Differences in outpatient, emergency, and inpatient use among pregnant women with a substance-related diagnosis

Courchesne‐Krak, Natasia S.; Kepner, Wayne; Rubano, Amanda; Marienfeld, Carla

doi:10.1016/j.ajogmf.2021.100559

Cited by 4 publications

(5 citation statements)

References 41 publications

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“…Routine prenatal and postpartum care are associated with improved obstetric and birth outcomes, but we find that Medicaidenrolled women with an OUD diagnosis are less likely to receive adequate prenatal care and attend a postpartum visit, and more likely to receive emergency care in the emergency department or obstetric triage setting-a finding that is consistent with prior research. 13,14 Given the benefits of prenatal and postpartum care, and because untreated OUD poses significant risks to mothers and infants, our findings suggest that pregnant women with OUD have been much less likely to be receiving the care they need for optimal clinical outcomes of mother and infant. Furthermore, increased receipt of emergency care suggests that instead of routine prenatal and postpartum care, these women may be substituting emergency care to address unmet physical and mental health needs.…”

Section: Discussionmentioning

confidence: 92%

“…We identified women who (1) received “adequate” prenatal care (defined as at least 7 visits), consistent with the literature defining adequate prenatal care when gestational age at delivery is unavailable 20,21 ; (2) attended a postpartum visit; and (3) had at least one emergency visit during the prenatal or postpartum period. One emergency visit is commonly used to identify receipt of emergency care in the maternal population, 7,8,14 and because many women are routed to obstetric triage when seeking emergency care during pregnancy, 22 especially later in pregnancy, using revenue codes for obstetric triage enables us to more accurately measure perinatal and emergency care receipt. A list of ICD-9 and revenue codes used to identify prenatal, postpartum, and emergency visits is provided in Appendix Table A3, http://links.lww.com/JAM/A427.…”

Section: Methodsmentioning

confidence: 99%

“…9 Although emergency care may substitute for scheduled prenatal and postpartum care, 9 especially for women with low perceived social support, 10 limited transportation access and reliance on emergency transport for health care, 11 or difficulty obtaining childcare for their other children, 12 people with higher emergency care receipt may have more frequent contact with the health care system generally. 10 Existing research has documented the association between substance use and receipt of inadequate prenatal and postpartum care 13 as well as higher emergency care receipt, 14 and others have described racial and ethnic disparities in prenatal, postpartum, and emergency health care receipt among Medicaid-insured women during the perinatal period 15,16 (R. K. Landis et al, unpublished data, 2022) However, prior studies have not examined the extent to which perinatal OUD may be associated with differential receipt of perinatal and emergency care in a large Medicaid population, nor have they explored racial and ethnic disparities in the receipt of prenatal, postpartum, and emergency care among women with perinatal OUD.…”

mentioning

confidence: 99%

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Disparities in Perinatal and Emergency Care Receipt Among Women With Perinatal Opioid Use Disorder in Medicaid, 2007 to 2012

et al. 2023

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Objectives This study aimed to better understand receipt of perinatal and emergency care among women with perinatal opioid use disorder (OUD) and explore variation by race/ethnicity. Methods We used 2007–2012 Medicaid Analytic eXtract (MAX) data from all 50 states and the District of Columbia to examine 6,823,471 deliveries for women 18 to 44 years old. Logistic regressions modeled the association between (1) OUD status and receipt of perinatal and emergency care, and (2) receipt of perinatal and emergency care and race/ethnicity, conditional on OUD diagnosis and controlling for patient and county characteristics. We used robust SEs, clustered at the individual level, and included state and year fixed effects. Results Women with perinatal OUD were less likely to receive adequate prenatal care (adjusted odds ratio [aOR], 0.45; 95% confidence interval [CI], 0.44–0.46) and attend the postpartum visit (aOR, 0.46; 95% CI, 0.45–0.47) and more likely to seek emergency care (aOR, 1.48; 95% CI, 1.45–1.51) than women without perinatal OUD. Among women with perinatal OUD, Black, Hispanic, and American Indian and Alaskan Native (AI/AN) women were less likely to receive adequate prenatal care (aOR, 0.68 [95% CI, 0.64–0.72]; aOR, 0.86 [95% CI, 0.80–0.92]; aOR, 0.71 [95% CI, 0.64–0.79]) and attend the postpartum visit (aOR, 0.85 [95% CI, 0.80–0.91]; aOR, 0.86 [95% CI, 0.80–0.93]; aOR, 0.83 [95% CI, 0.73–0.94]) relative to non-Hispanic White women. Black and AI/AN women were also more likely to receive emergency care (aOR, 1.13 [95% CI, 1.05–1.20]; aOR, 1.12 [95% CI, 1.00–1.26]). Conclusions Our findings suggest that women with perinatal OUD, in particular Black, Hispanic, and AI/AN women, may be missing opportunities for preventive care and comprehensive management of their physical and behavioral health during pregnancy.

