Prenatal screening for substance use and violence: findings from physician focus groups.

OBJECTIVE: To guide quality improvement activities, the study sought to identify effective strategies for influencing and improving physician screening and referral of pregnant women for violence and substance abuse (alcohol, drugs and tobacco). METHODS: This qualitative study conducted in Washington State consisted of interviews with eight physicians and focus groups with twenty-eight physicians who practice obstetric care. Physicians, selected using systematic sampling, were asked about perceptions on the importance of screening and barriers to effective screening, awareness of information and resources from the state Department of Health, and the effectiveness of various provider training strategies for improving prenatal screening. RESULTS: Physicians were most interested in practical, concise information for themselves and office staff. Referral information and patient handouts were identified as important tools to increase the efficacy of screening and intervention. Physicians supported in-person programs in offices or in hospitals but rejected use of audio conferences and direct mailings. CONCLUSIONS: This study provided insight about the way we deliver best practice information to physicians. Collecting qualitative data from physicians is important prior to developing statewide quality improvement activities aimed at this group.