Date of Award

January 2025

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Ariadna Forray

Abstract

The goal of this project was to compare the provider-patient relationship among pregnant patients with opioid use disorder (OUD) who did or did not have a history of moderate to severe trauma. The hypothesis was that patients with a trauma history would self-report worse relationships with their providers. This was an exploratory analysis of data from 169 patients enrolled in the Support Models for Addiction Related Treatment (SMART) trial. Trauma history, defined as probable post-traumatic stress disorder (PTSD), was determined by a score ≥31 on the PTSD Checklist for DSM-5 (PCL-5). The provider-patient relationship, collected at 26±4 weeks of pregnancy, was assessed using the Kim Alliance Scale (KAS). Multivariable regression was used to examine the association of KAS with probable PTSD among pregnant people with OUD. The mean KAS score for pregnant participants without trauma history (N=122) was 60.4 (SD±5.4) and for pregnant participants with trauma history (N=47) was 60.8 (SD±4.2), indicating strong provider-patient relationships across the group. Results did not demonstrate significant differences in KAS scores between those with and without probable PTSD, both between raw means and after adjusting for demographic variables. KAS scores were significantly higher among White participants compared to non-White participants, and significantly lower among participants who reported alcohol use during pregnancy compared to those who did not. Analyses do not show an association between trauma history and provider-patient relationship among pregnant patients with OUD. The unexpectedly high scores on the KAS, as well as the lack of significant differences in scores between those with and without a trauma history, may indicate that the provider-patient relationship is modified or mediated by other individual-, provider-, or site-specific factors. The significant differences in ratings of the provider-patient relationship by race and alcohol use status may reflect broader systemic inequalities and biases in healthcare.

Comments

This is an Open Access Thesis.

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