Screening, Brief Intervention, and Referral to Treatment for Prenatal Alcohol Use and Cigarette Smoking: A Survey of Academic and Community Health Care Providers

Ordean, Alice; Forte, Milena; Selby, Peter; Grennell, Erin

doi:10.1097/adm.0000000000000588

Cited by 13 publications

(19 citation statements)

References 13 publications

(22 reference statements)

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“…Additionally, using screening tools that can assess a broad spectrum of alcohol use problems (ie, mild to severe) can lead to more opportunities for clinicians to conduct appropriate brief interventions or provide referrals to treatment of the patient. A 2020 cross-sectional study surveyed family physicians, midwives, and obstetricians practicing in Canada and found that although nearly all clinicians reported screening pregnant women for alcohol use, brief interventions were not conducted as widely ( 32 ), which is consistent with the results of our analysis. USPSTF recommends that a brief intervention lasts 6 to 15 minutes and facilitates tailored feedback about the patient’s risks and potential consequences of their current drinking habits ( 23 , 33 ).…”

Section: Discussionsupporting

confidence: 83%

Screening and Brief Interventions for Alcohol Use During Pregnancy: Practices Among US Primary Care Clinicians, DocStyles 2019

et al. 2023

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Introduction Alcohol use during pregnancy can cause birth defects and developmental disabilities. From 2018 through 2020, 13.5% of pregnant women reported current drinking. The US Preventive Services Task Force recommends evidence-based tools (eg, AUDIT-C and SASQ) for implementing screening and brief interventions to reduce excessive alcohol use among adults, including pregnant people, for whom any alcohol use is considered excessive. Methods We used DocStyles 2019 data to conduct a cross-sectional analysis to examine current screening and brief intervention practices that primary care clinicians conduct among pregnant patients; clinicians’ confidence levels in conducting screening, brief interventions, and referral to treatment; and the documentation of brief interventions in the medical record. Results A total of 1,500 US adult medicine clinicians completed the entire survey. Among the respondents who conduct screening (N = 1,373) and brief interventions (N = 1,357) in their practice, nearly all reported implementing screening (94.6%) and brief interventions (94.9%) with their pregnant patients for alcohol use, but fewer than half felt confident about conducting their screening practices (46.5%). Two-thirds (64%) reported using a tool that met the criteria recommended by the US Preventive Services Task Force (USPSTF). Over half documented brief interventions in electronic health record notes (51.7%) or designated space (50.7%). Conclusion Pregnancy presents a unique opportunity for clinicians to incorporate screening into routine obstetric care and encourage behavior change among patients. Most providers reported always screening their pregnant patients for alcohol use, but fewer used evidence-based USPSTF-recommended screening tools. Increased clinician confidence in screening and brief intervention, the use of standardized screening tools tailored to pregnant people, and maximal use of electronic health record technology may enhance the benefits of their application to alcohol use, which ultimately can reduce adverse outcomes associated with alcohol use during pregnancy.

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Section: Discussionsupporting

confidence: 83%

Screening and Brief Interventions for Alcohol Use During Pregnancy: Practices Among US Primary Care Clinicians, DocStyles 2019

et al. 2023

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“…A survey of midwives from East of England showed that 60% routinely enquired about alcohol but only 29% routinely provided alcohol advice (Winstone & Verity, 2015). Similar findings were reported in a study of 118 healthcare professionals including midwives carried out in Canada (Ordean et al, 2020). Despite other studies in Norway, Australia and England reporting almost all midwives ask about alcohol and advise abstinence in line with the guidelines; fewer do so after the initial booking appointment and many do not use a validated alcohol screening tool to do so (Schölin et al, 2021; Smith, Dyson, et al, 2021).…”

Section: Introductionsupporting

confidence: 90%

Midwives and service users' perspectives on implementing a dialogue about alcohol use in antenatal care: A qualitative study

