National Drug Strategy
National Drug Strategy

Intergovernmental committee on Drugs working party on Fetal Alcohol Spectrum Disorders

Monograph

Fetal Alcohol Spectrum Disorders in Australia: An Update

June 2012

7.4 Health professional surveys, 2007

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A total of 1,001 (67.5%) WA health professionals (Aboriginal health workers, allied health professionals, community nurses, general practitioners and obstetricians) responded to the survey in 2007. Compared to 2002, an increased proportion of health professionals surveyed in 2007 knew all the essential features of FAS (11.7% in 2002 versus 15.8% in 2007)(Payne et al. 2005; Payne et al. 2011). Health professionals surveyed in 2007 had gained more experience with FAS: there was an increased proportion who had diagnosed FAS (4.8% in 2002 versus 7.3% in 2007) and who had seen FAS diagnosed by another person (51.3% in 2002 versus 59.8% in 2007). There was also an increase in the proportion surveyed in 2007 who suspected but did not diagnose FAS (34.1% in 2002 versus 42.3% in 2007) and were convinced of the diagnosis but did not record it (3.8% in 2002 versus 8.4% in 2007). There was an increase in the proportion of health professionals surveyed that had referred children to confirm a diagnosis of FAS (12.7% in 2002 versus 17.7% in 2007). There was an increase in the proportion of health professionals surveyed who were fairly prepared (7.7% in 2002 versus 15.0% in 2007), or somewhat prepared (22.8% in 2002 versus 33.2% in 2007) to deal with FAS and a decrease in the proportion who were not very prepared to deal with FAS (66.4% in 2002 versus 46.7% in 2007). There was nearly a two-fold increase in the proportion of health professionals surveyed in 2007 who agreed that health professionals are sufficiently aware of FAS (14.2% in 2002 versus 27.5% in 2007). In 2007, a greater proportion agreed there was a lack of community services to treat FAS effectively (43.5% in 2002 versus 53.3% in 2007) and that members of the community were concerned about FAS (24.1% in 2002 versus 33.8% in 2007). In 2007, there was little change from 2002 in the proportion of health professional surveyed who agreed that: making an early diagnosis of FAS may improve treatment plans for the affected child (84.4%); it was possible to prevent FAS (88.5%); the diagnosis of FAS may lead to a child or their family being stigmatised (54.7%); and parents may resist referral of their child for assessment and treatment services if FAS was diagnosed (40.4%) (Payne et al. 2011).

Compared to 2002, a decreased proportion of health professionals surveyed in 2007 said they would provide advice to women that was consistent with components of the current NHMRC Australian Alcohol Guideline for women who are pregnant or might soon become pregnant.These components were: to consider not drinking at all (89% in 2002, 68.3% in 2007); not to become intoxicated (27.8% in 2002, 11.0% in 2007); to have less than seven standard drinks over a week (29.1% in 2002, 11.0% in 2007) and on any one day to have no more than two standard drinks spread over at least two hours (38.2% in 2002, 20.1% in 2007) (Payne et al. 2011). Of health professionals surveyed in 2007, 85.8% said they offered advice that was consistent with the most recent (2009) NHMRC Australian alcohol guideline and said they would advise according to the message contained in the educational resources distributed in WA, that ‘No Alcohol in Pregnancy is the Safest Choice’. Overall, 98.1% of health professionals surveyed in 2007 said they would advise women either to consider not drinking at all or that ‘No Alcohol in Pregnancy is the Safest Choice’. Compared with 2002, an increased proportion of health professionals surveyed agreed that pregnant women should completely abstain from consuming alcohol (61.5% in 2002 versus 88.1% in 2007) and that women planning to become pregnant in the near future should completely abstain (56.9% in 2002 versus 78.2% in 2007). Health professionals surveyed agreed that drinking five or more standard drinks on one drinking occasion whilst pregnant may harm the fetus (83.3% in 2002 versus 91.5% in 2007). In 2007, there was a reduction in the proportion of health professionals surveyed who agreed that infrequent consumption of one standard drink of alcohol during pregnancy is not harmful to the mother or fetus (from 56.5% in 2002 to 29% in 2007). For health professionals who cared for pregnant women, there was no overall increase in 2007 in the proportion who routinely asked pregnant women about alcohol use (44.5% in 2002 versus 46.0% in 2007). There was an increase in the proportion of obstetricians (57.1% in 2002 versus 76.5% in 2007) who routinely asked about alcohol use. There was also an increase in the proportion of health professionals who routinely provided information about the consequences of drinking alcohol during pregnancy (24.7% in 2002 and 32.4% in 2007).

Of health professionals surveyed in 2007, 69.8% had seen the educational resources developed and distributed as part of this study. Of these professionals, 77.1% had used the resources and 48.5% said the resources had assisted them to change their practice or their intention to change their practice. Fewer health professionals surveyed in 2007 requested resources about FAS (83.9% in 2002 versus 54.0% in 2007) or written information for clients (78.7% in 2002 versus 54.3% in 2007) (Payne et al. 2011).

