TY - JOUR T1 - Prenatal Point-of-Care Tobacco Screening and Clinical Relationships JF - The Annals of Family Medicine JO - Ann Fam Med SP - 507 LP - 514 DO - 10.1370/afm.2290 VL - 16 IS - 6 AU - Aisha A. Bobb-Semple AU - Alexandria F. Williams AU - Martha E. Boggs AU - Katherine J. Gold Y1 - 2018/11/01 UR - http://www.annfammed.org/content/16/6/507.abstract N2 - PURPOSE Up to one-third of female smokers with Medicaid deny tobacco use during pregnancy. Point-of-care urine tests for cotinine, a tobacco metabolite, can help to identify women who may benefit from cessation counseling. We sought to evaluate patient and clinician perspectives about using such tests during prenatal care to identify smokers, with particular focus on the impact of testing on clinical relationships and the potential for tobacco cessation.METHODS We conducted 19 individual interviews and 4 focus groups with 40 pregnant or postpartum women covered by Medicaid who smoked before or during pregnancy. Patients also took the urine cotinine test and received sample results. Interviews were conducted with 20 health care practitioners. We analyzed the transcripts using an inductive approach and developed a model of how prenatal testing for cotinine could affect the patient-clinician relationship.RESULTS Patients were more likely than clinicians to believe that testing could encourage discussions on tobacco cessation but emphasized that the clinician’s approach to testing was critical. Clinicians feared that testing would negatively affect relationships.CONCLUSIONS Despite having reservations, low-income patients had a surprisingly favorable view of using point-of-care urine testing to promote smoking cessation during pregnancy, which could increase the availability of cessation resources to women who do not disclose their tobacco use to clinicians. ER -