Family Physicians Survey

Appendix_F_ Family Physicians.doc

A Survey of the Knowledge, Attitudes, and Practice of Medical and Allied Health Professionals Regarding Fetal Alcohol Exposure

Family Physicians Survey

OMB: 0920-0692

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This survey asks for information on your knowledge, attitudes and practices about diagnosis, treatment and prevention of Fetal Alcohol Syndrome (FAS) and other prenatal alcohol-related disorders. Please answer the questions by checking the box(es) of the appropriate response(s), by circling the appropriate response(s), or by filling in the blanks. (Family Physicians)





1. During a typical work week, what proportion of your time do you spend in the following professional activities? If you do not spend any time in a particular activity, please indicate this by entering zero (0) hours in the appropriate space.


Activity: % of Hours:


Direct patient care (self-employed)………………………………………

Direct patient care (other than self-employed)……………………...……

Administration……………………………………………………....……

Academic medicine (medical student or resident teaching)…...….……...

Research…………………………………………………………….……

Fellowship training………………………………………………….……

Other……………………………………………………………………...

100%

T OTAL ………………………………….…





The following questions are for family physicians who provide some DIRECT PATIENT CARE. If

y ou do NOT provide direct patient care, please check this box and go to Q# 23.



G ENERAL KNOWLEDGE


2. What would you estimate the overall prevalence of Fetal Alcohol Syndrome in the United States to be?

1 in 10 1 in 100 1 in 1,000 1 in 10,000 1 in 100,000



3. Please check which of the two statements below corresponds most closely with your personal viewpoint. Please pick only ONE box.


O ccasional consumption of alcohol (one Pregnant women or women planning

drink per day or less) during pregnancy to become pregnant should completely

i s not harmful to the mother or abstain from consuming alcohol.

fetus. (Skip to Question #4)


I believe that occasional alcohol consumption is safe during the following trimesters of pregnancy, (check all that apply):


1 st trimester 2nd trimester 3rd trimester


4 . In your opinion, how many drinks per week can a pregnant woman consume without risk of adverse pregnancy outcomes? (Circle your answer)

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14+



5 . In your opinion, how many drinks per occasion can a pregnant woman consume without risk of adverse pregnancy outcomes? (Circle your answer)

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14+



6. Please indicate whether you agree or disagree with the following statements:


Agree

Disagree

Don’t Know

FAS occurs at similar rates in all socioeconomic groups of society


1


2


3

FAS occurs at similar rates among all cultures and ethnic groups


1


2


3


7. Please indicate whether you agree or disagree with the following statements:



Agree

Disagree

Don’t Know

Alcohol’s effect on fetal development remains unclear


1


2


3

Prenatal alcohol exposure is a significant risk factor for permanent brain damage


1


2


3

Alcohol withdrawal in a baby at birth is the worst outcome of prenatal alcohol exposure


1


2


3

Young adults with FAS usually achieve successful independence at the expected time (18 to 21 years)


1


2


3

Early diagnosis and ongoing surveillance of FAS may lead to implementation of secondary prevention of disabilities


1


2


3



8. Do you consider any of the following problems to be associated with Fetal Alcohol Syndrome?



Yes

No

Don’t Know

Infantile withdrawal symptoms

1

2

3

Delayed development

1

2

3

Birth defects/malformations

1

2

3

Psychiatric (DSM IV) disorders

1

2

3

Lowered IQ/retardation

1

2

3

Continued on next page



Yes

No

Don’t Know

Behavioral problems

1

2

3

Low birth weight

1

2

3

Long term emotional disorders

1

2

3

Addictions

1

2

3

Legal problems

1

2

3

Attention deficit hyperactivity disorder

1

2

3


9. Which of the following are included in the facial dysmorphia associated with Fetal Alcohol Syndrome? (Check all that apply)

Large inner canthal distance Short palpebral fissures

F ull lips Smooth philtrum

T hin upper lip Flaring nares

Don’t Know/Unsure



10. It is easiest to diagnose FAS at what age?


Newborn Early Childhood


Adolescence Adulthood

Don’t Know/Unsure


11. Please indicate whether you agree or disagree with the following statement.



Agree

Disagree

Don’t Know

Making a diagnosis of FAS stigmatizes the child and family

1

2

3



D IAGNOSIS & TREATMENT OF WOMEN



Please consider your own practice over the past 5 years when answering the following questions.

