Acceptability of Substance Use Screening of Pregnant Patients in Acute Care Settings

Substance use among pregnant patients leads to significant maternal and infant morbidity and mortality. Acute unscheduled care visits may be an opportunity to identify substance use early in pregnancy for treatment referral. This study examined the acceptability of using the Tobacco, Alcohol, Prescription Medication, and Other Substance Use (TAPS) screening tool with pregnant patients in acute care settings.

Adult pregnant patients without prior prenatal care who presented for unscheduled care at a tertiary care academic medical center were eligible for inclusion. Enrollment of a convenience sample occurred in the emergency department (ED) and the obstetric care triage unit (OB). Participants completed the TAPS screening tool as well as a Post-TAPS survey (as used with previous TAPS acceptability research) regarding TAPS acceptability utilizing a 5-point Likert scale. Responses of agreed or strongly agreed were considered to be positive responses. Results were expressed as proportions with 95% CIs. Data from ED and OB participants were compared using a two sample Z-test with p<0.05 being considered statistically significant.

One hundred twenty-five pregnant patients were enrolled (89 ED, 36 OB). Substance use was reported by 57% (48 - 66%) of participants, which included 48% (39 – 57%) cannabis, 28% (20 – 37%) alcohol, 17% (11 – 25%) tobacco, and 5% (2 – 10%) other illicit drug use. In the Post-TAPS survey, participants reported that the TAPS survey was easy to understand 99% (96 - 100%). Participants felt comfortable answering the questions (98%, 93 - 100%) and were willing to answer questions like these in an obstetric office (93%, 87 - 96%). Participants reported that they answered the TAPS substance use questions honestly (99%, 96 - 100%), but only 70% (61 - 78%) of participants indicated that they thought their friends would answer honestly at an obstetric office. There were no significant differences in Post-TAPS survey responses between ED and OB participants.

The rate of self-reported substance use in newly diagnosed pregnant patients through the TAPS survey was high. Overall, pregnant patients responded positively to TAPS screening in acute care environments in both ED and OB settings. Screening of pregnant patients in acute care environments using the TAPS tool is acceptable to identify patients for substance use education and treatment referral.