Reproductive-Age Women's Experience of Accessing Treatment for Opioid Use Disorder: “We Don't Do That Here”



      For reproductive-age women, medications for opioid use disorder (OUD) decrease risk of overdose death and improve outcomes but are underutilized. Our objective was to provide a qualitative description of reproductive-age women's experiences of seeking an appointment for medications for OUD.


      Trained female callers placed telephone calls to a representative sample of publicly listed opioid treatment clinics and buprenorphine providers in Florida, Kentucky, Massachusetts, Michigan, Missouri, North Carolina, Tennessee, Virginia, Washington, and West Virginia to obtain appointments to receive medication for OUD. Callers were randomly assigned to be pregnant or non-pregnant and have private or Medicaid-based insurance to assess differences in the experiences of access by these characteristics. The callers placed 28,651 uniquely randomized calls, 10,117 to buprenorphine-waivered prescribers and 754 to opioid treatment programs. Open-ended, qualitative data were obtained from the callers about the access experiences and were analyzed using a qualitative, iterative inductive-deductive approach. From all 28,651 total calls, there were 17,970 unique free-text comments to the question “Please give an objective play-by-play of the description of what happened in this conversation.”


      Analysis demonstrated a common path to obtaining an appointment. Callers frequently experienced long hold times, multiple transfers, and difficult interactions. Clinic receptionists were often mentioned as facilitating or obstructing access. Pregnant callers and those with Medicaid noted more barriers. Obtaining an appointment was commonly difficult even for these persistent, trained callers.


      Interventions are needed to improve the experiences of reproductive-age women as they enter care for OUD, especially for pregnant women and those with Medicaid coverage.
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      Julia C. Phillippi PhD, CNM, is an Assistant Professor at Vanderbilt University School of Nursing and a Certified Nurse-Midwife at Vanderbilt University Medical Center. Her research focuses on access to perinatal care.


      Rebecca Schulte, BA, is a health research assistant. She is currently pursuing her MPH with a concentration in epidemiology. Her research interests include physical activity, nutrition, and chronic disease prevention and the impacts of social determinants on health.


      Kemberlee Bonnet, MA, is a social scientist and the Vanderbilt University Qualitative Research Core coordinator. Her background is in social psychology, and she is experienced in community-based recruitment, focus group development and facilitation, conducting one-on-one and group interviews, and qualitative data analysis.


      David G. Schlundt, PhD, is an Associate Professor of Psychology at Vanderbilt University and is the director of the Vanderbilt Qualitative Research Core. His research has focused broadly on health and behavior in diabetes, obesity, heart disease, and cancer.


      William O. Cooper, MD, MPH, Cornelius Vanderbilt Professor of Pediatrics and Health Policy at Vanderbilt University School of Medicine, is a practicing pediatrician and conducts research on safety of prescription medications during pregnancy for pregnant women and their infants.


      Peter R. Martin, MD, MSc, is Professor of Psychiatry and Behavioral Sciences and Pharmacology and an addiction psychiatrist at Vanderbilt University Medical Center. His research includes the molecular basis, diagnosis, and treatment of drug use disorders and substance-induced mental disorders.


      Katy Backes Kozhimannil, PhD, MPA, is Professor at the University of Minnesota School of Public Health and Director of the University's Rural Health Research Center. Her research contributes evidence for clinical and policy strategies to advance racial, gender, and geographic equity.


      Stephen W. Patrick, MD, MPH, MS, is the Director of the Vanderbilt Center for Child Health Policy, Associate Professor of Pediatrics and Health Policy and a neonatologist at Vanderbilt University Medical Center. His research focuses on improving outcomes for pregnant women and infants affected by the opioid crisis.