Educational Practices About Folic Acid Supplementation Poster

1
Educational Practices About Folic Acid
Supplementation - Doomed to Failure? A March of
Dimes Sponsored Project Amy J. Hoffman1,2, Robert
G. Resta1, Amber L. Roche 1,2 1 Swedish Medical
Center, Seattle, WA 2 Institute for Public Health
Genetics, University of Washington, Seattle, WA
This project is supported by a grant from the
March of Dimes.
Results
Introduction
Conclusions

• Folic acid supplementation prior to pregnancy is
  a key factor in preventing neural tube defects.
• Washington State Pregnancy Risk Assessment
  Monitoring System (PRAMS) data administered by
  the CDC for 1993-1996 show that 70 of women
  recall a discussion with their health care
  provider about folic acid during pregnancy.
• We set out to answer the following questions
  about folic acid education
• What do physicians think they tell patients?
• What do patients remember they were told?
• Is patient education documented in charts?
• What patient sociodemographic factors influence
  whether or not a healthcare provider will discuss
  the role of folic acid in the prevention of
  neural tube defects?

• For most of these women, education about folic
  acid supplementation occurred at an inappropriate
  time, i.e. after conception, when supplementation
  will not prevent neural tube defects. Other than
  being pregnant, only educational level influences
  whether or not a physician will discuss folic
  acid with their patients. Results also showed
  that documentation of patient education is very
  poor.
• To address this situation, we initiated a
  multi-pronged statewide effort to improve folic
  acid educational practices
• a state wide mailing under the auspices of the
  WA State Dept. of Health, advising physicians,
  nurses and midwives of the importance of
  preconception folic acid supplementation
• a web site containing physician and patient
  information http//www.swedishmedical.org/
  PregnancyForesight/Home.html
• articles in medical organizations newsletters
• focus groups with medical practices to help
  develop useful educational materials
• development of a Well Woman Visit form to help
  physicians document their educational efforts
  with patients

• 351 charts were reviewed 34 providers were
  surveyed 120 pregnant women completed surveys
  104 non-pregnant women were surveyed.
• Chi-square analyses showed that pregnant
  patients who were better educated were more
  likely to remember a discussion of folic acid
  with their physicians. Other demographic
  variables were not associated with patient recall
  (see Table 2).
• The most important predictor of a recall of a
  discussion of folic acid was whether or not the
  patient was pregnant. Figures 1 2 show that
  while nearly 80 of pregnant women recalled a
  discussion of folic acid, less than half of the
  non-pregnant women recalled such a discussion.
  This is not simply a matter of poor patient
  recall nearly 75 of physicians stated that they
  do not discuss folic acid supplementation with
  their non-pregnant patients. Also, well over 90
  of charts had no documentation of patient
  education.

Table 1. Survey Sample Demographics. Age
Mean29.89, SD6.48 Language 83.0
English Ethnicity 64.7 Caucasian Education
69.8 Post High School Insurance 59.4
Private
Table 2. Chi-square Analyses for Folic Acid
Discussion by Sociodemographic Factors. Durin
g Pregnancy During Non-Pregnancy
Visit Language .037 3.233 Ethnicity .990 2
.000 Education 10.718 4.192
Insurance 2.588 5.582 plt.01
Note, chi-square analyses grouped by Language
English vs. non-English Ethnicity White vs.
non-White Education college vs. no college
Age lt22 vs. gt22 Insurance private vs.
governmental assistance
Methods

• Surveys were distributed to physicians and
  patients in 3 obstetric clinics and 3 family
  practice clinics in Washington State.
• Physicians were asked about their education
  practices on pregnancy-related topics, including
  folic acid.
• Convenience sample of female patients (aged
  18-45) who read English or Spanish, asking them
  to recall if these topics were discussed before
  or during pregnancy.
• Random sample of patient charts was surveyed for
  documentation of patient education. The
  inter-observer agreement on chart reviews was
  gt0.95.
• IRB approval as the March of Dimes Prenatal
  Health Education Survey from Swedish Medical
  Center.

Figures 1 2. Folic Acid Discussion Recall and
Chart Documentation
Yes
Yes
NCBDDD Poster 43