Lijewski Virginia, Straub Heather, Klie Kaylin, Hwang Sunah S, Sheeder Jeanelle
Department of Obstetrics and Gynecology, University of Colorado, Aurora, USA.
Department of Family Medicine, University of Colorado, Aurora, USA.
J Racial Ethn Health Disparities. 2025 Jun 27. doi: 10.1007/s40615-025-02523-5.
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.
评估医疗服务提供者在患者护理中进行药物使用筛查/检测的做法，并确定其应用中的差异。我们假设患者的种族和社会脆弱性（SV）与医疗服务提供者自我报告的药物使用筛查/检测率的增加独立且共同相关。
采用2×2析因 vignette 设计对妇产科、助产和家庭医学医疗服务提供者进行调查。每个 vignette 中患者的年龄和医疗特征相同，但有两个因素二分变化：（1）患者的种族（黑人与白人）和（2）患者的 SV 水平。计算描述性统计量以评估受访者特征。进行卡方检验或 Fisher 精确检验以评估药物使用筛查/检测做法中的差异。
与看到非 SV 患者 vignette 的医疗服务提供者相比，看到 SV 患者 vignette 的医疗服务提供者报告说，患者的住房情况（41%对10%，p<0.01）、药物使用史（97%对67%，p<0.01）以及产前检查次数（59%对27%，p = 0.02）影响了他们对患者进行药物使用筛查/检测的决定。看到 SV 黑人患者 vignette 的医疗服务提供者更有可能报告患者的住房情况（47%对6%，p = 0.04）、药物使用史（93%对56%，p = 0.01）以及孕周（20%对0%，p = 0.03）影响了他们的筛查/检测建议。
医疗服务提供者报告说，患者的 SV 水平影响了他们推荐筛查/检测的决定。种族和 SV 的组合对报告的筛查/检测做法决定影响最大。本研究结果强调需要标准化的机构药物使用检测方案，以减少医疗服务提供者在基于个体患者人口统计学的药物使用筛查/检测中的偏见和歧视。
