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

To assess providers' substance use screening/testing practices in patient care and identify disparities in their application. We hypothesized that patient race and social vulnerability (SV) are independently and jointly associated with increased rates of provider self-reported substance use screening/testing.

A 2 × 2 factorial vignette design was used to survey OB/GYN, Midwifery, and Family Medicine providers. The patients' age and medical characteristics were identical in each vignette, but two elements varied dichotomously: (1) the patient's race (Black vs. White) and (2) the patient's level of SV. Descriptive statistics were computed to assess respondent characteristics. Chi-square or Fisher's exact tests were performed to assess disparities in substance use screening/testing practices.

Providers shown the SV patient vignette, compared to providers shown the vignette for a non-SV patient, reported that the patient's housing (41% vs. 10%, p < 0.01), substance use history (97% vs. 67%, p < 0.01), and the number of prenatal care visits (59% vs. 27%, p = 0.02) influenced their decision to screen/test the patient for substance use. Providers shown the vignette for the SV Black patient were more likely to report the patient's housing (47% vs. 6%, p = 0.04), substance use history (93% vs. 56%, p = 0.01), and gestational age (20% vs. 0%, p = 0.03) influenced their screening/testing recommendations.

Providers reported that the patient's level of SV influenced their decision to recommend screening/testing. The combination of race and SV had the largest impact on reported decisions regarding screening/testing practices. The results of this study highlight the need for standardized institutional substance use detection protocols to reduce provider bias and discrimination in substance use screening/testing based on individual patient demographics.