title: Physician response to prenatal substance exposure.
abstract: OBJECTIVE
  To examine physician responses to suspected prenatal substance exposure and the reasons underlying these responses.
  
  
  METHODS
  National mail survey of practicing obstetricians and pediatricians who see neonates. Response rate: 63%.
  
  
  RESULTS
  More than 70% of physicians reported having ever suspected prenatal substance exposure. Response rates did not vary by specialty. Twenty-seven percent reported that they had never suspected prenatal substance exposure. The most common lifetime pattern (60%) was some response whenever prenatal substance exposure was suspected; next most common was no suspicion (27%). Just over 10% had a discretionary response: acting in some cases of suspected prenatal substance exposure but ignoring others. Two percent consistently ignored their suspicions. Getting help for the patient and protecting the fetus were the most common reasons to act. Among those who had ignored their suspicions, lack of sufficient evidence of substance use was the most often cited reason. There were some important specialty differences in reasons for response and non-response and in specific responses likely to be taken. Obstetricians are far more likely to provide the patient with information and get a substance use history; pediatricians are more inclined to involve outsiders.
  
  
  CONCLUSIONS
  Obstetricians and pediatricians seem quite willing to act on their suspicions of prenatal substance exposure, and generally respond by taking positive actions. Specialty differences are few and reflect practice differences.
authors.affiliation: RAND, Santa Monica, California 90407-2138, USA. zellman@rand.org
authors.forename: G L
authors.initials: GL
authors.lastname: Zellman
authors.forename: R M
authors.initials: RM
authors.lastname: Bell
authors.forename: C
authors.initials: C
authors.lastname: Archie
authors.forename: H
authors.initials: H
authors.lastname: DuPlessis
authors.forename: J
authors.initials: J
authors.lastname: Hoube
authors.forename: A
authors.initials: A
authors.lastname: Miu
mesh_terms: D001291:Attitude of Health Personnel; D005260:Female; D006801:Humans; D009774:Obstetrics; D010372:Pediatrics; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000534:rehabilitation; D011297:Prenatal Exposure Delayed Effects; D012017:Referral and Consultation; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000534:rehabilitation; D014481:United States