In Philadelphia, Pennsylvania, rates of opioid use disorder (OUD), nonfatal overdose death, and neonatal abstinence syndrome far exceed national averages.1–3 These outcomes, which are attributed to decreased access to social support and treatment services during the perinatal period, disproportionately affect non-Hispanic Black populations.4–7
In response, the University of Pennsylvania established the Perinatal Resources for Opiate Use Disorder (PROUD) program in 2021. This co-located, multidisciplinary care model, housed in the Department of Family Medicine and Community Health is staffed by family medicine obstetrics (FMOB) and obstetrics and gynecology (OB/GYN) attending physicians with backgrounds in addiction medicine. The program has expanded perinatal OUD treatment services to include dedicated certified recovery specialists, behavioral health personnel, social workers, pharmacists, and program coordinators. PROUD engages with learners from a multitude of disciplines, further fostering interdepartmental collaboration, and represents a groundbreaking initiative to train a new generation of clinicians by bridging the gap between medical education and the urgent need for perinatal OUD care.
TYPES OF LEARNERS
In 2021, the PROMOTE program also started to train family medicine residents to address the leading contributors to health care disparities and poor maternal health outcomes including OUD. The program has had two cohorts rotate through PROUD. Additional learners include OB/GYN residents and fellows in addiction psychiatry, addiction medicine, and maternal fetal medicine. Medical students rotate through PROUD as part of the family medicine clerkship. Learners receive unique training in perinatal substance use through an innovative curriculum including direct clinical care in PROUD, didactic-based learning, and antepartum OUD consultation along with maternal fetal medicine. Several PROUD attending physicians also staff inpatient obstetrics, the newborn nursery, and addiction medicine consultations, providing continuity of teaching across multiple contexts.
NUMBER OF LEARNERS
Since the program’s inception, 12 family medicine residents on the PROMOTE obstetrics track, three OB/GYN residents, eight medical students, six psychiatry addiction medicine fellows, and two family medicine addiction medicine fellows have completed rotations in PROUD.
EVALUATION METHOD
The success of PROUD is assessed through resident performance metrics, patient outcomes, and feedback from interdisciplinary team members. Continuous improvement has been driven by regular evaluations from both learners and instructors with real-time and iterative adjustments to the curriculum.
FINDINGS
PROUD patient service use has included certified recovery specialist outreach, transportation support, and social work services. With this multidisciplinary approach the program has linked patients to inpatient substance use treatment, ongoing behavioral health treatment, and social services, most commonly housing, food, and job training support. Among patients, 68% identified as Black, indigenous, or people of color, and 76% had Medicaid insurance. To date, PROUD has supported 76 new patients and 29 deliveries and has provided care to 32 infants. The patient retention rate (defined as three or more visits) increased from 46.8% in year 1 to 76.7% in year 2.
Several learning objectives have been identified through iterative program evaluation and feedback from learners and instructors, as follows:
-
1.
Clinical competence: learning diagnosis, treatment, and management of OUD during the perinatal period.
-
2.
Interdisciplinary collaboration: fostering collaboration between family medicine, obstetrics, pediatrics, addiction medicine, behavioral health, peer support, and social work for comprehensive care.
-
3.
Harm reduction: providing education on evidence-based harm reduction strategies.
-
4.
Motivational interviews: cultivating a patient-centered approach that emphasizes empathy, cultural competence, and shared decision making to improve outcomes and reduce stigma.
-
5.
Community engagement: establishing connections with community resources and support networks to ensure continuity of care beyond the clinical setting.
PROUD represents a pioneering effort to integrate interdisciplinary OUD education into family medicine residency programs. By equipping future clinicians with the skills and knowledge needed to address the unique challenges of perinatal OUD, this initiative aims to improve maternal–child outcomes among families affected by OUD.
ACKNOWLEDGMENTS
This project was supported by the Health Resources and Services Administration (grant T34HP42132-02-01) and the Pennsylvania Department of Drug and Alcohol Programs.
CONFLICTS OF INTEREST
The authors report no conflicts of interest.
REFERENCES
- 1. Philadelphia Department of Public Health . Unintentional drug overdose fatalities in Philadelphia, 2021. . Available at: https://www.phila.gov/media/20221026113548/CHARTv7e3.pdf . Accessed November 20, 2023.
- 2. Philadelphia Department of Public Health . Improving outcomes: maternal mortality in Philadelphia. Available at: https://www.phila.gov/media/20210322093837/MMRReport2020-FINAL.pdf . Accessed November 20, 2023.
- 3.Campbell J, Matoff-Stepp S, Velez ML, Cox HH, Laughon K. Pregnancy-associated deaths from homicide, suicide, and drug overdose: review of research and the intersection with intimate partner violence. J Womens Health (Larchmt). 2021;30(2): 236–244. 10.1089/jwh.2020.8875 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Collier AY, Molina RL. Maternal mortality in the United States: updates on trends, causes, and solutions. Neoreviews. 2019;20(10):e561–e574. 10.1542/neo.20-10-e561 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Forray A, Yonkers KA. The collision of mental health, substance use disorder, and suicide. Obstet Gynecol. 2021;137(6):1083–1090. 10.1097/AOG.0000000000004391 [DOI] [PubMed] [Google Scholar]
- 6.Trost SL, Beauregard JL, Smoots AN, et al. Preventing pregnancy-related mental health deaths: insights from 14 US maternal mortality review committees, 2008–17. Health Aff (Millwood). 2021; 40(10):1551–1559. 10.1377/hlthaff.2021.00615 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Singh JA, Cleveland JD. National US time-trends in opioid use disorder hospitalizations and associated healthcare utilization and mortality. PLoS One. 2020;15(2):e0229174. 10.1371/journal.pone.0229174 [DOI] [PMC free article] [PubMed] [Google Scholar]