Table 3.

Barriers to Providing Screening, Assessment, Brief Intervention, and Referral Services to Prevent Alcohol-exposed Pregnancies

  • Non-therapeutic attitude among family medicine physicians

    A public health concern, not a clinical problem

    A concern that questioning about alcohol use will lead to patient resistance, discomfort, and exiting from the practice

    Other health problems are more urgent or important

    Denial that drinking is a problem

    Feeling that treatment isn’t effective

  • Inadequate knowledge and clinical skills

    Limited training in medical school and residency

    Feel ill-prepared to deal with the realities of screening and assessment

    Lack of provider self-efficacy, feeling you can’t make a difference

    Provider reference material lacks information and consistent recommendation to abstain

  • Lack of time

  • Inadequate reimbursement

  • System barriers

    Lack of intervention tools

    Lack of a system strategy or protocol

    Lack of treatment and referral resources

    Lack of office staff involvement

  • Legal barriers