PATHHome: Randomized Clinical Trial of Telehealth Versus Group Care to Improve Maternal Engagement in Women With Perinatal Substance Use Disorder [ID 1063]

INTRODUCTION: Kentucky reports some of the highest rates of perinatal substance use disorder (PSUD) nationwide, concentrated in Appalachia. We compared two education-based interventions to engage women in their prenatal and recovery care. METHODS: We conducted a cluster randomized controlled clinical trial across 13 clinical sites. We compared Telehealth versus In-person Group to deliver a pregnancy education recovery curriculum to women with PSUD on medication for opioid use disorder (MOUD). Educational sessions were every 2 weeks. Prenatal and MOUD care were provided by the community provider. Engagement measures: appropriate urine drug screen (UDS) at delivery, percent of prenatal visits and intervention sessions attended, and MOUD visits attended. RESULTS: From March 2018 to October 2023, 269 women, 82 in Telehealth and 187 in Group, were enrolled. Although baseline demographics were similar between arms, three clinical covariates were different. More women in Telehealth started MOUD prior to pregnancy (69.6% versus 52%, P =.015). Fewer women in Telehealth experienced a relapse during pregnancy (17.7% versus 41.7%, P =.0003) or experienced lifetime incarceration (49.4% versus 65.1%, P =.0314). There were no differences between arms regarding maternal engagement: appropriate UDS at delivery (Group 77.1%, Telehealth 64.6%; odds ratio 1.1; CI, 0.38–3.43; generalized linear mixed model P =.8087), prenatal visits (Group 67.4±2.3%, Telehealth 71.6±3.4%; linear mixed model [LMM] P =.9882), intervention sessions (Group 46.9±2.6%, Telehealth 50.3±3.6%; LMM P =.7418), and MOUD visits (Group 8.78±0.67, Telehealth 12.38±1.75; LMM P =.2523). CONCLUSIONS/IMPLICATIONS: Telehealth and Group are equally effective in engaging women in their pregnancy and recovery care. Health systems should consider expanding Telehealth to improve access for complex rural patients and providers, improving perinatal outcomes.