In 2007, a total of 82 WA consultant paediatricians (61.7%) completed the postal survey (Payne et al. 2011) using the questionnaire modified from that developed and used in the 2002 survey (Payne et al. 2005). Despite access to educational materials, there was no improvement in paediatricians’ knowledge of the essential features of FAS (20.0% in 2004 and 18.3% in 2007). In 2007, there was little change from 2004 in the proportion of surveyed paediatricians who had: ever seen a case of FAS diagnosed by another person (90.2%); themselves diagnosed FAS (58.5%); suspected but not diagnosed FAS (78.0%); and been convinced of the diagnosis but did not record it (13.4%) (Elliott et al. 2006). There was a small increase in the proportion of paediatricians surveyed in 2007 who referred children to confirm a diagnosis of FAS (33.3% in 2004 versus 39.0% in 2007). Few paediatricians (about 6% in the surveys in 2004 and 2007) reported being very prepared to deal with FAS. There was an increase in the proportion of paediatricians surveyed in 2007 who agreed that members of the community were concerned about FAS (27.8% in 2004 and 35.4% in 2007). A smaller proportion agreed that FAS is easy to diagnose in the first year of life (30.0% in 2004 and 14.6% in 2007) and fewer paediatricians agreed that making an early diagnosis of FAS may improve treatment plans for the affected child (74.7% in 2004 and 65.9% in 2007).

In 2007, there was little change from 2004 in the proportion of paediatricians surveyed who agreed that: it was possible to prevent FAS (90.2%); the diagnosis of FAS may lead to a child or their family being stigmatised (67.1%); there was a lack of community services to treat FAS effectively (53.7%); the physical features consistent with FAS may be more difficult to diagnose in Australian Aboriginal children (53.7%) (Payne et al. 2011).

There was a reduction in 2007, compared with 2004, in the proportion of paediatricians who said they would advise women according to components of the 2001 NHMRC Australian Alcohol Guideline for women who are pregnant or might soon become pregnant, that was current in 2004 and 2007. These components were: to consider not drinking at all (88.9% in 2004, 68.3% in 2007); not to become intoxicated (31.1% in 2004, 18.3% in 2007); to have less than seven standard drinks over a week (35.6% in 2004, 14.6% in 2007); and on any one day to have no more than two standard drinks spread over at least two hours (47.8% 2004, 11.0 in 2007) (Payne et al. 2011). In 2007, 81.7% of paediatricians surveyed offered advice that was consistent with the 2009 NHMRC Australian alcohol guideline and in accordance with the message contained in the educational resources that ‘No Alcohol in Pregnancy is the Safest Choice’. Also, 96.3% said they would advise women to consider not drinking at all or that ‘No Alcohol in Pregnancy is the Safest Choice’. There was a significant increase from 2004 in the proportion of paediatricians surveyed who agreed with the statements that pregnant women should completely abstain from consuming alcohol (48.9% in 2004 versus 75.6% in 2007) and that women planning pregnancy should completely abstain from consuming alcohol (42.2% in 2004 versus 74.4% in 2007). There was a significant reduction in the proportion of paediatricians that agreed infrequent consumption of one standard drink of alcohol during pregnancy is not harmful to the mother or fetus (from 66.7% in 2004 to 43.9% in 2007). Amongst paediatricians surveyed in 2007 who took pregnancy histories (n=69), there was little change in the proportion who routinely asked about alcohol use in pregnancy (22.4% in 2004 versus 21.7% in 2007). In 2007 a higher proportion routinely provided information about the consequences of alcohol use in pregnancy (5.3% in 2004 versus 10.1% in 2007) (Payne et al. 2011).

In 2007, 65.9% of paediatricians surveyed had seen the educational resources distributed and of these, 66.7% had used them and 29.6% said the resources assisted them to change or their intention to change their practice. There was a significant decrease in the proportion of
paediatricians surveyed who requested resources about FAS (61.1% in 2004 versus 43.9% in 2007) or written information for clients (67.8% in 2004 versus 48.8% in 2007)(Payne et al. 2011).

There remains a need for regular educational and training opportunities and dissemination of locally relevant, evidence based resources for a range of professionals who deal with FASD in Australia. These include health professionals, educators, and individuals who work in disability and community services and the justice system. Workforce development could be achieved by funding local or international experts to conduct formal training courses and/or the dissemination of resources such as those developed by the Alcohol and Pregnancy group convened by the Telethon Institute for Child Health Research in Perth. These are available at alcoholpregnancy.childhealthresearch.org.au/alcohol-and-pregnancy-resources.aspx (This website link was valid at the time of submission).

Key points


* available from A Telethon Institute for Child Health Research website

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