Disparities in Healthcare Providers' Substance Use Detection Practices for Pregnant Patients

Area of Science:

• Healthcare disparities
• Medical ethics
• Patient care

Background:

• Substance use screening is crucial for patient care.
• Disparities in screening practices may exist based on patient demographics.
• Social vulnerability (SV) is a key factor influencing healthcare access and outcomes.

Purpose of the Study:

• To evaluate healthcare providers' substance use screening and testing practices.
• To identify potential disparities in screening based on patient race and social vulnerability.
• To test the hypothesis that race and SV independently and jointly affect screening rates.

Main Methods:

• A 2x2 factorial vignette design survey was administered to OB/GYN, Midwifery, and Family Medicine providers.
• Vignettes featured patients with identical medical characteristics but varied dichotomously in race (Black vs. White) and social vulnerability (SV) level.
• Descriptive statistics and chi-square/Fisher's exact tests were used to analyze disparities in reported screening/testing practices.

Main Results:

• Providers reported that patient social vulnerability (SV) influenced decisions to screen/test for substance use (e.g., housing concerns, substance use history).
• The combination of Black race and high SV significantly impacted providers' reported decisions, influencing considerations of housing, substance use history, and gestational age.
• Providers were more likely to cite patient housing and substance use history as factors when presented with SV patients.

Conclusions:

• Patient social vulnerability (SV) significantly influences provider decisions on substance use screening and testing recommendations.
• The intersection of patient race and SV demonstrates the most substantial impact on reported screening/testing practices.
• Standardized institutional protocols are necessary to mitigate provider bias and discrimination in substance use screening, ensuring equitable patient care.