight open communication and personalized care and offer strong support and ongoing encouragement for the mother's OUD treatment and recovery process.
Collapse
Affiliation(s)
- Vanessa L Short
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Karen Alexander
- College of Nursing, Thomas Jefferson University, Philadelphia, PA, USA
| | - Meghan Gannon
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Diane J Abatemarco
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Neera K Goyal
- Department of Pediatrics, Sidney Kimmel College of Medicine, Thomas Jefferson University, Philadelphia, PA, USA.,Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| |
Collapse
|