Obstetric Care for Women with Opioid Use Disorder: Evaluation of Online Patient Resources in Utah

Opioid use in pregnancy has increased at an alarming rate, mirroring the opioid epidemic that is sweeping our nation. Drug-related overdose deaths outnumber deaths from auto accidents in the United States (Krans & Patrick, 2016) and data from the Utah Perinatal Morality Review Committee found that drug-induced death is the leading cause of pregnancy-associated death for Utah women (Smid et al., 2018). As Opioid Use Disorder (OUD) continues to rise in women of reproductive age, high rates of newborn complications have followed. The estimated incidence of Neonatal Abstinence Syndrome (NAS) has increased 400% nationally, from 1.2 per 1,000 hospital births in 2000 to 5.8 in 2012 (Ko et al., 2017). OUD places a considerable public health burden on families, hospitals and our health system. Universal screening for OUD and early intervention in pregnancy can prevent overdose deaths, medical complications, and psychosocial deterioration (Kolodny et al., 2015) while improving health outcomes for pregnant women and their infants (Ko et al., 2017). Pregnant women with OUD face many barriers in obtaining timely prenatal care andenrollment in substance treatment programs. Barriers might include child-care issues, poor or absent health insurance and financial resources, lack of access to gender-specific care, a limited number of providers with obstetrics and addiction treatment expertise, social stigma, and fear of legal consequences (Saia et al., 2016). Because women with OUD face many barriers to engaging in health care using traditional methods, online resources and information may be their first access point. Research has shown using smartphones and the Internet can be effective in overcoming barriers to accessing health information about substance use disorders. A recent study conducted among patients enrolled in substance use disorder treatment programs found that 88% of participants had used the Internet to search for medical or health-related topics (Masson, Chen, Levine, Shopshire, & Sorensen, 2019). Reaching pregnant women with OUD through online resources can overcome barriers and improve access to needed health care. The Council on Patient Safety in Women's Health Care (2019) has created a patient safety and quality initiative to address the health care needs of women and newborns affected by OUD. The first quality improvement measure is to provide every family and patient with education about opioid use disorder (OUD) as a treatable, chronic disease and offer education concerning neonatal abstinence syndrome (NAS) and newborn care. Access to reliable, local resources for women with OUD is vital and careful evaluation of the quality of resources and online education is needed. According to Kirby, Reynolds, Walker, Furer and Pryor (2018), "Factors that contribute to higher quality health websites include readability (reading level appropriate for members of the public-grade 6-8 reading level), usability, and evidence-based information that addresses common questions among potential users" (p.118). Utah is in the beginning stages of implementing this national safety bundle and a subcommittee of the Utah Women and Newborns Quality Collaborative has been tasked with compiling and evaluating OUD in pregnancy and NAS content for the state website. This project will help families and women struggling with OUD find the information and resources they need to access health care and achieve the best possible health outcomes for mom and baby.