Dyson

Onukwugha

Howlett

et al. 2023

Journal of Advanced Nursing

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Aim There are barriers to midwives engaging in conversations about alcohol with pregnant women. Our aim was to capture the views of midwives and service users to co‐create strategies to address these barriers. Design Qualitative description. Methods Structured Zoom‐based focus group interviews of midwives and service users where we presented known barriers and sought solutions to midwives discussing alcohol use in antenatal settings. Data collection took place between July and August 2021. Results Fourteen midwives and six service users attended five focus groups. Barriers considered were as follows: (i) lack of awareness of guidelines, (ii) poor skills in difficult conversations, (iii) lack of confidence, (iv) lack of belief in existing evidence, (v) women would not listen to their advice, and (vi) alcohol conversations were not considered part of their role. Five strategies to address barriers to midwives discussing alcohol with pregnant women were identified. These were as follows: Training that included mothers of children with Foetal Alcohol Spectrum Disorder, champion midwives, a service user questionnaire about alcohol for completion before the consultation, questions about alcohol added to the maternity data capture template and a structured appraisal to provide a means of audit and feedback on their alcohol dialogue with women. Conclusions Co‐creation involving providers and users of maternity services yielded theoretically underpinned pragmatic strategies to support midwives to ask advise assist about alcohol during antenatal care. Future research will test if the strategies can be delivered in antenatal care settings, and if they are acceptable to service providers and service users. Impact If these strategies are effective in addressing barriers to midwives discussing alcohol with pregnant women, this could support women to abstain from alcohol during pregnancy, thus reducing alcohol‐related maternal and infant harm. Patient and public contribution Service users were involved in the design and execution of the study, considering data, supporting intervention design and delivery and dissemination.

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“…Technology provides an exciting option. It can be implemented consistently across patients, with minimal staff involvement, and conducted during natural waiting periods, integrating easily within the workflow of the clinic [ 17 - 19 ]. It has also been shown to improve disclosure of substance use in anonymous studies [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

Risk Identification in Perinatal Health Care Settings via Technology-Based Recruitment Methods: Comparative Study

Beatty,

Zelenak,

Gillon

et al. 2024

JMIR Form Res

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Background Digital screening and intervention tools have shown promise in the identification and reduction of substance use in health care settings. However, research in this area is impeded by challenges in integrating recruitment efforts into ongoing clinical workflows or staffing multiple study clinics with full-time research assistants, as well as by the underreporting of substance use. Objective The aim of the study is to evaluate pragmatic methods for facilitating study recruitment in health care settings by examining recruitment rates and participant characteristics using in-person–based versus flyer approaches. Methods This study compared recruitment rates at a Women’s Health clinic in the Midwest under 2 different recruitment strategies: in person versus via a flyer with a QR code. We also examined the disclosure of substance use and risk screener positivity for the 2 strategies. We also obtained information about the current use of technology and willingness to use it for study participation. Results A greater percentage of patients recruited in person participated than those recruited via flyers (57/63, 91% vs 64/377, 17%). However, the final number recruited in each group was roughly equal (n=57 vs n=64). Additionally, participants recruited via flyers were more likely to screen positive for alcohol use risk on the Tolerance, Annoyed, Cut Down, Eye-Opener alcohol screen than those recruited at the clinic (24/64, 38% vs 11/57, 19%; χ21=4.9; P=.03). Participants recruited via flyers were also more likely to screen positive for drug use risk on the Wayne Indirect Drug Use Screener than those recruited at the clinic (20/64, 31% vs 9/57, 16%; χ21=4.0; P=.05). Furthermore, of the 121 pregnant women, 117 (96.7%) reported owning a smartphone, 111 (91.7%) had an SMS text message plan on their phone, and 94 (77.7%) reported being willing to receive SMS text messages or participate in a study if sent a link to their phone. Conclusions The distribution of flyers with a QR code by medical staff appears to be an efficient and cost-effective method of recruitment that also facilitates disclosure while reducing the impact on clinic workflows. This method of recruitment can be useful for data collection at multiple locations and lead to larger samples across and between health systems. Participant recruitment via technology in perinatal health care appears to facilitate disclosure, particularly when participants can learn about the research and complete screening using their own device at a place and time convenient for them. Pregnant women in an urban Midwestern hospital had access to and were comfortable using technology.

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Screening, Brief Intervention, and Referral to Treatment for Prenatal Alcohol Use and Cigarette Smoking: A Survey of Academic and Community Health Care Providers

Cited by 13 publications

References 13 publications

Screening and Brief Interventions for Alcohol Use During Pregnancy: Practices Among US Primary Care Clinicians, DocStyles 2019

Screening and Brief Interventions for Alcohol Use During Pregnancy: Practices Among US Primary Care Clinicians, DocStyles 2019

Midwives and service users' perspectives on implementing a dialogue about alcohol use in antenatal care: A qualitative study

Risk Identification in Perinatal Health Care Settings via Technology-Based Recruitment Methods: Comparative Study

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