Fetal Alcohol Syndrome

1. Fetal Alcohol Syndrome A National Survey of Health Professionals presented by Margaret Clarke MD & Suzanne Tough PhD funded by Health Canada

2. National SurveyPurpose • Obtain information about current knowledge and attitudes towards FAS • Identify areas appropriate for policy development and education for health professionals • Provide baseline national information for determining impact of education

3. Why a National Survey? • Physician Surveys • 1991 in Saskatchewan • 1998 in Alberta • Revealed substantial variation in familiarity and clinical practice with regard to FAS and alcohol use during pregnancy

4. Overall Methods • Proposal developed • Submitted to Ethics at U of C • Questionnaire developed and endorsed • Questionnaire pilot tested with physicians • Mailing lists obtained, incentive approved • Programmed for Teleform and Internet • Mail out, follow up, scanning, analysis

5. Administrative Methods • Proposal submitted to Health Canada to replicate survey nationally • Health Canada convened National Advisory Committee on FAS • Health Canada arranged meetings with professional groups and all groups approved having survey sent out to their membership

6. National Advisory Committee • Research team met with National Advisory Committee regarding • endorsement of questionnaire • health disciplines to be included • discussion of methodology • physician incentives • CME credits • Web based survey • Time lines: 10 weeks

7. Questionnaire Categories • General Knowledge and Attitudes -10 questions, all participants • Prevention Issues • 14 questions, Family Physicians, OBGYN, Midwives • Diagnostic Issues • 16 questions, Pediatricians, Psychiatrists, Family Doctors and Midwives • Demographics • 10 questions, all participants

8. Survey package: Methods • Survey introduced on organization letter head-endorsed • photo copy signature of Organizational ‘head’ • original signature of study investigators • incentive: palm pilot draw • return envelope with stamp

9. Final Response Rates

10. Response Rate by Region

11. Response Rate By Professional Group

12. Drinking Patterns and Attitudes

13. Recent Data • 60-75% consumption in all women 18-34 • 25% of women feel moderate or social drinking OK during pregnancy • Up to 25% report drinking during pregnancy- variability in range from 16-25% in Canada (when children are age 3) • Increased rate of frequent and binge drinking in pregnancy noted in last decade in US and Canada • Recent study (Jacobson 2002) – reported that women reported more alcohol consumption retrospectively than during pregnancy

14. Overview of Knowledge and Practice of Canadian Health Providers (All Groups)

15. Canadian Health Providers Attitudes Towards Moderate Alcohol Consumption (All Groups) • Accepted definition is less than 2 per day (4 drinks per occasion) for women or less than 14 per week • 91% of Health providers identified less than 2 drinks per occasion -up to 14 drinks per week and 75% identified 3 or fewer drinks per week • Implication: Health providers are advising “in moderation" and not defining actual amounts of alcohol intake – in present survey less 50% of health providers frequently discussed with the patient what in moderation meant

16. When Do Canadian Health Providers Discuss Risks of Alcohol Consumption During Pregnancy?

17. Survey Results: Family Physicians, Midwives and Obstetricians • Prior to pregnancy 40% discuss the risks of alcohol use and impact on fetus • 94% ask about alcohol consumption once the women is pregnant (then 86% ask if the woman drank prior to pregnancy) • 88% recommend no alcohol during pregnancy (79% of midwifes,84%ObGyn,90% family physicians)

18. What are Barriers to Discussing Alcohol with Women of Childbearing Age? • Time –overall 58% key barrier for family physicians and obstetricians • Information not in a useful form (49%) • Perception that clients already have good knowledge (43% -overall) midwifes 72% • Perceived lack of interest on the part patient (31%)

19. Prevention Practices: Family Dr, Midwives, Obstetricians

20. How Do Canadian Health Providers Determine Level of Risk of Drinking During Pregnancy? • 62% used a standard tool (the most common CAGE) – 74% of Family Doctors versus 45% Obstetricians and 20% of Midwives • Practitioners using screening tools were under 49 years and were far more likely to live in Quebec • Use of screening tool were also more likely to obtain history of addictions , alcohol use and family history of addictions • Binge drinking pattern was recognized as a risk by 73% of providers

21. Practices with Women Found to be Drinking During Pregnancy FOR MODERATE DRINKERS • 65% always discuss the adverse effects of alcohol • 70% always advise to abstain • 12% refer to treatment FOR BINGE OR HEAVY DRINKERS • 88% discussed adverse effects • 85% always advise to abstain • 53% refer to treatment • Most practitioners accurately identify the complex social and psychological barriers to treatment access

22. Provider Preparedness – All Groups Who Reported Caring for Pregnant Women with Addictions of Birth Mother

23. Diagnosis Overview (All Groups) • FAE term is poorly understood across professional groups • 70% identified FAE as a partial expression of FAS • 40% recognized that FAE does not result in better social outcome • 14% recognized that FAE is not a less severe form of FAS

24. Provider Diagnosis

25. Provider Diagnosis

26. Secondary Disabilities

27. What Supports Do Canadian Providers Perceive As Helpful? • More than 60% identified registry of specialists for consultation, referral resources and clinical practice guidelines • Only 25% wanted training in addictions counseling, assistance with diagnosis or access to information via telemedicine

28. Alberta Comparison

29. Summary • Preliminary results indicate improved understanding of FAS • Feel time is limitation to discussing alcohol before pregnancy, while training is limitation to diagnosis • Missed opportunities in prevention? • Only half prepared to care for women with pregnant women with addictions

30. Summary • Educational initiatives which can target needs of physicians and midwives in both prevention and diagnosis of FAS • Access to resources and counseling tools for physicians and midwives to assist pregnant women who are found to be drinking • Better tools to provide anticipatory guidance to all women of childbearing age

31. Next Steps • Development of a plan for educational initiatives within and between professional organizations • Prevention curriculum at medical school level with a specific focus on drugs and alcohol as well as broader social determinants • Standardized training in FAS diagnosis • Research and evaluation regarding effectiveness of prevention and intervention strategies

32. Figure 2Percentage of Movies and Songs Associating Alcohol/Drugs With: Wealth or luxury Wealth or luxury Sexual activity Sexual activity Crime or violence Crime or violence Movies Popular Songs Anti-use statement Anti-use statement Refusal to use Refusal to use Pro-use statement or advocacy of use Pro-use statement or advocacy of use No consequence to user No consequence to user Based on the 33 movies and 156 songs that portrayed alcohol/drug use.