Advertisement

Reply

      We thank Eden et al for their letter regarding an oversimplification of the medical specialties categorized as primary care in our analysis. We agree that family medicine physicians, certified nurse midwives, and advanced practice providers are important providers of maternity care services, especially in rural settings, and play a critical role closing both the maternity and substance use treatment gap for pregnant and postpartum women.
      The proportion of family medicine providers providing maternity care has declined steadily over the past decade, and we were unable to account for the provision of maternity care services beyond provider specialty in our analysis.
      • Tong S.T.
      • Makaroff L.A.
      • Xierali I.M.
      • et al.
      Proportion of family physicians providing maternity care continues to decline.
      • Barreto T.
      • Peterson L.E.
      • Petterson S.
      • Bazemore A.W.
      Family physicians practicing high-volume obstetric care have recently dropped by one-half.
      Because of the limitations inherent in our claims dataset, we choose to categorize family medicine providers as primary care providers.
      Certified nurse midwives and other advanced practice providers (eg, nurse practitioners) are also important providers of both maternity care and substance use treatment services, including opioid pharmacotherapy. However, nurse practitioners and physician assistants have only been able to prescribe buprenorphine through the Comprehensive Addiction and Recovery Act since early 2017, and our analysis was limited to data from 2013–2016.
      Qualify for Nurse Practitioners (NPs) and Physician Assistants (PAs) Waiver.
      Thus, we were unable to include the important contribution from advance practice providers in our analysis.
      Given that many pregnant women with opioid use disorder continue to lack access to evidence-based medication-assisted treatment, future research is needed to further understand the gaps in the substance use treatment provider workforce including the type, frequency, and quality of clinical care services beyond pharmacotherapy provided by prescribing providers.

      References

        • Tong S.T.
        • Makaroff L.A.
        • Xierali I.M.
        • et al.
        Proportion of family physicians providing maternity care continues to decline.
        J Am Board Fam Med. 2012; 25: 270-271
        • Barreto T.
        • Peterson L.E.
        • Petterson S.
        • Bazemore A.W.
        Family physicians practicing high-volume obstetric care have recently dropped by one-half.
        Am Fam Physician. 2017; 95: 762
      1. Qualify for Nurse Practitioners (NPs) and Physician Assistants (PAs) Waiver.
        (Available at:)

      Linked Article

      • Improving treatment of opioid use disorder in pregnancy: first define the workforce
        American Journal of Obstetrics & GynecologyVol. 221Issue 4
        • Preview
          As Hollander et al1 report, the maternity care workforce in the United States has not adapted to care adequately for the growing number of pregnant women with opioid use disorder. We agree that obstetric providers could help fill a gap in opioid treatment during pregnancy, particularly in rural areas. However, we would like to draw attention to the problem of lumping a diverse group of medical specialties and provider types into a broad “primary care” category.
        • Full-Text
        • PDF