Title:

Health care providers’ roles and attitudes towards substance use disorder during pregnancy

Authors:

Margaret A. Williams, Suzanne Muir, Lauren Padalino, Brian M. Casey, William M. Perez, Sara Mazzoni, Lorie M. Harper

Background:

• Patients with substance use disorder (SUD) are vulnerable to stigmatization in the healthcare system.
• Stigma associated with SUD leads to delayed care and worse health outcomes.
• SUD during pregnancy may be associated with increased social and legal penalties including felony charges and loss of custody.
• Previous ACOG committee opinions have:
  • 1) cited the adverse health outcomes of policies used to criminalize SUD during pregnancy
  • 2) discouraged parent-child separation that is based solely on SUD
  • 3) addressed obstetrician-gynecologists’ responsibility to advocate for and refer patients to comprehensive substance misuse treatment programs

Specific Aims:

• To examine hospital staff attitudes towards SUD during pregnancy.
• To analyze differences in attitudes by staff members’ role. 

Methods:

• The Collaborative Values Inventory from the National Center on Substance Abuse and Child Welfare was distributed to inpatient and outpatient providers and staff at a tertiary care center for women and infants.
• Self-reported interaction with pregnant, postpartum, or newborn patients was a criterion for participation.
• The 57-item survey addressed drug testing, parenting, child removal/reunification, treatment/relapse, and SUD as a disease.
• Staff were classified based on their self-reported area of work:
  • 1) MD/NP
  • 2) RN
  • 3) PCT/Other: patient care technicians, surgical technicians, ultrasound technicians, respiratory therapists
  • 4) Clerical staff

• Groups were compared using chi square tests or analysis of variance (ANOVA) as appropriate.

Results:

• 942 staff received the Collaborative Values Inventory
• 237 (25%) responded
• Baseline Characteristics (Table 1)

• • The majority of respondents were female (92.8% of total), although males comprised 35% of MD/NPs.
  • The majority of respondents in the MD/NP and RN categories identified as white, whereas the majority of respondents in the PCT/Other and Clerical categories identified as black.
  • RNs reported more years of experience than MD/NPs and clerical staff. 

• Attitudes towards Drug Testing (Fig 1):

• • The majority of respondents, regardless of role, supported universal drug screening of pregnant women and infants.
  • MD/NPs were significantly less likely to support universal drug testing or to view drug screening results as the best indicator of recovery.

Figure 1

• Perception of Competency

• • The minority of MD/NPs reported competency in working with or on behalf of substance using populations (38.5%) compared to the majority of respondents in the RN, PCT/Other, and Clerical categories (71.7%, 66.7%, 52.6%).

• Parenting

• • The majority of respondents in the MD/NP, RN, and PCT/Other categories agreed that people with SUD can be effective parents, compared to a minority of clerical staff.
  • The majority of RN, PCT/Other, and Clerical staff agreed that babies who test positive for illegal drugs, or prescription medications not prescribed to their mother, should be removed from parental custody (86.7%, 91.4%, 95%), compared to a minority of MD/NPs (36.7%).

• Attitudes towards SUD Treatment (Fig 2):

• • The majority of respondents agreed that SUD is a disease.
  • MD/NPs were more likely to support pharmacotherapy for SUD during pregnancy and to recognize that treatment beyond pharmacotherapy and withdrawal management is needed.
  • The majority of respondents in a non-MD/NP role reported that pharmacotherapy for SUD is substituting one drug for another.

Figure 2

Conclusions:

• The majority of hospital staff recognized SUD as a disease.
• Responses regarding treatment highlight discrepancies in perception of the need for pharmacotherapy and indications for drug screening.
• Educational efforts should be targeted based on providers’ roles in an aim to improve uniformity around an evidence-based approach to SUD treatment during pregnancy and reduce stigma associated with SUD in pregnancy.