FY19-20 Maternal Fetal Telemedicine Services

The epidemic of substance use has been a focus of several public health initiatives in Kentucky with limited, but select tangible successes. The problem is dramatic in the Commonwealth with the state consistently ranking in the top 5 for adverse outcomes including overdose deaths (Rudd et al,1 see Figure 1). However, the rate of increase in mortality in Kentucky is lower than several neighboring states suggesting some beneficial strategies are being implemented. Enhancing access to evidence-based strategies is difficult in the Appalachian region, given the distance to specialist care and the need for multi-disciplinary approaches for this population. Particular rural counties in the state remain hardest impacted by the opioid epidemic, see Figure 2. These areas are served by regional hospital networks and the University of Kentucky. Partnering with the state, the University of Kentucky has attempted to increase its capacity to provide evidence-based treatment strategies for patients with opioid use disorders. One area of shared interest is the pregnant population. Pregnant women have historically undergone a detoxification approach for the management of this condition at our institution until three-years ago when a multispecialty group was formed to provide additional supportive, evidence-based approaches. The purpose of this proposal is to expand access to the expertise of our multi-dimensional approach to substance use disorders in pregnancy into areas of the state most impacted by the epidemic. Although treatment programs have expanded in Appalachia, pregnancy unfortunately has been a subpopulation excluded by many providers due to fears related to treatment-associated adverse outcomes. Exclusion of the pregnant population negates the potential maternal benefit for access to therapy as pregnancy represents a time-in-life for motivational change.2 In addition, fetal, neonatal, and infant outcomes can be improved by engaging this population. Particular outcomes which will be targeted include a reduction in preterm birth, fetal growth restriction, and reduction in NAS which can be facilitated by better surveillance of pregnancy through patient engagement and application of standardized neonatal assessments and treatments. At the University of Kentucky, we are also interested in studying the effect of substance use disorders on fetal developmental programming, which has life-long implications. Our multi-specialty team of social work, peer support, Maternal Fetal Medicine specialists, Addiction Medicine specialists, and Neonatologists attempts to address specific needs related to treatment in pregnancy. This program, entitled PATHways, has a home at the Polk-Dalton Clinic of University of Kentucky. The treatment program primarily serves women from the Bluegrass Region and is designed as a two-year intervention addressing the continuum of need related to pregnancy, new motherhood, and infancy. Our goal is to enhance connections to providers across Appalachia in Kentucky and Eastern West Virginia to improve short-term and long-term outcomes related to this population.