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Introduction: Existing literature about student-run clinics (SRCs) often focuses on student rather than patient experiences. To begin to gather data on norms and practices at SRCs nationally, this pilot study surveyed faculty leaders from SRCs around the country about metrics such as clinic organization, patient demographics, and care services. Methods: A 38-question survey was distributed via email to members of the Student Run Free Clinic Faculty Association (SRFCFA) in October 2021. All responses were collected electronically via Qualtrics survey software. Results: Most SRCs are held at least once weekly in variable physical locations. All SRCs surveyed use an electronic medical record. Student leadership typically rotates annually. Preceptors skew towards generalists rather than specialists. Clinics have variable patient volumes but see majority uninsured and non-English-speaking patient populations. Responses about consistency of result communication, follow-up visits, referrals to specialty care, and management of high-risk patients were mixed. The majority of respondents did not feel that learner experience was prioritized over patient care. Conclusion: The design and operations of SRCs nationwide is variable and not standardized. There remains a limited understanding of patient experiences and patient-centered outcomes at SRCs, and thus it is difficult to guide best practices. Future efforts to collect patient perspectives and outcomes should be emphasized given the vulnerable populations these clinics serve.
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OBJECTIVE: Although naltrexone is an evidence-based medication for opioid use disorder (MOUD), few data are available with use in pregnancy. Our objective was to assess outcomes of pregnant individuals with opioid use disorder (OUD) taking naltrexone compared with those taking methadone or buprenorphine. DATA SOURCES: We undertook a systematic review using electronic database search (PubMed, CINAHL, EMBASE, PsycInfo), conference proceedings, and trial registries including ClinicalTrials.gov . METHODS OF STUDY SELECTION: We conducted an electronic search of research articles through May 2023 for randomized controlled trials, prospective cohort, and retrospective cohort studies of naltrexone (oral, implant, or extended release) compared with methadone or buprenorphine (sublingual or extended release) among pregnant individuals with OUD. After double review of all articles, we abstracted obstetric (primary outcome: gestational age at delivery), neonatal (primary outcome: neonatal abstinence syndrome [NAS]), and substance use outcomes. TABULATION, INTEGRATION, AND RESULTS: Five studies met eligibility criteria; four were retrospective cohort studies, and one was a prospective cohort study. Four studies included data on gestational age at delivery (weeks) with no difference detected between the two groups in any study (mean difference ranging -0.20, 95% CI, -1.49-1.09 to 0.8, 95% CI, -0.15 to 1.75). Three studies included data on NAS with all studies detecting a lower risk in the naltrexone group compared with methadone or buprenorphine (relative risk ranging from 0.08, 95% CI, 0.01-1.16 to 0.15, 95% CI, 0.06-0.36). Most studies (four of five) had a moderate or high potential for selection bias primarily driven by small sample size and lack of controlling for confounders. CONCLUSION: Although the evidence base is limited, available data suggest that naltrexone use in pregnancy is a reasonable MOUD option with reassuring perinatal outcomes. To enhance confidence in this conclusion and to assess substance use outcomes, further comparative studies of pregnant people with OUD taking naltrexone and other MOUD types are needed. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, 42017074249.
