683 Healthcare access among rural-dwelling american indians and non-American Indians with opioid use disorder in pregnancy

Abstract

Opioid use disorder (OUD) in pregnancy disproportionately impacts rural and American Indian (AI) communities, but limited data are available about access to care for this population. Our objective was to examine access to care for rural-dwelling AI and non-AI pregnant individuals with OUD. We used unannounced standardized patients (USPs) to request new patient appointments by phone for AI and non-AI pregnant individuals with OUD at clinics with primary care and obstetric (OB) care services in three rural Utah counties. Distinct AI and non-AI profiles were developed to signal the USP’s identity (e.g. utilizing Indian Health Service insurance). We coded audio recordings and USP post-visit questionnaires to measure a) clinic familiarity with buprenorphine for treatment of OUD; b) OUD treatment, defined as an appointment with a buprenorphine prescriber; c) referral provision when care was unavailable; and d) availability of OUD care at referral locations. We compared outcomes for AI and non-AI USP profiles using chi-square. We made 34 calls to 17 primary care or OB clinics, 6 of which included a buprenorphine prescriber on the Substance Abuse and Mental Health Services Administration’s practitioner locator. Among clinical staff answering calls, 15 (44%) were unfamiliar with buprenorphine. OUD treatment was available in 9 calls (27%) but only offered in 5 calls (15%). Among clinics with a listed buprenorphine prescriber, OUD treatment was offered 42% of the time. Most clinics (n= 23/29, 79%) not offering OUD treatment did provide a referral; however, 60% referrals did not have a buprenorphine prescriber or were not reachable. No differences in treatment availability were observed between AI and non-AI pregnant individuals (Table). Both AI and non-AI pregnant rural-dwelling individuals with OUD experience significant barriers accessing care. Improving OUD knowledge and referrals practices among rural clinics may increase access to care for this high-risk population.