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Exploring Sustainable Opportunities for Telemedicine and Digital Health in the Care of Women with Opioid Use Disorder: Lessons from the COVID Pandemic (Supplement to Moms in Recovery (MORE): Defining Optimal Care for Pregnant Women and Infants)

Funding Source

Patient-Centered Outcomes Research Institute (PCORI)

Project Period

9/1/20 - 8/31/21

Principal Investigator

Sarah Lord, PhD (Geisel School of Medicine at Dartmouth); Daisy Goodman, CNM, DNP, MPH (Dartmouth Hitchcock Medical Center)

Other Project Staff

Haiyi Xie, PhD; Deborah Johnson, MHA; Scott Gerlach, BA; Alicia Hosmer, BS; Allison Tobar, BS; MORE Study Advisory Committee

Project Summary

Pregnant and parenting women with opioid use disorder (OUD) face disproportionate challenges in access to maternity care and treatment for substance use and related conditions. The COVID pandemic has compounded these challenges. For women with OUD, the pandemic has created risks beyond social isolation, including anxiety of contracting the virus, interrupted maternity care, addiction treatment and mental health services, increased incidence of intimate partner and domestic violence, increased stress due to child care and home-schooling, exacerbation of anxiety and posttraumatic stress, reduced availability of critical resources such as transportation, and increased economic insecurity, including loss of employment and housing.

Health systems have responded to COVID restrictions in a number of ways, including regulatory easements for use of telehealth for initiating and monitoring patients on buprenorphine, greater flexibility for take-home medications for OUD, and expanded reimbursement for phone and video meetings with providers and peer supports. Telehealth approaches have been useful in bridging patient access to substance use and mental health services. Online programs and mobile apps have also been used to ensure service accessibility, quality, and safety of patients and providers. While providers have adapted practices to respond to the pandemic, there is much to be learned about what practice adaptations have led to transformations in care that would be beneficial to sustain, and how the pandemic has impacted women with OUD and other substance use disorders (SUDs) and their experiences of care.

To address these gaps, this enhancement to the Mom in Recovery (MORE) Study has three Specific Aims:
Aim 1. Describe how the pandemic has changed the delivery of maternity care, substance use treatment and related care for pregnant and parenting women with OUD/SUD
Aim 2. Describe how the pandemic has changed the experiences of maternity care, substance use treatment and related care for pregnant and parenting women with OUD/SUD
Aim 3. Determine what service delivery adaptations could be sustained to provide ongoing benefits to pregnant and parenting women with OUD/SUD and related mental health conditions.

We will leverage the MORE Study infrastructure and partner network throughout New Hampshire, Vermont and Maine to conduct a mixed methods study with service providers from maternity care and addiction and mental health treatment settings and with pregnant and parenting women with SUDs (including OUD) from our partner catchment areas. Online surveys and interview guides will be iteratively developed with the MORE Study Advisory Committee. Surveys will be completed by service providers (n=120) and women with lived experience (n=220). Interviews will be conducted with a purposive sample of the providers (n=60) and women (n=50). Study results will inform practice guidelines for service stakeholders regarding use of telehealth and digital treatment approaches. Results will also inform hypothesis generation for patient-centered comparative effectiveness research (CER).

Public Health Relevance

COVID-19 presented new barriers for treating women with SUDs, including OUD. Barriers can reveal opportunities and service providers have turned to telehealth and other digital care approaches to more effectively reach patients and continue to provide quality care. Study results will yield valuable information about the potential sustainability of care innovations that have emerged from the COVID-19 epidemic and about infrastructure targets to support sustainability of these innovations.