I f you do not provide prenatal care to women, please check the box and proceed to Q# 20.




12. When seeing patients for prenatal care, who would you most likely ask about alcohol use?: (Check ONE box; options continue on next page)


With all pregnant women, at the initial visit

With pregnant women I suspect might be drinking, at the initial visit


With all pregnant women, at the initial visit and at subsequent visits as well


W ith pregnant women I suspect might be drinking, at the initial visit and at subsequent visits as well


13. When seeing patients, who would you most likely educate about the risk of alcohol use during pregnancy?: (Check ONE box)


All pregnant women and all women of childbearing age


All pregnant women


Pregnant women I knew or suspected to be using alcohol

P regnant women I suspected to be using alcohol AND pregnant women who had risk factors associated with drinking (smokers, substance abusers)


13a. How do you usually manage pregnant women who report alcohol use? (Check all that apply)


Discuss adverse effects Advise reduction


Advise abstinence Refer to treatment



O ther (please specify) ___________________________________.


14. Which of the following methods do you usually use to obtain information about alcohol use? (Check all that apply)


Physician asks patient during examination Patient fills out a questionnaire


N onphysician staff asks the patient Use of a screening tool (CAGE, TWEAK, T-ACE, etc.)


15. If you use one of the screening tools listed above, which do you prefer to use, or which do you use most commonly? (Check ONE box)


CAGE MAST


TWEAK AUDIT


T-ACE Other (please specify) __________


None

16. During the past 12 months, how many babies have you delivered that you have….(if none, enter “0”)



Number of patients in past 12 months

suspected as possible FAS?


recognized as having FAS?



Number of patients in past 12 months

diagnosed as FAS?


referred to confirm a diagnosis of FAS?


provided care for FAS?



17. What are the barriers (if any) in your practice affecting alcohol assessment and management of patient’s alcohol use during pregnancy? (Check all that apply)


Time limitations Lack of referral sources


Patient sensitivity Confidentiality issues


Need for additional training to enhance assessment skills Lack of financial reimbursement

None



18. What resources do you feel are needed to improve alcohol use assessment in your clinical practice? (Check all that apply)


Information regarding thresholds for adverse reproductive outcomes


Referral sources for patients with alcohol problems


Training and consultation in assessment and counseling


Reimbursement by insurance and providers for screening and assessment


Other ( explain) ______________________________________________.



D IAGNOSIS & TREATMENT OF CHILDREN



P lease consider your own practice over the past 5 years when answering the following questions.

If you do not provide primary care to children, please check the box and proceed to Q# 23.




19. During the past 12 months, how many patients have you… (if none, enter “0”)



Number of patients in past 12 months

suspected as possible FAS?


recognized as having FAS?


diagnosed as FAS?


referred to confirm a diagnosis of FAS?


provided care for FAS?



20. Do you make use published diagnostic criteria for FAS in your practice?


Yes……1 No……2


If yes, which one of the following do you use?


Institute of Medicine criteria


American Academy of Pediatrics criteria


Seattle 4 digit diagnostic criteria


Other (please specify) _______________________________________________


21. Many providers do not make the diagnosis of FAS in their practice. Please indicate which of the following factors may contribute to this situation. (Please select all that apply)


Lack of time needed to make diagnosis


Lack of specific training to make the diagnosis


Belief that making the diagnosis will not make a difference to the individual


Other (please specify)_________________________________________



T RAINING/PERCEIVED COMPETENCE/PERCEIVED NEEDS


22. Do you recall receiving any formal training in the following FAS competencies and if so, indicate where you received this training:




YESYY




NO

Medical School

Post-grad (residency)

CME (received credit)

Other


Ability to recognize the constellation of features associated with FAS and other alcohol-related effects







Understanding of the basic biomedical mechanisms that result in FAS







Ability to select valid and reliable assessment instruments to screen for/diagnose FAS and other alcohol-related disorders







Ability to identify risk factors and interventions for secondary FAS disabilities







Ability to plan and perform clinically relevant treatment and management plans to assist and aid both the patient with FAS and their families











Continued on next page



YES



NO

Medical School

Post-grad (residency)

