Addressing Prenatal Alcohol and Other Substance Use

Online prenatal alcohol course

add

A Note About Language

The words we use matter, especially when discussing alcohol and substance use disorders. The authors have made efforts to use destigmatizing and inclusive language throughout this presentation to help reduce stigma and negative bias.

Although the term “women” may be used in this presentation, the American Academy of Family Physicians recognizes that family physicians treat people of all gender identities, including people who are cisgender, transgender, gender nonbinary or otherwise gender expansive. The AAFP believes all people should have equitable access to respectful, high-quality, safe health care. In this presentation, the term "women" is intended to be used inclusively.

Prenatal exposure to alcohol and other drugs is a leading cause of birth defects and neurodevelopmental abnormalities in the United States.

This prenatal alcohol course and PI-CME activities are designed to support family physicians and their team members in enhancing screening, brief intervention and referral to treatment (SBIRT) for prenatal alcohol and other substance use for improved patient outcomes.

Topics Include

Stage A: Assessing the current practice by gathering baseline data.
Stage B: Implementing appropriate interventions to improve SBIRT for prenatal alcohol and other substance use.
Stage C: Evaluating the impact of interventions by collecting a new set of data and comparing it to the baseline.

Learning Objectives

Screen reproductive age adults for alcohol and other substance use.
Provide the appropriate intervention or referral depending on the substances used.
Establish strategies for team roles, workflows and documentation.
Link patients with alcohol and substance use to community resources.
Ensure that patient-friendly and uniform language is used for screening and interventions.

Additional details

For this activity, you will utilize the American Academy of Family Physicians' (AAFP) Office Champions Quality Improvement Model, which consists of three distinct stages.

Stage A

In stage A, you must enter data from a minimum of 10 charts meeting the selection criteria below to determine your baseline alcohol and other substance use.

Medical charts selection criteria

Women (people) of reproductive age (WRA) seen in your practice during the past 12 months.

Identifying eligible patients’ charts for stage A

There are many ways to select charts for review. To get an estimate of current performance and to reduce potential selection bias, we suggest using your daily patient schedule to help identify eligible patients.

Choose an index date that reflects care occurring before this activity, such as the day you register for this PI-CME activity.
Identify all eligible patients seen on your selected index date for chart review.
Proceeding backward, select all eligible patients seen on each preceding day until at least 10 are available for chart review.

Stage B

There are numerous ways to improve alcohol and other substance use screening, brief intervention and referral to treatment (SBIRT) in your practice. The intervention doesn’t necessarily need to be major; even small changes can have a significant impact. Some examples include making workflow or process adjustments, standardizing documentation procedures, implementing uniform screening methods and/or tools, updating electronic medical records (EMR) to capture and/or measure SBIRT activities, providing staff training on prenatal alcohol and other substance use and establishing community referrals. For more comprehensive information, please review the AAFP’s Addressing Alcohol and Other Substance Use Practice Manual.

Keep in mind that the minimum interval for implementing your stage B interventions should be within 30 to 90 days.

Stage C

In stage C, you must enter your data to reassess your performance using a second sample of at least 10 different charts.

Medical charts selection criteria

WRA seen in your practice since you began implementing stage B interventions (30 to 90 days) of this PI-CME activity.

Identifying eligible patients’ charts for stage A

In stage C, you should use a similar approach for chart selection. Patients seen since you have implemented your stage B Interventions are strongly preferred.

Establish a date on or after the day you implemented stage B interventions as your index date.
When you have entered stage C and are ready to pull charts for review, first choose all eligible patients seen on that day for chart review.
Proceeding backward up to the index date, choose all eligible patients seen on each proceeding date until you have at least 10 charts available for review.
- For example, if you implemented stage B interventions on November 1, you would not use any medical charts before November 1 to identify eligible patients.
This chart review activity will help you learn more about performance measurement. It will also provide insight into strengths as well as opportunities to improve your services. Completing a subsequent chart review will allow you to detect trends and see how changes in your office structure, processes and resources affect prenatal alcohol and substance use screening, brief intervention and referral to treatment.

At the conclusion of the activity, the AAFP will provide you with data analytics that compare the results from stage A and stage C, offering valuable insights into the impact of your intervention.

This project is supported by the Centers for Disease Control and Prevention (CDC) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $280,000 with 100 percent funded by CDC/HHS. The contents are those of the authors and do not necessarily represent the official views of, nor an endorsement by, CDC/HHS or the U.S. Government.

My account