(62) Assessment of COVID-19 Driven Changes in an Integrated OBGYN Addiction Treatment Clinic

Introduction:
The COVID-19 pandemic emerged in the midst of the persistent opioid overdose epidemic in the United States. COVID-19 incidence and mortality are particularly high among at-risk groups, including those with opioid use disorder (OUD). Pregnant and parenting people are particularly vulnerable to the risks associated with both COVID-19 and OUD. Through the COVID-19 pandemic, changes in the delivery of care, such as a switch from face-to-face consultations to telemedicine, were made to optimize the accessibility and quality of care. No study has evaluated how OUD treatment outcomes evolved during the implementation of these care provision changes amongst this high priority population. This study compares buprenorphine continuation and visit attendance across three COVID-19 pandemic phases among pregnant and parenting people receiving buprenorphine for OUD.

Methods:
We conducted a secondary analysis from a cohort of patients from an OBGYN addiction treatment clinic research registry. All patients are invited to participate in the registry. For those who consent, monthly chart abstractions are conducted beginning with their first clinic visit. Inclusion criteria for the current study were having an OUD diagnosis, receiving buprenorphine during at least one 30-day period during the pre-COVID-19 phase, and initiating treatment by January 2020. Outcomes were buprenorphine continuation, total visit attendance (including behavioral health and medical provider visits) and percentage of virtual visits for each of the 30-day periods. Our independent variables were three COVID-19 phases: pre-COVID-19 phase (August 2019 - February 2020), early-COVID-19 phase (March 2020- December 2020), and late-COVID-19 phase (January 2021 - June 2021). Cohort characteristics are described using univariate statistics. Mixed effect regression models controlling for insurance type, age, race, and duration of treatment determined the impact of the COVID-19 phases on the outcome variables.

Results:
Participants (N=27) were about half Black (48.2%) and half White (51.9%) with a mean age of 31 years (SD=4.0). Most had Medicaid insurance (85.2%), were unemployed (74.1%), and living in their home (66.7%). More than half of the participants had custody of at least one child (63%). All had a mental health comorbidity and about half (51.9%) were prescribed psychiatric medications. The cohort averaged 23.31 (range 19-25) 30-day treatment periods during the study timeframe. Buprenorphine continuation significantly decreased after the pre-COVID-19 phase (96.5%, 91.2%, and 74.6%) of 30-day periods in each phase respectively. Overall, visit attendance in 30-day periods decreased significantly from the pre-COVID-19 phase
(89.5%) to the early-COVID-19 phase (79.9%) and late-COVID-19 phase (64.6%). Percentage of 30-day periods with medical provider visits decreased significantly only for the third phase (86.7%, 78.0%, 64.6%) and behavioral health visits decreased significantly overall (32.3%, 19.8%, 7.2%). Percentage of 30-day periods with virtual visits increased substantially between the first two phases and remained high during the late-COVID-19 phase (0.39%, 47.8%, 39.6%).

Conclusion:
Buprenorphine continuation and visit attendance declined over the three COVID-19 phases. Yet, treatment engagement remained relatively high likely due to implementation of patient-centered treatment strategies that support recovery. The high rate of virtual visits into the late-COVID-19 phase further demonstrates that healthcare accessibility can be achieved for vulnerable populations in a telehealth-system.

References: Nielsen, T., Bernson, D., Terplan, M., Wakeman, S. E., Yule, A. M., Mehta, P. K., … Schiff, D. M. (2020). Maternal and infant characteristics associated with maternal opioid overdose in the year following delivery. Addiction, 115(2), 291–301. https://doi.org/10.1111/add.14825

Preis, H. Mahaffey, B., Heiselman, C., & Lobel, M. 2020. Vulnerability and resilience to pandemic-related stress among U.S. women pregnant at the start of the COVID-19 pandemic. Social Science & Medicine . DOI: 10.1016/j.socscimed.2020.113348

Schiff, D. M., Nielsen, T., Terplan, M., Hood, M., Bernson, D., Diop, H., … Land, T. (2018). Fatal and Nonfatal Overdose among Pregnant and PostpartumWomen in Massachusetts. Obstetrics and Gynecology, 132(2), 466–474. https://doi.org/10.1097/AOG.0000000000002734

Wang, Q. Q., Kaelber, D. C., Xu, R., & Volkow, N. D. (2020). COVID-19 risk and outcomes in patients with substance use disorders: analyses from electronic health records in the United States. Mol Psychiatry, 1-10. doi:10.1038/s41380-020-00880-7 https://www.cdc.gov/nchs/nvss/vsrr/covid19/index.htm

Diversity, Equity, and Inclusion: The current study is an assessment of an OBGYN addiction treatment clinic which treats pregnant and parenting people who have substance use disorders. Our clinic is affiliated with a large academic medical center in a Medicaid-expanded state which serves as a safety net for the region and treats predominately individuals with low-incomes and identifying as a racial or ethnic minority. We aim to provide health equity through practices such as communicating with Medicaid to arrange transportation to appointments and implementing a lenient late policy. Our clinic works to not only serve patients from all backgrounds within our community, but also provide inclusive care. On average, we serve 63 patients per month with over 180 patients in total. Overall, 35.9% of our patient population identify as Black, 61.4% as White, and 2.72% as other racial identities. The majority (79.0%) of your patients are insured through Medicaid. The study specifically took diversity, equity, and inclusion into account by focusing on clinical practices that address social drivers of health and are aimed to benefit all our patients as well as by capturing a wide range of psychosocial characteristics within our study participants.