A majority of women who deliver infants with cocaine in their body fluids at birth report minimal or no prenatal care. The affected children often do not receive adequate perinatal and pediatric care. This lack of medical care can in part be attributed to mother's chemical dependence, as addicts are known to neglect themselves and their families. However, the subtle barriers to proper care within the health system itself are not always clear. The overall objective of this proposal is to improve health care of drug using mothers and their drug exposed infants and children by conducting a pilot survey of their physician caregivers.
The aims of this pilot study are: 1) to develop and test a reliable questionnaire for survey of medical practitioners to identify the attitudinal, economic, resource, training, legal and other barriers to proper health care of mothers and children with perinatal drug exposure; 2) to pilot test the questionnaire on physicians in specialties that are the primary caregivers for the perinatal drug exposed; and 3) to develop a study protocol based on this pilot work for a more systematic study that would identify and recommend practical strategies to overcome these barriers. Two hundred physicians will be surveyed from each of the following specialties: obstetrics, neonatology, pediatrics, and family practice. The 800 U.S. physicians will be randomly selected from the AMA physician masterfile. To identify the optimal approach for survey administration, four approaches will be used on 50 subjects in each of the four specialties: 1) sending questionnaires via bulk mail; 2) mailings using first class mail; 3) follow-up telephone calls after a mailed questionnaire; and 4) a telephone survey. The response rates of these approaches will be compared. Each of the four specialties will receive a modified version of the questionnaire. A core set of questions will be common to all questionnaires to permit comparisons between specialty groups. Additional specialty specific questions will examine the unique issues confronting each specialty. The development and testing of these questions and methods for administering them will lead to more systematic study, and improved information on: 1) how to involve drug using women and their children in appropriate health care; 2) improved identification, diagnosis (and reporting where required) of drug using women; 3) identification of special issues confronting their physician care takers; and 4) technical and other supports for practitioners to improve their care. Assuming that the pilot testing is successful, the preliminary data will be shared with concerned specialty societies and government planners. A protocol will be submitted for more systematic study and improved maternal and child care for this underserved population.
