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Pediatric Primary Care of Children With Intrauterine Opioid Exposure: Survey of Academic Teaching Practices
Jessica F Rohde1, Barbara H Chaiyachati2, Neera Shah Demharter3
1Division of General Academic Pediatrics (JF Rohde and C Dorrian), Nemours Children's Health, Wilmington, Del; Sidney Kimmel Medical College (JF Rohde, C Dorrian, and NK Goyal), Thomas Jefferson University, Philadelphia, Pa; Value-Based Service Organization (NK Goyal, JF Rohde and C Dorrian), Nemours Children's Health, Philadelphia, Pa.
Insights
Pediatricians rarely screen for opioid use during pregnancy, despite its importance. Improving access to treatment for parental opioid use disorder can reduce barriers in primary care for infants with intrauterine opioid exposure.
Area of Science:
- Pediatrics
- Public Health
- Neonatology
Background:
- Intrauterine opioid exposure (IOE) has risen significantly, creating unmet needs for affected infants.
- Current primary care guidelines for children with IOE are lacking.
- Understanding clinician practices and barriers is crucial for improving care.
Purpose of the Study:
- To assess screening and referral practices for children with IOE in primary care settings.
- To identify barriers encountered by clinicians in managing children with IOE.
- To explore clinician and practice factors associated with perceived barriers.
Main Methods:
- A cross-sectional survey was distributed to pediatric clinicians across 28 primary care clinics.
- The survey collected data on screening, referral practices, and barriers related to parental opioid use disorder (OUD).
- Descriptive statistics and cluster analysis were used to analyze survey responses.
Main Results:
- While 99.3% of clinicians deemed parental substance use screening important, only 11.6% routinely screened.
- Half of respondents routinely referred children with IOE to early intervention and social work.
- Lack of standard substance use screening was the primary barrier to addressing parental OUD.
Conclusions:
- Significant variation exists in pediatric primary care screening and referral for children with IOE.
- Enhanced access to parental OUD treatment programs may reduce perceived barriers for clinicians.
Objective:
Intrauterine opioid exposure (IOE) has increased over the last 2 decades and is associated with additional needs after birth. To date, no clinical guidelines address the primary care of children with IOE. We aimed to characterize clinician-reported screening and referral practices, barriers to effective primary care for children with IOE, and clinician- and practice-level characteristics associated with perceived barriers.
Methods:
We conducted a cross-sectional survey of pediatric residents, pediatricians, and advanced practitioners at 28 primary care clinics affiliated with 7 pediatric residency programs (April-June 2022). We assessed screening and other clinical practices related to IOE and perceived barriers to addressing parental opioid use disorder (OUD). We used descriptive statistics to analyze survey responses, assessed the distribution of reported barriers, and applied a 2-stage cluster analysis to assess response patterns.
Results:
Of 1004 invited clinicians, 329 (32.8%) responses were returned, and 325 pediatric residents and pediatricians were included in the final analytic sample. Almost all (99.3%) reported parental substance use screening as important, but only 11.6% screened routinely. Half of the respondents routinely refer children with IOE to early intervention services and social work. Lack of standard screening for substance use was the most frequently selected barrier to addressing parental OUD. Participants reporting fewer barriers to addressing parental OUD identified having greater access to OUD treatment programs and home visiting programs.
Conclusions:
Pediatricians report variations in primary care screenings and referrals for children with IOE. Access to parental OUD treatment programs may mitigate perceived barriers to addressing parental OUD in the pediatric office.
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