202304 Screening for past alcohol drinking behavior among pregnant women

Monday, November 9, 2009

Kate Hughes , University of Pittsburgh, Pittsburgh, PA
Sara Schussler , University of Pittsburgh, Pittsburgh, PA
Diane Dado, MSW , Magee-Women's Research Institute, Magee-Women's Hospital, Pittsburgh, PA
Keri L. Rodriguez, PhD , Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System and Geriatric Research, Education, and Clinical Center, Pittsburgh, PA
Robert Arnold, MD , University of Pittsburgh School of Medicine, Pittsburgh, PA
Susan Zickmund, PhD , Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA
Kevin Kraemer, MD , University of Pittsburgh School of Medicine, Pittsburgh, PA
Doris Rubio, PhD , Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA
Judy C. Chang, MD, MPH , Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA
Background: Fetal alcohol syndrome is the leading preventable cause of mental retardation. Women with problem alcohol use prior to pregnancy are at risk for continuing alcohol use during pregnancy. Although most obstetric care providers report screening their pregnant patients for alcohol use, little is known about what questions providers use or whether they ask about past problem drinking.

Objective: To examine provider-patient screening conversations about alcohol use during the first obstetric visits.

Methods: We audio-taped and transcribed verbatim first obstetrics visits in an outpatient hospital clinic, then qualitatively analyzed them for content and process of communication. Alcohol screening discussions were categorized as past use questions, current use questions, and general questions (not specifying past or current use).

Results: Fifty-one patients and 29 obstetric care providers (21 residents, 5 midwives, 3 nurse practitioners) participated. Alcohol discussions occurred in 50 of the 51 patient visits, 94% initiated by the provider. In 19 visits (37%), the provider used general questions without specifying either past or current alcohol use (e.g., Any alcohol use?). In 19 visits (37%), the provider only asked about alcohol use during the current pregnancy (e.g., Any alcohol use this pregnancy?) and did not ask about past or even recent use. In only 10 visits (20%) did the providers explicitly ask about past alcohol drinking patterns.

Conclusion: During first outpatient visits most obstetric care providers did not specifically assess past drinking behavior. Patients with past alcohol use problems who are at risk for continued use during pregnancy are then missed.

Learning Objectives:
Describe patient-provider conversations about alcohol use in the first obstetrics visit.

Keywords: Communication, Alcohol

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I was the primary person to perform the coding and analysis, as well as the main person to summarize these findings in this abstract. I have been working as a student research assistant on this data for over a year. I first joined the research team focusing on this project on patient-provider communication during the first obstetrics visit as a part of an overview research course. Through my work coding transcripts for this study, I made the observation that obstetric care providers varied in whether and how they assessed their pregnant patient for past alcohol use. This then became the focus of my own student research project for which I led the coding and analysis under Dr. Chang’s mentorship. As part of my educational experience for this research, I have met regularly with Dr. Chang to discuss various aspects of conducting patient-provider communication research and other clinically based research. I have been given readings on various research methods, and have also read articles and other materials focusing on alcohol use during pregnancy. I gained insights from the other co-authors who all have various different expertises on the topic ranging from specialists in sociology, communication, ethics, substance use/addiction, and public health research. I am a pre-med student and being a researcher on this project has shown me the importance of research in the medical field and the valuable conclusions that are a result of this effort. My interest in research was piqued by this project and has influenced my own career plans as I am now considering a career as a physician and researcher. I have previously been involved with other research studies and my experiences were with data entry and interpretation. I have attended research symposiums and national conferences where projects I had worked on were being presented, and have observed both poster presentations and oral presentations. I created and presented a poster on some of this work for an undergraduate research symposium at the University of Pittsburgh last spring, as well.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.