Fetal alcohol spectrum disorder prevention approaches among Canadian physicians by proportion of Native/Aboriginal patients: Practices during the preconception and prenatal periods

Objective: To examine if physician knowledge and practices related to fetal alcohol spectrum disorders (FASD) and its prevention vary based on the proportion of Native/Aboriginal patients served. Methods: A questionnaire was mailed to a national random sample of Canadian physicians between October 2001 and May 2002. The main outcome measure was responses regarding knowledge about and prevention of FASD. Bivariate analysis was used to compare practice patterns and knowledge between those who cared for a higher proportion (>= 10%) and a lower proportion (< 10%) of Native/Aboriginal patients. Results: The overall response rate was 39.4% (1,700/4,313), and 21.4% of physicians reported that >= 10% of their clinical practice was comprised of Native/Aboriginal patients. Those caring for a greater proportion of Native/Aboriginal patients were significantly (p < 0.05) more likely to discuss sexual and emotional abuse (approximately 20% vs. 10%) and a history of addictions (52% vs. 44%) with women of childbearing age. In prenatal interviews, they were also significantly (p < 0.05) more likely to routinely include a history of addictions treatment (70% vs. 62%) and drinking prior to pregnancy awareness (91% vs. 85%), as well as more likely to ask about evidence of alcohol related defects in other children (50% vs. 37%), and discuss the drinking pattern of the patient-s partner (25% vs. 18%). Conclusions: Physicians who had a higher proportion of Native/Aboriginal patients appeared to be more attuned to the issues of FASD and to assess risk in a more comprehensive manner. However, support for improved identification of women at risk and referral opportunities is warranted.