Telemedicine Valuable for Pregnant Women With Opioid Use Disorder
FEBRUARY 05, 2020
Constance Guille, MD, MSCR
A team of investigators from the Medical University of South Carolina (MUSC) found there were no statistically significant differences in treatment retention rates between pregnant women who received opioid use disorder treatment via telemedicine compared to in-person.
Constance Guille, MD, MSCR, of the psychiatry and behavioral sciences department, and colleagues conducted a nonrandomized controlled trial to learn if using telemedicine for opioid use disorder treatment was associated with similar maternal and newborn outcomes compared with traditional in-person care. They found that virtual opioid use disorder care in obstetric practices did lead to similar outcomes for both mothers and newborns.
Guille and the team recruited participants from data in the Women’s Reproductive Behavioral Health Program at MUSC. Women were identified and grouped by treatment delivery type: in-person treatment in their obstetrician’s office (54 women) and telemedicine for treatment in their provider’s facility (44 women).
The primary outcome for mothers was treatment retention—continuous addiction treatment, including uninterrupted treatment with buprenorphine and > monthly visits with the prescribing psychiatrist during pregnancy—at 6–8 weeks postpartum. An additional maternal outcome included positive urine drug screen results.
The main outcome for newborns was neonatal abstinence syndrome documented in the electronic health record (EHR). Other outcomes were length of newborn hospital stay and birth weight per EHR.
In total, 98 women with a mean age of 30.23 years from 4 outpatient obstetric practices were offered addiction services in person or via telemedicine. Women were seen weekly for 4 weeks, then every 2 weeks for 4 weeks, and monthly thereafter.
Following the initial evaluation, 41 of 44 women (93.2%) in the telemedicine group and 48 of 54 women (88.9%) in the in-person group continued treatment in the investigators’ program. After 6–8 weeks postpartum, 35 of 41 participants (85.4%) in the telemedicine group, and 44 of 48 (91.7%) in the in-person group were retained in treatment.
Positive urine screening results at the 6–8-week postpartum visit were noted in 4 of 41 (9.8%) of those in the telemedicine group and 10 of 48 (20.8%) of the in-person group.
The investigators could not obtain newborn outcomes for 2 babies in the telemedicine group and 2 babies in the in-person group. In the telemedicine cohort, 17 of 39 children (43.6%) were born with neonatal abstinence syndrome, while 28 of 45 (62.2%) in the in-person group had it. Babies in the telemedicine group were in the hospital following delivery for more days (9.1) than the in-person group (8.4).
More women in the telemedicine group reported being either married, engaged, or living with a partner compared to the in-person group (76.1% [35 of 44] vs 53.6% [30 of 54]; P = .02). Those in the in-person group were more likely to be prescribed a benzodiazepine for the treatment of an anxiety disorder when they first started as opposed to the women in the telemedicine group (32.14% [18 of 54] vs 10.87% [5 of 44]; P = .02).
As the opioid epidemic continues to take the lives of many, evidence-based treatment for opioid use disorder is necessary. Telemedicine can provide a solution to help make treatment more accessible to pregnant women to reduce maternal mortality and improve maternal and child health, Guille and the team concluded.
The study, “Treatment of Opioid Use Disorder in Pregnant Women via Telemedicine,” was published online in JAMA Psychiatry.
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