Primary Submission Category: Reproductive health
Socioenvironmental and Structural Factors Affecting Integration of Substance Use Care into Obstetric Settings within a Large National Healthcare System
Authors: Jessica LaHote Teaniese L. Davis Denice Arnold Emma Mitnick Jomarie dela Pena Jessica LaHote Claire Sterk
Presenting Author: Kelli Stidham Hall*
Objective: To explore (1) perspectives and experiences of stakeholders from a national healthcare organization regarding socioenvironmental and structural factors, facilitators, and barriers affecting integration of the substance use disorder (SUD) care cascade in obstetric settings and (2) strategies for increasing access to care and ensuring equitable outcomes for pregnant/postpartum patients who use drugs (PPWUD).
Methods: In-depth individual semi-structured interviews were conducted with 16 national- and regional-level administrators, clinicians, and staff across the organization. Key themes were identified using a modified grounded theory approach and Dedoose software.
Results: Intersecting stigmas (substance-, pregnancy-, race-, and poverty-related) occurring within (e.g., provider discomfort/discrimination) and outside (e.g., cultural norms, child welfare/criminalization policies) the health system emerged as major barriers to SUD service access and utilization for PPWUD. Systems-level challenges to SUD care integration across the organization included limited resources and variation in regional practices. Perspectives on universal urine screening were nuanced: stakeholders from some regions felt it reduces biased practices; others felt it “sets women up” for encounters with legal or child welfare systems. Strengthened departmental collaborations (obstetrics, family medicine, pediatrics, neonatology, behavioral health), warm handoffs, co-located services, telehealth infrastructure, multi-sector referral networks for support programs, and championship from leaders were deemed promising strategies for integrating SUD care, increasing access, and improving equitable outcomes.
Conclusion: Participants viewed service models that can address a holistic set of care needs (substance, reproductive, social) as a priority for patient-centered, equitable care. Results identified intervention and implementation targets for maternal health equity across the organization.