支持产后参与戒毒护理的干预措施:原则与陷阱。

IF 5.1 Q1 SUBSTANCE ABUSE Substance Abuse and Rehabilitation Pub Date : 2023-07-03 eCollection Date: 2023-01-01 DOI:10.2147/SAR.S375652
Shayna Mazel, Karen Alexander, Camille Cioffi, Mishka Terplan
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引用次数: 0

摘要

对一般成瘾的最佳管理与孕期和产后护理之间存在根本性的脱节。成瘾是一种慢性疾病,需要在整个生命过程中进行一定程度的管理。然而,在美国,生育护理是偶发性的,并且更多集中在妊娠期,而不是生育期的其他阶段。由于几乎所有的孕妇都有资格享受医疗补助,因此在获得保险方面优先考虑怀孕期,但在产后的不同阶段,获得保险的机会就会终止。这就造成了结构上的不匹配:只在妊娠期对成瘾这一慢性病进行偶发性管理。虽然药物使用障碍(SUD)患者可以在孕期获得治疗,但产后治疗的流失很常见。产后是一个脆弱性增加的时期,保险的变化和照顾新生儿的责任在医疗系统和医疗服务提供者撤出护理的背景下发生碰撞。因此,产后复吸、吸毒成瘾复发、用药过量和用药过量死亡比孕期更为常见,而吸毒死亡已成为美国孕产妇死亡的主要原因。本综述探讨了支持产后参与成瘾护理的干预措施。首先,我们将对示范项目和有实证依据的干预措施进行范围界定,这些干预措施已被证明可提高产后护理的持续性。然后,我们通过回顾临床和伦理原则来探讨当代护理的现实情况,尤其关注减少伤害。最后,我们就改善产后护理的策略(临床、研究和政策)提出建议,并强调在采用循证和以人为本的服务时可能存在的隐患。
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Interventions to Support Engagement in Addiction Care Postpartum: Principles and Pitfalls.

There is a fundamental disconnect between the optimal management of addiction in general and care delivery in pregnancy and postpartum. Addiction is a chronic condition requiring some degree of management across the life course. Yet, in the US, reproductive care is episodic and centers more on pregnancy than at other stages of the reproductive life course. Pregnancy is prioritized in access to insurance as almost all pregnant people are Medicaid eligible but access ends at varying points postpartum. This results in a structural mismatch: the episodic management of the chronic condition of addiction only within gestational periods. Though people with substance use disorder (SUD) may access care in pregnancy, treatment attrition is common postpartum. Postpartum is a time of increased vulnerabilities where insurance churn and newborn caretaking responsibilities collide in a context of care withdrawal from the health system and health providers. In part in consequence, return to use, SUD recurrence, overdose, and overdose death are more common postpartum than in pregnancy, and drug deaths have become a leading cause of maternal deaths in the US. This review addresses interventions to support engagement in addiction care postpartum. We begin with a scoping review of model programs and evidence-informed interventions that have been shown to increase continuation of care postpartum. We then explore the realities of contemporary care through a review of clinical and ethical principles, with particular attention to harm reduction. We conclude with suggestions of strategies (clinical, research, and policy) to improve care postpartum and highlight potential pitfalls in the uptake of evidence-based and person-centered services.

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审稿时长
16 weeks
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