Moving toward integrated care for perinatal opioid use disorder and mental health in an urban safety-net hospital: A formative implementation evaluation

Abstract

Background

Opioid use disorder (OUD) among pregnant and parenting individuals in the U.S. is a major public health concern. Current policies and procedures are not conducive to effective management of OUD in perinatal patients, who require multidisciplinary approaches. These approaches can challenge rigid healthcare structures, protocols, and staff beliefs. A formative evaluation was conducted of an integrated model of care, introduced as a first step in a system change process to provide comprehensive care to patients with perinatal OUD.

Methods

Rapid qualitative analysis was conducted of interviews with hospital staff (n = 19), staff at local organizations serving the population (n = 15), and patients (n = 5). Using the PRISM implementation framework, we evaluated current resources, gaps in care, treatment priorities, and feasibility, acceptability, and appropriateness of proposed changes.

Results

There is a need for a centralized, long-term, healthcare system-linked space where pregnant and parenting women can obtain evidence-based, culturally- and life-stage-competent OUD treatment. Changing governmental policies is not enough to effect change; champions within the system are needed to advocate for changes in organizational policies and staff training. System-level changes must reduce departmental silos, improve integration with community and public health resources, and address the culture of stigma to create psychological safety for patients. Patients need to feel safe and supported throughout the healthcare system.

Conclusion

The proposed integrated model of care was acceptable and appropriate; hospital employees provided clear guidance to ensure feasibility. Developing a multidisciplinary care team with coordinated care pathways, data reporting infrastructure, and staff education to reduce stigma are next steps.