Obstetrics and Gynecology Provider Experience Screening for Harmful Alcohol Use: An Unmet Need for Standardized Screening and Intervention

Abstract

Introduction Early identification of at-risk alcohol use is key to preventing complications of alcohol use disorder (AUD). Obstetrics and gynecology (OB/GYN) providers are in a unique position to screen for alcohol use in young female patients who may not otherwise seek traditional primary care. The purpose of this study was to learn how OB/GYN providers screen for and manage harmful alcohol use in their clinical care. Method We surveyed OB/GYN providers in a single health care system regarding how they screen for and manage alcohol use. The results were reported using descriptive statistics. Bivariate analysis to assess the impact of physician characteristics on responses was performed using chi-square testing. Results From the results, it was observed that 64.7% and 60.6% of OB/GYN providers screen for alcohol use most or all of the time during obstetrics and gynecologic visits, respectively. Less than half of providers refer patients with at-risk use for further interventions or treatment (41.0% referred to an addiction specialist, 41.0% recommended discussing their behavior with their PCP, 35.9% referred to social work, 10.4% referred to gastroenterology or hepatology). Providers who screened did so most commonly by directly asking patients about their alcohol use (70.6% during obstetrics and 60.1% during gynecologic visits). Only 11.8% and 15.2% of providers who screened did so using standardized screening methods (e.g. CAGE (Cut down, Annoyed, Guilty, and Eye-opener) questionnaire and Alcohol Use Disorders Identification Test-Consumption (AUDIT-C)) during obstetrics and gynecologic visits, respectively. Only 30.8% of the providers felt they received adequate training on AUD. Providers who had experience taking care of a patient with severe alcohol-related liver disease (100% v. 0%, χ²=4.69, p=0.047) or died from this (100% v. 0%, χ²=11.35, p<0.01) were more likely to refer to gastroenterology. Conclusions Further work needs to be done to improve screening for and management of harmful alcohol use in OB/GYN clinics. Standardized screening methods were rarely used. Education of OB/GYN providers on AUD management and facilitating referrals for addiction care are opportunities to prevent the consequences of AUD in at-risk female patients.

Keywords: addiction medicine; alcohol use disorder; alcohol-related liver disease; multidisciplinary care; women’s health.