Development of an unannounced standardized patient protocol to evaluate opioid use disorder treatment in pregnancy for American Indian and rural communities
| Autor: | Jacob D Baylis, Shayla Archer, Amy Binns-Calvey, Lori Begaye, Elizabeth Charron, Marcela C. Smid, Saul J. Weiner, A. Taylor Kelley, Gerald Cochran |
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| Rok vydání: | 2021 |
| Předmět: |
Rural Population
Medicine (General) medicine.medical_specialty Unannounced standardized patients Population Context (language use) Access to care Prenatal care 01 natural sciences 03 medical and health sciences Study Protocol R5-920 0302 clinical medicine Social pathology. Social and public welfare. Criminology Pregnancy Health care medicine Opiate Substitution Treatment Humans 030212 general & internal medicine 0101 mathematics education HV1-9960 American Indian or Alaska Native education.field_of_study business.industry Public health 010102 general mathematics Quality of care Opioid use disorder General Medicine medicine.disease Opioid-Related Disorders Rural health care Buprenorphine Health psychology Family medicine Female Rural area business |
| Zdroj: | Addiction Science & Clinical Practice Addiction Science & Clinical Practice, Vol 16, Iss 1, Pp 1-15 (2021) |
| ISSN: | 1940-0640 |
| Popis: | Background Opioid use disorder (OUD) disproportionately impacts rural and American Indian communities and has quadrupled among pregnant individuals nationwide in the past two decades. Yet, limited data are available about access and quality of care available to pregnant individuals in rural areas, particularly among American Indians (AIs). Unannounced standardized patients (USPs), or “secret shoppers” with standardized characteristics, have been used to assess healthcare access and quality when outcomes cannot be measured by conventional methods or when differences may exist between actual versus reported care. While the USP approach has shown benefit in evaluating primary care and select specialties, its use to date for OUD and pregnancy is very limited. Methods We used literature review, current practice guidelines for perinatal OUD management, and stakeholder engagement to design a novel USP protocol to assess healthcare access and quality for OUD in pregnancy. We developed two USP profiles—one white and one AI—to reflect our target study area consisting of three rural, predominantly white and AI US counties. We partnered with a local community health center network providing care to a large AI population to define six priority outcomes for evaluation: (1) OUD treatment knowledge among clinical staff answering telephones; (2) primary care clinic facilitation and provision of prenatal care and buprenorphine treatment; (3) appropriate completion of evidence-based screening, symptom assessment, and initial steps in management; (4) appropriate completion of risk factor screening/probing about individual circumstances that may affect care; (5) patient-directed tone, stigma, and professionalism by clinic staff; and (6) disparities in care between whites and American Indians. Discussion The development of this USP protocol tailored to a specific environment and high-risk patient population establishes an innovative approach to evaluate healthcare access and quality for pregnant individuals with OUD. It is intended to serve as a roadmap for our own study and for future related work within the context of substance use disorders and pregnancy. |
| Databáze: | OpenAIRE |
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