Computerized clinical decision support may promote contraceptive counseling for women prescribed teratogenic medications
Each year, 12 million women of reproductive age receive prescriptions for drugs that can potentially cause birth defects (teratogenic). Alerting women to these risks and providing them with contraceptive counseling is very important. However, less than 50 percent of women actually receive such counseling. A new study concludes that electronic medical records with clinical decision support (CDS) systems can improve counseling and prescribing practices, including the frequency of discussing the risks of medication use during pregnancy.
In the study, 41 primary care physicians (PCPs) received a CDS system. One group was randomized to receive a simple version that delivered a cautionary alert when ordering potentially teratogenic medications. The second group of PCPs received a CDS system that used a tailored alert text and a structured order set for safe prescribing. All PCPs, regardless of which CDS they received, were only alerted once per encounter with a patient. The researchers abstracted data from 35,110 encounters of 9,972 female patients of child-bearing age.
Before CDS was implemented, 24.2 percent of patient visits had documented contraceptive counseling when a teratogenic drug was prescribed. Following CDS implementation, this increased to 26.5 percent in both CDS groups. Those who received the multifaceted CDS reported an increase in the number of times per month they discussed medication risks during pregnancy with women to whom they prescribed teratogenic drugs. They also improved several prescribing and counseling practices. However, PCPs reported more satisfaction with the simple CDS system. Thus, the researchers conclude that, although CDS systems have the potential to boost provision of family planning services when fertile women are prescribed potentially teratogenic medications, further refinement of these systems is needed. Their study was supported in part by the Agency for Healthcare Research and Quality (HS17093).
See "Clinical decision support to promote safe prescribing to women of reproductive age: A cluster-randomized trial," by Eleanor Bimla Schwarz, MD, MS, Sara M. Parisi, MS, MPH, Steven M. Handler, MD, PhD, and others in the Journal of General Internal Medicine 27(7), pp. 831-838, 2012.