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Section: Discussionmentioning

confidence: 92%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Disparities in Perinatal and Emergency Care Receipt Among Women With Perinatal Opioid Use Disorder in Medicaid, 2007 to 2012

et al. 2023

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“…, prematurity, fetal demise, and postnatal mortality). 20 In contrast, in a study of pregnant patients with a substance-related disorder, antepartum ED use and hospitalizations reflect perceived complications, 21 including both mental and physical health conditions that the ED is poorly equipped to address. Indeed, Gilroy and Tomczyk 19 found that visiting the ED did not significantly improve early pregnancy quality of care and Varner et al 10 concluded that ED use conferred higher future risk of severe maternal and perinatal morbidity.…”

Section: Discussionmentioning

confidence: 96%

Antepartum Emergency Department Use and Associations with Maternal and Neonatal Outcomes in a Large Hospital System

Sabloak,

Yee,

Feinglass

2023

Women's Health Reports

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Objectives: Prenatal care in the United States has remained unchanged for decades, with pregnant patients often experiencing high rates of hospital emergency department (ED) visits. It is unknown how many of these ED visits are potentially preventable with better access to timely and effective outpatient or home prenatal care. This multihospital health system quality improvement study was undertaken to analyze patient risk factors for acute antepartum hospital use as well as associations with adverse maternal and neonatal birth outcomes. Methods: The retrospective cohort study analyzed electronic health record and administrative data on ED visits in the 270 days before a delivery admission for alive, singleton births at nine system hospitals over 52 months. We use logistic regression to estimate the likelihood of hospital use by patient demographic and clinical characteristics and present the association of acute antepartum hospital use with maternal and neonatal birth outcomes. Results: Overall, 17.5% of 68,200 patients had antepartum ED visits, including 248 inpatient admissions, with significant variation between hospitals. As compared to non-Hispanic white patients, Hispanic and especially non-Hispanic Black and Medicaid patients had significantly higher odds of acute antepartum hospital use as did patients with preexisting conditions. Birth outcomes were significantly ( p < 0.01) worse among individuals with antepartum hospital utilization. Conclusion: Acute antepartum hospital use was concentrated among lower income, minority patients, and those with chronic conditions with significant variation across system hospitals. There is a need for research into innovations in prenatal care that are best at reaching our most vulnerable patients, reducing preventable hospital utilization, and improving birth outcomes.

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“…Universal screening is one effective approach to identifying pregnant people needing substance use-specific services and other services related to social determinants of health (Wright et al, 2016 ) that may improve outcomes and reduce healthcare costs (Courchesne-Krak et al, 2022 ). Research supports the effectiveness of universal screening, brief intervention, and referral to treatment (SBIRT) in primary care (Madras et al, 2009 ) and obstetric settings (Hostage et al, 2020 ; Ulrich et al, 2021 ).…”

Section: Objectivesmentioning

confidence: 99%

Early Insights into Implementation of Universal Screening, Brief Intervention, and Referral to Treatment for Perinatal Substance Use

Reese,

Glover,

Fitch

et al. 2023

Matern Child Health J

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Objectives Perinatal substance use is a growing concern across the United States. Universal screening, brief intervention, and referral to treatment (SBIRT) is one systems-level approach to addressing perinatal substance use. The objective of this study is to assess early efforts to implement SBIRT in an outpatient obstetric clinic. Methods The research team implemented universal screening with the 5 P’s screening tool. Providers then engaged patients in a brief intervention and referred to a care manager who then worked with patients via tele-health to connect patients with needed services. Feasibility was measured through the collection of aggregate data describing frequency of universal screening and referral to treatment. The implementation team met bi-weekly to reflect on implementation barriers and facilitators. Results In the first year of implementation, 48.5% of patients receiving care in the clinic completed the 5 P’s screener at least once during the perinatal period. Screening occurred in a little over a quarter (26.5%) of eligible visits. Of the 463 patients that completed the 5 P’s at least once during the perinatal period, 195 (42%) unique patients screened positive (answered yes to at least one question). Conclusions for Practice Early implementation efforts suggest this approach is feasible in this obstetric setting. Similar implementation studies should consider implementing universal screening for substance use and perinatal mood and anxiety disorders simultaneously; guide efforts using an implementation framework; invest resources in more intensive training and ongoing coaching for providers; and adopt strategies to track frequency and fidelity of brief intervention.

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Differences in outpatient, emergency, and inpatient use among pregnant women with a substance-related diagnosis

Cited by 4 publications

References 41 publications

Disparities in Perinatal and Emergency Care Receipt Among Women With Perinatal Opioid Use Disorder in Medicaid, 2007 to 2012

Disparities in Perinatal and Emergency Care Receipt Among Women With Perinatal Opioid Use Disorder in Medicaid, 2007 to 2012

Antepartum Emergency Department Use and Associations with Maternal and Neonatal Outcomes in a Large Hospital System

Early Insights into Implementation of Universal Screening, Brief Intervention, and Referral to Treatment for Perinatal Substance Use

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