Healthcare Providers and Folic Acid

1. Healthcare Providers and Folic Acid Results of a 2002 survey assessing obstetric-gynecology and family practice physicians’ awareness and practices regarding folic acid

2. Results from Gallup Survey • 2004 women • January/February 2002

3. Things Women Reported Might Encourage them to Take a Multivitamin DailyMarch of Dimes Folic Acid Survey, 2002

4. Results from Physician Survey • 362 OB/GYN’s • 249 FP’s • June/July 2002

5. Perceived Nutrient Requirements forNon-Pregnant Woman of Childbearing Age Q. 10 “How much [of nutrient] should a typical non-pregnant woman of childbearing age consume daily?” Note: Correct RDA responses are outlined. Asterisked (*) categories include a small number of verbatim responses that were close to, but different from, the pre-coded categories listed in the chart.

6. Perceived Recommended PreconceptionalFolic Acid Dose for NTD Patients Q. 21 “To the best of your knowledge, what is the recommended preconceptional daily dose of folic acid for women who have had a pregnancy affected by NTD?”

7. Perceived Benefits of Folic Acid Q. 14 “Please tell me whether each statement is true or false, or if you are not sure.” Note: Correct responses are outlined.

8. Optimal Time for Starting Folic Acid Q. 18 “When should women begin to take folic acid, to prevent neural tube defects?”

9. Preconceptional Care • On average, those physicians who provide any prenatal care see 20% (FPs: 21%) of all their prenatal patients for a preconceptional care visit prior to their pregnancy. Q. 8 “Thinking about all of the women you see for prenatal care, what percentage did you see for a preconceptional care visit prior to their pregnancy?”

10. Perceived Percentage of Unintended Pregnancies Q. 19 “To the best of your knowledge, about what percentage of all pregnancies in the US are unintended?” Correct response (“about 50%”) is outlined.

11. When Do Physicians Recommend Multivitamins/Folic Acid? Q. 15 “In your practice, do you always, usually, occasionally, or never recommend multivitamins or folic acid supplementation:…?”

12. Patient-Initiated Inquiries • Almost all respondents (80% of OB/GYNs and 92% of FPs) report that less than one-quarter of their patients bring up the issue of folic acid on their own.

13. Issues Addressed at Annual Well-Woman Exam Q. 7 “Which issues do you always, usually, occasionally, or never address at an annual well-woman exam with a woman of reproductive age, that is, under age 45?”

14. Reasons Physicians Don’t Always Recommend Folic Acid or Multivitamins • Both OB/GYNs and FPs cite lack of knowledge (~40%) and lack of time (30%) as the primary reasons that some physicians may not address folic acid with all women of childbearing age. • Physicians note a need for more knowledge or information about folic acid, nutrition, and unintended pregnancy.

15. Preferred Information Sources • Each physician identified up to two types of medical information resources that would be effective at reaching him/her with information about folic acid. • Medical journals are the most popular information source, attracting the attention of two-thirds of the OB/GYNs and FPs. • Much smaller segments express a preference for obtaining information through medical associations or medical conferences (10%-12% each), the Internet (6%-7%), or any other modality. Q. 22 “What sources of medical information would be most effective at reaching you with information about folic acid?”

16. Resources Needed for Patients • Physicians were asked to identify up to two types of resources he/she would like to have to promote folic acid intake among patients. • Tangible printed materials were the most popular request. • 57% of OB/GYNs and 66% of FPs requested patient brochures. • Additional resources requested include posters and charts, articles, Spanish and other non-English-language publications, and handouts or literature for patients. Q. 23 “What resources would you like to have to promote preconceptional folic acid intake in your female patients of reproductive age?”

17. Summary: Understanding of Folic Acid • While physicians universally understand the role of folic acid in preventing some birth defects, only one-half are aware of the RDA for a typical non-pregnant woman of child-bearing age (that is, one with no other conditions or risk factors that would warrant additional folic acid).

18. Summary: Timing of Folic Acid • Although physicians understand the need for women to take folic acid prior to becoming pregnant, in practice they seldom take the initiative to recommend folic acid except after conception. • Many are not aware of the high percentage of unintended pregnancies. • Only one-fifth initiate preconceptional care visits.

19. Summary: Prevention or Well-Woman Care • Folic acid supplementation (including multivitamins) is low among many competing priorities for physicians during the provision of preventive or well-woman care. • Both lack of information and lack of time during a busy exam schedule are major factors that prevent physicians from addressing folic acid with their patients.

20. Summary: Folic Acid After NTD Event • Opportunities are being missed to prevent recurrence of NTD-affected pregnancies due to physicians’ lack of awareness of the recommended peri-conceptional dose, and their limited initiative in promoting folic acid preconceptionally.

21. Summary: Information and Communications • Three-quarters of physicians recall seeing information on folic acid from a variety of sources; they prefer to obtain information about folic acid through their professional journals. • Two-thirds of physicians prefer printed handouts to communicate with patients about folic acid.