Provider–patient relationships and trauma among pregnant patients with opioid-use disorder

IF 2.5 4区 医学 Q2 SUBSTANCE ABUSE
Molly Doernberg MPH, Kathryn Gilstad-Hayden PhD, Kimberly A. Yonkers MD, Ariadna Forray MD
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引用次数: 0

Abstract

Background and objectives

The provider–patient relationship is integral to medical practice and health outcomes, particularly among vulnerable patient populations. This study compared the provider–patient relationship among pregnant patients with opioid-use disorder (OUD), who did or did not have a history of moderate to severe trauma.

Methods

This was an exploratory data analysis of 119 patients enrolled in the Support Models for Addiction Related Treatment trial. Probable posttraumatic stress disorder (PTSD) was determined by a score ≥ 31 on the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. The provider–patient relationship was assessed at 26 ± 4 weeks of pregnancy using the Kim Alliance Scale (KAS). Multivariable regression was used to examine the association of KAS with probable PTSD among pregnant people with OUD.

Results

The mean KAS score for pregnant participants without probable PTSD (N = 88) was 61.4 (SD ± 2.8) and for pregnant participants with probable PTSD (N = 31) was 59.6 (SD ± 3.7). Results demonstrated significant differences in KAS scores between those with and without probable PTSD after adjusting for demographic variables. Adjusted mean total KAS scores and scores on Empowerment and Communication subscales were significantly lower among those with probable PTSD compared to those without (p = .04 and 0.02, respectively) but did not differ significantly on Collaboration and Integration subscales.

Conclusions and scientific significance

Analyses show an association between probable PTSD and provider–patient relationship among pregnant patients with OUD, with those with probable PTSD having a worse alliance with obstetric providers. This novel finding helps characterize the provider–patient relationship among a uniquely vulnerable population and can inform efforts to integrate trauma-informed practices into prenatal care.

阿片类药物使用失调症孕妇患者的医患关系和心理创伤。
背景和目标:医疗服务提供者与患者之间的关系是医疗实践和健康结果不可或缺的一部分,尤其是在弱势患者群体中。本研究比较了有或没有中重度创伤史的阿片类药物使用障碍(OUD)孕妇患者的医患关系:这是对 119 名参加 "成瘾相关治疗支持模式 "试验的患者进行的探索性数据分析。根据《精神疾病诊断与统计手册》第五版创伤后应激障碍核对表的评分≥31分,确定可能患有创伤后应激障碍(PTSD)。在怀孕 26±4 周时,使用金氏联盟量表(KAS)对医患关系进行评估。采用多变量回归法研究了 KAS 与患有 OUD 的孕妇中可能出现的创伤后应激障碍之间的关系:无可能患有创伤后应激障碍的孕妇(88 人)的平均 KAS 得分为 61.4(SD ± 2.8),有可能患有创伤后应激障碍的孕妇(31 人)的平均 KAS 得分为 59.6(SD ± 3.7)。结果表明,在对人口统计学变量进行调整后,患有和未患有可能的创伤后应激障碍的孕妇的 KAS 得分存在明显差异。与无创伤后应激障碍者相比,可能患有创伤后应激障碍者的调整后平均 KAS 总分以及赋权和沟通分量表得分明显较低(p = .04 和 0.02,分别为 0.04 和 0.02),但在协作和融合分量表上没有明显差异:分析表明,在患有 OUD 的孕妇中,可能患有创伤后应激障碍的患者与提供者和患者之间的关系存在关联,其中可能患有创伤后应激障碍的患者与产科提供者之间的关系较差。这一新颖的发现有助于描述产科服务提供者与患者之间的关系,并为将创伤知情实践纳入产前护理提供参考。
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来源期刊
CiteScore
5.00
自引率
0.00%
发文量
118
期刊介绍: The American Journal on Addictions is the official journal of the American Academy of Addiction Psychiatry. The Academy encourages research on the etiology, prevention, identification, and treatment of substance abuse; thus, the journal provides a forum for the dissemination of information in the extensive field of addiction. Each issue of this publication covers a wide variety of topics ranging from codependence to genetics, epidemiology to dual diagnostics, etiology to neuroscience, and much more. Features of the journal, all written by experts in the field, include special overview articles, clinical or basic research papers, clinical updates, and book reviews within the area of addictions.
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