Mobile Application Enhanced Care in Pregnant Women with Opioid Use Disorder

Abstract

Abstract:

Project title: Mobile Application Enhanced Care in Pregnant Women with Opioid Use Disorder

Author names: Maria Manriquez, MD; Mackenzie Oleksak, MS4

Clinical Importance: Opioid using women and prospective children are part of a national crisis of chronic and complex health challenges requiring transdisciplinary skills and coordination.

Objective: Evaluate the effectiveness of mobile application to improve treatment engagement and neonatal outcomes.

Design: Prospective cohort feasibility study occurring June 2019-March 2020. Setting: BUMCP Women's Institute & MIHS Women's Care Clinic

Participant & Control Groups: 33 patients approached by PI or Nurse OUD Care Coordinator on inclusion criteria of age 18-50, pregnant, and receiving treatment for opioid use disorder. Population-based sample of 23 participated. Historical controls via secondary anonymous data on 23 similar patients from a period 180-120 days prior selected via same inclusion criteria after participant data was collected.

Intervention: Mobile Application Platform for Pregnant Women with OUD connects participants with their care team via secure messaging, video, and phone modalities. Emphasizes a personalized care plan and educational activities.

Main Outcomes and Measures: Formulated prior to data collection. Increased maternal engagement in treatment, measured by OBGYN & MAT appointment attendance rates and decreased relapse occurrences. Improved neonatal outcomes, measured by decreased NOWS occurrences and length of NICU stays.

Results: Total 46 patients pregnant receiving treatment for opioid use disorder, 23 control and 23 interventions. No participants withdrawn. Average total number appointments in intervention (16.65, SD 6.09) statistically significantly higher than control (11.13, SD 6.56), p<0.05. Average appointments attended in intervention (15.78, SD 6.19) statistically significantly higher than control (7.65, SD 5.19), p<0.05. Median missed appointments in intervention (0, range 0.00-1.00) statistically significantly lower than control (3, range 1.00-6.00), p<0.05. Significant association (p=0.028) between control/participant and no neonatal withdrawal, participant (82.61%) vs control (52.17%).

Conclusions and Relevance: Increased intervention attendance rates show application correlated with positive maternal outcomes regarding increased participant engagement in OBGYN & OUD care. No difference in relapse rates, so cannot conclude association with intervention and mothers maintaining sobriety. Decrease in neonatal withdrawal syndrome but no difference between NICU stay lengths. This pilot study demonstrates the utility of a technology-based care coordination system for pregnant women with OUD and justifies the need for further investigation within more robust experimental and clinical settings.