Functions of Interdisciplinary Primary Care Teams That Support Pregnant People With Substance Use Disorders.

Abstract

An interdisciplinary, team-based approach to delivering medical, behavioral, and supportive care can help pregnant people with substance use disorder (SUD) manage this chronic condition and care for themselves and their family. We identified the professionals, roles, and functions of these care teams. We conducted a qualitative observational study of 7 organizations that implemented team-based SUD care for pregnant people. We observed clinical team operations and conducted semistructured interviews with leaders and care team professionals. We used an inductive and comparative approach to analyze data. The organizations varied in ownership, type (medical, SUD treatment, behavioral health) and rural-urban location. We identified 14 care team functions and organized them into 5 categories: medical care, behavioral health care, coordination and resources, support and engagement, and quality improvement leadership. Clinicians (family physicians, certified nurse midwives), registered nurses, medical assistants, licensed clinical social workers, certified alcohol and drug counselors, peer support professionals, and doulas carried out these functions. All teams provided care coordination, outreach and engagement, referral to specialists, transitional care, community resource connection, social and emotional support, and advocacy functions. Of the 4 nonmedical organizations, only 2-a behavioral health organization and an SUD treatment organization-carried out the medical care functions; one had a family physician on the team. There are 14 functions that policy makers, payers, health care organization leaders, and individuals should expect from an interdisciplinary care team that is delivering whole-person SUD care to pregnant individuals. Investment in programs that train full-scope family medicine clinicians can strengthen care for people with SUD during pregnancy.