Objective: To identify, factors associated with obstetricians' treatment recommendations for pregnant women with an opioid use disorder (PWOUD), and to determine the prevalence of physicians waivered for buprenorphine as a medication-assisted treatment (MAT).Methods: We conducted a structured online survey of a nationally representative sample of 565 obstetrical physicians, with a response rate of 38%. Logistic regression models were derived to identify factors that influence treatment recommendations for PWOUD. The Clopper-Pearson method was used to derive the confidence interval (CI) for the number of physicians waivered for buprenorphine.Results: Approximately 77% of respondents had provided care for a PWOUD within the last year. Physicians reported that at least 75% of their PWOUD received Medicaid for prenatal care. The most common opioids used at patient presentation were prescription opioids, with the second most common being methadone. A total of 14.0% had buprenorphine waivers (95% CI: 11.6-16.7%), and among those waivered, 47% prescribed buprenorphine to PWOUD. Factors associated with buprenorphine waiver encompass referrals to community support services. The three most prominent factors associated with adherence to standard of care were: type of opioid at presentation, patient's choice, and physician's experience. Type of opioid was associated with methadone presentation, socioeconomic status, shared decision making and practice setting. Patient's choice was associated with physician preparedness and practice duration. Physician's experience was associated with referral to recovery-oriented services.Conclusions: Novel interventions are needed to (1) promote office-based treatment for opioid use disorder through continuing medical education, (2) provide physicians with access to recovery-oriented resources and (3) increase patient autonomy in healthcare decision making. These proposed evidence-based interventions will promote best practices for women and their infants and greater accessibility to standard of care.

中文翻译：

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美国在治疗阿片类药物使用障碍孕妇中与遵守护理标准相关的因素的调查。

目的：确定与阿片类药物使用障碍（PWOUD）孕妇的产科医师治疗建议相关的因素，并确定放弃丁丙诺啡作为药物辅助治疗（MAT）的医师患病率。方法：我们进行了结构化对565名全国医师的在线样本进行的在线调查，回复率为38％。得出逻辑回归模型以识别影响PWOUD治疗建议的因素。使用Clopper-Pearson方法得出放弃丁丙诺啡的医生人数的置信区间（CI）。结果：在过去一年中，大约77％的受访者提供了PWOUD护理。医生报告说，他们至少有75％的PWOUD接受了医疗补助进行产前护理。患者就诊时使用的最常见的阿片类药物为处方阿片类药物，其次是美沙酮。共有14.0％的患者接受丁丙诺啡豁免（95％CI：11.6-16.7％），其中，有47％的丁丙诺啡处方PWOUD。与丁丙诺啡豁免相关的因素包括转介到社区支持服务。遵守护理标准的三个最重要因素是：阿片类药物的表现，患者的选择和医生的经验。阿片类药物的类型与美沙酮的呈递，社会经济地位，共同的决策制定和实践环境有关。患者的选择与医师的准备和执业时间有关。医生的经验与转介面向恢复的服务有关。需要采取新的干预措施，以（1）通过持续的医学教育促进针对阿片类药物使用障碍的办公室治疗，（2）为医生提供以恢复为导向的资源，以及（3）在医疗保健决策中增加患者的自主权。这些拟议的循证干预措施将促进妇女及其婴儿的最佳做法，并使人们更容易获得护理标准。