A Low-threshold Comprehensive Shared Medical Appointment Program for Perinatal Substance Use in an Underserved Population

Abstract

Objectives: We describe retention in care, medication for opioid use disorder (MOUD) prescribing, and urine toxicology outcomes of a comprehensive perinatal shared medical appointment model that combined medication, group-based counseling, and recovery supports. Methods: We conducted a retrospective study of program retention between 11/1/16 and 3/31/20 in pregnant and postpartum women with substance dependence or use disorder. Disengagement reasons, MOUD prescribing, and urine toxicology were abstracted from medical records. A Cox proportional hazards model was used to evaluate risk factors for program disengagement.Results: Approximately 87% of patients had OUD and 80% were pregnant at the initial visit (N ¼ 140). Retention at 3 months, 6 months, 1 year, and 2 years was approximately 86%, 78%, 66%, and 48%, respectively. Over 97% of patients were prescribed MOUD and 88% of all urine toxicology results were negative for nonprescribed opioids. Patients enrolled after initiation of wraparound services (HR 0.52, 95% CI 0.28-0.96) and those attending more shared medical appointments (HR 0.90, 95% CI 0.87-0.93) had a lower hazard of disengagement after controlling for other covariates. Loss to follow-up was the most common disengagement reason. Conclusions: A low-threshold, comprehensive perinatal shared medical appointment program had high retention rates, increased access to evidence-based MOUD, and high rates of opioid-negative urine toxicology. Participants enrolled after wraparound services began had a lower hazard of disengagement. Future research in perinatal substance use should evaluate the most optimal and costeffective components of comprehensive programs to inform standard of care.

The Michigan Clinical Consultation and Care model (MC3 Perinatal): A Novel Approach to Perinatal Mental Health Care

“…Historically, SUD and IPV are predictors of poor retention in mental health programming, particularly when combined with underlying severe psychopathology -such as severe perinatal anxiety [54][55][56][57][58][59][60]. In our study, because IPV and substance use risk did not predict attrition from the program, this highlights the importance of accessible, patient-facing mental healthcare for these particularly vulnerable patient populations.…”

Evaluation of the Michigan Clinical Consultation and Care Program: An Evidence-Based Approach to Perinatal Mental Healthcare

“…Historically, substance use disorder (SUD) and IPV are predictors of poor retention in mental health programming, particularly when combined with underlying severe psychopathology, such as severe perinatal anxiety [61][62][63][64][65][66][67]. In our study, because IPV and substance use risk did not predict attrition from the program, this highlights the importance of accessible, patient-facing mental healthcare for vulnerable patient populations.…”

Psychiatric comorbidities and their treatment predict buprenorphine continuation among postpartum people with opioid use disorder

“…Prior work has suggested that collaboration and shared decision making between providers in the perinatal period can encourage treatment for both psychiatric conditions and OUD in this critical time period ( Raffi et al, 2021 ). In addition, prior work has shown greater treatment engagement among patients with OUD who are receiving care that includes wraparound services that involves behavioral health and care coordination ( Ganetsky et al, 2022 ). Although prior work has called attention to the need for integrated care, the evidence of the efficacy of this care remains limited.…”