246681 Obstetric care providers' screening for illicit drug use during pregnancy

Tuesday, November 1, 2011: 4:50 PM

Judy C. Chang, MD, MPH , Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA
Cynthia Holland, MPH , Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh Medical Center, Pittsburgh, PA
Meghan K. Schwab, MPH , Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA
Diane Dado, MSW , Magee-Women's Research Institute, Magee-Women's Hospital, Pittsburgh, PA
Kevin Kraemer , University of Pittsburgh School of Medicine, Pittsburgh, PA
Doris Rubio, PhD , Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA
Keri Rodriguez, PhD , Pittsburgh Healthcare System and Geriatric Research, Education, and Clinical Center, Pittsburgh, PA
Nancy Day, PhD , Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
Robert Arnold, MD , University of Pittsburgh School of Medicine, Pittsburgh, PA
     
Background: Identifying illicit drug use during pregnancy is the first step toward intervention and preventing the negative consequences of perinatal drug use. However, little is known about how obstetric care providers screen for illicit drug use and what methods of questionning elicits more disclosure.

Objective: To examine patient-provider illicit drug use screening conversations during the first obstetric visit.

Methods: Audio-recordings of patient-provider conversations during the first obstetric visit were qualitatively analyzed for drug screening questions; these questions were categorized by whether they were: 1) detailed (e.g. naming specific drugs), 2) general (e.g., "Any drugs?") and 3) if the provider asked about illicit drugs with more than one question.

Results: Two-hundred fifty patients and 56 obstetric care providers participated. In 224 visits (89.6%) providers screened for illicit drug use in some manner. Seventy-seven patients (31.7%) disclosed illicit drug use. Drug use disclosures were more likely when providers' screening was: 1) detailed (RR 2.12, 95% CI 1.57-3.04) and 2) repeated (RR 2.73, 95% CI 1.93-3.84). A provider asking about drug use using very general questioning was less likely to result in a patient's drug use disclosure (RR 0.39, 95% CI 0.28-0.55).

Conclusion: Identification of illicit drug use during pregnancy may increase if obstetric care providers use more detailed questions and repeated questioning to screen their pregnant patients.

Learning Areas:
Communication and informatics
Public health or related research

Learning Objectives:
Discuss illicit drug use screening styles used during the first obstetric appointment. Identify screening methods that elicit disclosure of illicit drug use during the first obstetric appointment.

Keywords: Maternal Health, Substance Abuse Assessment

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present because I am the prinicipal investigator of the project from which the data presented was collected. The project researched patient-provider communication about substances. I am also a practicing obstetric care provider who is committed to providing the best possible prenatal care to women.
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.

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