246774 Asking about Past Drug Use Among Pregnant Patients

Tuesday, November 1, 2011

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 , Magee Womens Hospital/Chang Research Group, 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 L. Rodriguez, PhD , Center for Health Equity Research and Promotion; Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, 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: Illicit drug use during pregnancy is associated with negative pregnancy, infant and maternal outcomes. Past illicit drug use is a predictor of perinatal drug use. However, little is know whether obstetric care providers screen for past drug use during clinic visits. Objective: To examine patient-provider discussions during the first obstetric visit for screening of past drug use. Methods: First obstetric visits between obstetric care providers and pregnant patients were audio-recorded. Conversations were qualitatively analyzed for drug screening questions; these questions were then categorized by whether the provider specifically asked about past or present use. 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. Providers asked specifically about current use in 78 visits (31.2%), and about past use in 60 visits (24.0%). In 143 (57.2%) visits, questioning about drug use did not specify past or current use (e.g., "Drugs?" or "Any drug use?"). Seventy-three patients (29.2%) disclosed illicit drug use. Patient disclosure of drug use was associated with questions specifying past (RR 3.30; 95% CI 2.34-4.63) or current (RR 1.99; 95% CI 1.40-2.85) use. Disclosure was less likely if the screening did not specify time of use (RR 0.34; 95% CI 0.23-0.51). Conclusion: A provider specifically asking about past and current drug use are both effective but underutilized techniques for identifying illicit drug use among pregnant patients. Providers who screen using general, nonspecific questions may be missing opportunities for intervention during the first obstetric visit.

Learning Areas:
Communication and informatics
Public health or related research

Learning Objectives:
Describe obstetric provider's screening regarding past substance use with pregnant patients.

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.