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Integrating SUD and OB/GYN care: policy challenges and opportunities : final report
Integrating SUD and OB/GYN care: policy challenges and opportunities : final report
- Collection:
- Health Policy and Services Research
- Author(s):
- Berman, Julie Seibert, author
Dobbins, Erin, author
Theism Elysha, author
Murray, Madeline, author
Stockdale, Holly, author
Feinberg, Rose, author
Hinde, Jesse, author
Karon, Sarita L., author - Contributor(s):
- United States. Department of Health and Human Services. Office of Behavioral Health, Disability, and Aging Policy, issuing body.
- Publication:
- Washington, D.C. : Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, Office of Behavioral Health, Disability, and Aging Policy, January 2022
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Delivery of Health Care, Integrated
Prenatal Care
Substance-Related Disorders -- therapy
Mental Health Services
Obstetrics
Women's Health Services
United States
United States. Department of Health and Human Services - Genre(s):
- Technical Report
- Abstract:
- The United States is experiencing a public health crisis related to substance use disorders (SUD). While many are impacted by this crisis, women--particularly pregnant women--are vulnerable to the adverse outcomes associated with SUD (National Institute on Drug Abuse, 2018). Incidence of SUD among pregnant women can affect quality of life and health care costs for both mother and infant. Maternal SUD are associated with significantly increased hospital costs and length of stay, especially in Medicaid programs (Patrick et al., 2015; Winkelman et al., 2018; Clemens-Cope et al., 2019). Thus, pregnancy is a critical time to address SUD for women. Women are more likely to have insurance coverage during pregnancy and thus are more likely to interact with health care professionals, such as obstetricians and gynecologists (OB/GYN) (Center for Substance Abuse Treatment, 2009; Jessup & Brindis, 2005; Bishop et al., 2017). These interactions present opportunities to link pregnant women with SUD to much needed treatment services. Integrated OB/GYN and SUD services may be a viable option for providing access to SUD care for women of child-bearing age in order to reduce the impacts of SUD on mother, child, and health care spending. This report aims to address the treatment opportunities for pregnant and postpartum (or parenting) women (PPW) with SUD by describing opportunities to integrate OB/GYN and SUD care as well as barriers to integrated care delivery. To achieve this goal, we scanned existing integrated OB/GYN and SUD program models, reviewed literature on the effectiveness of integrated OB/GYN and SUD program models, interviewed subject matter experts, and convened a technical expert panel (TEP). The program scan and literature review identified ten distinct models of care and a variety of methods for integrating OB/GYN and SUD care. This included emerging and existing models of care, standalone and statewide efforts to integrate OB/GYN and SUD care, services addressing social determinants of health, and partnerships supporting integrated OB/GYN and SUD care. Existing literature primarily describes models of care or clinical guidelines. Fewer evaluations of the feasibility and effectiveness, meta-analyses, and review articles were present in the literature. Technical experts and interviewees recommended expanding the definition of integrated care to include different types of providers, clinical and non-clinical support services, payment information, and family member support. Interviewees stressed that certain models are more successful in some locations than others. Having the financial resources to hire and retain a care coordinator helps programs to address social determinants of health. Reimbursement models that support comprehensive service provision would best facilitate integrated care. The experts participating in the TEP emphasized that the pregnancy timeline and stages of OB/GYN and SUD care delivery are important factors in integrating and improving care. TEP members recommended expanding care locations to primary care and in-home follow-up. At the same time, TEP members noted that a shortage of health care providers trained in SUD care and an overall shortage of addiction medicine specialists limit access to care. Stigma remains a barrier to SUD care, despite the fact that the medical model of SUD has gained wide acceptance in the behavioral health community. For example, SUD is viewed less empathetically than mental health disorders experienced in the prenatal and postpartum periods. Legal concerns--particularly related to laws mandating that health care providers must report known or suspected substance use among pregnant patients--also serve as barriers to integrated OB/GYN and SUD treatment.
- Copyright:
- The National Library of Medicine believes this item to be in the public domain. (More information)
- Extent:
- 1 online resource (1 PDF file (vi, 34 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 9918367882906676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918367882906676