The effect of legal and hospital policies on physician response to prenatal substance exposure.

Objectives: To determine the influence of a state's legal environment and a hospital's Prenatal Substance Exposure (PSE) protocol on physicians' propensity to respond when prenatal substance exposure is suspected.

Methods: Using a sample of 1367 physicians from every state and the District of Columbia, we formulate a set of linear models to determine the impact of the legal environment and hospital protocol on physicians' response to PSE, the agreement between physicians' perceptions and actual state legal environments, and physicians' motivation to act when PSE is suspected.

Results: Both protocol and legal environment showed to be significantly correlated with physicians' propensity to take action when PSE is suspected (p < 0.05). Our analysis shows that physicians prefer a public health (patient-centered) approach to more punitive measures.

Conclusions: Our results suggest a policy strategy focused first on enacting laws that would encourage a patient-centered approach, by developing and using hospital protocols to implement state policy, and then on educating physicians about the actual legal environment.