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BACKGROUND: • 25% of women presenting for prenatal care are using substances. • Substance Use Disorders (SUDs) in pregnancy are associated with preterm birth, intrauterine growth restriction, placental abruption, increased risk of C-section. • Infants exposed to in utero illicit substances have higher likelihood of being small for gestational age, experiencing a neonatal opioid withdrawal syndrome that requires prolonged NICU hospitalization, and are at higher risk of developmental delay. • Societal costs of SUDs in pregnancy include worsening mental illness, increased utilization of the foster care system, early death secondary to overdose, and associated financial burdens. • The nature of SUDs, and how they are perceived by society, has made it difficult for pregnant women to receive appropriate care. • Pregnant women suffering from addiction often feel they cannot trust the medical system and fear the potential loss of their infants. • There is considerable variation in the way that pregnant women with chemical dependency are treated, and most models have not been adequately studied. • Project Nurture is a novel treatment model combining prenatal care, primary care, and addiction treatment with a multidisciplinary team • Housed within Providence Milwaukie Family Medicine Residency, Project Nurture has also provided doctors in training with valuable experience caring for women and babies affected by SUDs, including: • Training in Medication Assisted Therapy • Education and experience on managing high risk pregnancy care for patients with SUDs • Caring for newborns with Neonatal Opioid Withdrawal Syndrome, both in and out of the NICU • Participating in an innovative primary care model • Pediatric primary care for infants with utero drug exposures • Managing buprenorphine induction during pregnancy • Continuity delivery experiences • Developing knowledge of community resources available to patients with SUDs
OBJECTIVES: • Assess resident interest, experience, and goals related to addiction care for pregnant women and families • Examine common primary care outcomes for women and families involved in the Project Nurture program
METHODS: 1. Pregnancy-related outcomes, social measures, and primary care outcomes were tracked for 3 years for all participating Project Nurture patients and their infants. 2. Current and former residents of Providence Milwaukie Family Medicine were surveyed on their training experience and translation to independent primary care practice. 3. Data was compiled and analyzed for review and exploration of outcomes and trends.
RESULTS: • 84% of surveyed residents indicated an interest in addiction medicine prior to entering the program. • The majority of current residents indicate that they will feel comfortable managing infants with Neonatal Opioid Withdrawal Syndrome in their future practice. • The majority of current residents indicate that they will feel comfortable addressing addiction with pregnant patients in their future practice.
• 87% of Project Nurture patients obtained long-acting contraception (Nexplanon, intrauterine device, tubal ligation). • 80% of infants born to Project Nurture were completely up to date on their recommended vaccinations. • 77% of Project Nurture patients had successfully obtained long-term custody of their infants. • 88% of Project Nurture patients were up to date on well woman care such as cervical cancer screening.
CONCLUSIONS: • Incoming residents value addiction medicine training. • Residents recognize importance of managing addiction in their future practice. • Project Nurture and other MAT models of care provide valuable training experiences. • Residents plan to care for patients and families suffering from addiction. • Resident training experiences have provided a foundation for providing addiction care in future practice.
Graduate Medical Education
Conference / Event Name
Academic Achievement Day, 2020
Providence Oregon Family Medicine Residency, Milwaukie, OR
Thomas, Roxanne; Brischetto, Brenda; Reagan, Josh; and Ruegg, Daniel, "Project Nurture: An Educational Model for Substance Use Disorder Treatment During & After Pregnancy: Saving lives, saving money, saving families, and training future doctors" (2020). Milwaukie Family Medicine. 4.