CME (received credit)

Other

When appropriate, be able to make a referral for further workup in a child with FAS






Appreciation and ability to use interdisciplinary team evaluations for individuals with FAS






Ability to assist clients in accessing local FAS-related resources, including family support






Utilization of techniques for effectively communicating information to individuals with FAS, their family members, and care providers






Demonstration of the ability to provide ethical protections to the patient with FAS regarding confidentiality and autonomy






Ability to educate pregnant women about the effects of alcohol on their babies






Ability to screen women for risky or hazardous drinking






Ability to conduct alcohol cessation brief interventions







23. If you have received any formal training on FAS in any venue (medical school, residency, CME), overall, would you say that training was:


Poor


Fair


Good


Excellent



24. In general, how prepared do you feel to:



Very Prepared

Somewhat Prepared

Somewhat Unprepared

Very Unprepared

Diagnose persons with possible FAS or other alcohol-related disorders





Manage/coordinate the treatment of persons with FAS and other alcohol-related disorders










Very Prepared

Somewhat Prepared

Somewhat Unprepared

Very Unprepared

Conduct brief interventions for alcohol abstinance







25. Please rate how helpful the following kinds of materials or supports would be to you in your clinical practice.



Very Helpful

Somewhat Helpful

Not Very Helpful

Not At All Helpful

Concise provider and staff information on prevention, diagnosis, and intervention on FAS and other alcohol-related disorders





Patient education materials on the impact of alcohol use during pregnancy on children






Clinical guidelines for best practices for diagnosis of FAS and other alcohol-related disorders





Registry of specialists available for consultation about FAS and other alcohol-related disorders





Listing of community-based resources for children with FAS





Materials for office practice including FAS screening and referral checklists and pocket reminders of diagnostic criteria







26. What mechanisms would be most helpful to you for receiving training on FAS prevention, diagnosis, and intervention? (Check all that apply)



Very Helpful

Somewhat Helpful

Not Very Helpful

Not At All Helpful

Regional Conferences (CME)





Internet-based learning opportunities





On-site training for myself and colleagues





Self-study materials (eg, CD-ROM, videos)






27. Please indicate whether the following types of FAS-related training and educational materials are available in the community where you practice, and whether these resources are helpful, or would be helpful if they became available.



Available

Not Available

Very Helpful

Somewhat Helpful

Not Very Helpful

Not At All Helpful

Regional Conferences (CME)







Internet-based learning opportunities










Continued on next page


Available

Not Available

Very Helpful

Somewhat Helpful

Not Very Helpful

Not At All Helpful

On-site training for myself and colleagues







Self-study materials (eg, CD-ROM, Videos)








B ACKGROUND INFORMATION



28. What is your gender? Male Female


29. What is your primary employment site? (Please select only one)


Solo practice / 2 physician practice Community-based health center


Group practice / Staff model HMO Other (please specify), ___________


Medical School or parent university ______________________________


Hospital or clinic ______________________________



30. Please check this box if you identify yourself as Hispanic/Latino

This question is optional, but important to the survey.



Hispanic/Latino



31. With what racial group do you identify yourself? (Mark all that apply) This question is optional, but important to the survey.



White Asian


American Indian/Alaska Native Native Hawaiian/Pacific Islander



African American





3 2. What is your age?




3 3. Years in practice:



34. Do you consider your primary employment location to be: Check ONE response


Urban inner city Rural


Urban not inner city Suburban



35. In what area of interest do you spend most of your time?


Care of children


C are of adults


Care of seniors


Care of pregnant women


Subspecialty area (specify, i.e. sports medicine) _______________________________________



Some questions from this survey were taken from:

Clarke M, Tough SC. A National Survey Regarding Knowledge and Attitudes of Health Professionals About Fetal Alcohol Syndrome. Health Canada Final Report, January 2003.


Shane T. Diekman, et al. A Survey of Obstetrician-Gynecologists on Their Patient's Alcohol Use During Pregnancy. ACOG. Vol 95, Number 5: 756-763 May 2000

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File Typeapplication/msword
File TitleAs you know, prenatal exposure to alcohol is known to be harmful to the developing fetus,
AuthorYulee Choe
Last Modified Bysic3
File Modified2008-01-10
File Created2008-01-10

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