[Clinicians] Region VIII Clinician Seeking Prenatal ProgramInformation

[Keith Horwood]

My practice is similar to Dave's to let folks know up front if they have a history, but I usually phrase it as something like "That is really great you have been clean and sober since xxxx.  I know that that is not easy, and since I can't tell by looking who is using and who is not, I reccomend you be tested from time to time.  This will help me by informing me if you are having trouble, and may help you to know that you may be tested at any visit, it might just help you stay clean."  I have never had anyone get offended or refuse, despite quite a few who then test positive, although a number of them are sure someone must have spiked their juice.

Keith

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Keith Horwood
Medical Director
Community Health Centers
Salt Lake City, UT
>>> <drder52 at aol.com> 11/13/08 9:26 PM >>>
Hi all,
I use urine tox screens in the patient who has admitted to substance 
abuse and says she''ll stay clean.
Then I tell her I'll check her urine from time to time to assess 
adherence to their goal.  I'll also check urine tox screens as part of 
the work up for psychiatric symptoms, vital sign instability, placental 
abruption, etc.  For a first time OB patient I ask about and advise 
against substance use, but I do not feel compelled to prove anyone a 
liar until evidence based medicine clearly shows it to be useful.
David Robinson



-----Original Message-----
From: Shannon Kolman <shannon at champsonline.org>
To: clinicians at champslists.org
Sent: Thu, 13 Nov 2008 12:30 pm
Subject: [Clinicians] Region VIII Clinician Seeking Prenatal Program 
Information

Hello CHAMPS Clinician Listserv Members,

We had a request from a Region VIII clinician that I thought
may be a good question for the members on this listserv.* Please see the
submission below and reply to this listserv address with any pertinent
information you have.

Thanks!

*

We are getting ready to start a program specific to our
pregnant women. *It will involve universal screening, inhouse referral,
and follow up.* A recent large study in California performed urine tox 
screens on
all patients at their first visit in addition to validated questionnaire
screening. *Patients consented to the screens.* I am concerned about
offering the u
rine screens to all patients in that many patients will 
be in the
precontemplative or not ready to change stage and could be run off 
prior to
establishing a relationship with a provider.* I just read a large book 
on
Dual Diagnosis and it mentions that urine screens are useful only after
engaging the patient in a stage of readiness to change.* I would like to
pull on the experience of others in the CHAMPS network in designing our
program. *How do providers balance the need to move quickly towards
recovery with a fetus at risk versus running off the patient? *Is
universal urine screening worth it just to report these families to DFS 
for
further supervision and/or forced parenting plans?*

I would appreciate any information you can share.
*Thanks

Sharon Mulvehill MD

Assistant Professor

Montana Family
Medicine Residency Program

123 S. 27th
  St

Billings, Mt*
59101

406-651-6451

sharon.mul at riverstonehealth.org

*

*

Shannon Kolman, MBA

Clinical Programs Director

CHAMPS (Community Health Assoc. of Mountain Plains States)

600 Grant
  Street, Suite 800

Denver, CO
 80203

Ph: 303-861-5165

Fax: 303-861-5315

Email: shannon at champsonline.org

www.champsonline.org

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