Research Activities, June 2013
Two simple questions can help avoid prescribing of teratogenic drugs to pregnant or soon-to-be pregnant women
Asking female patients about their pregnancy intentions and their contraceptive practices can help provide primary care physicians with information needed to prescribe potentially teratogenic medicines safely, according to a new study. The two questions constitute a contraceptive vital sign (CVS). Half of all pregnancies in the United States are unplanned because of failure to use effective family planning. Nonusers of family planning techniques risk being pregnant without knowing it, and run an increased risk of bearing a deformed infant when taking teratogenic prescription drugs that can interfere with normal embryonic or fetal development.
The researchers randomly assigned 26 physicians from a large academic internal medicine practice to an intervention group that added the CVS to the intake questionnaire. They randomly assigned another 27 physicians from the practice to a control group that used an intake form with standard questions. During the study period, there were 816 visits to intervention physicians during which they asked the CVS questions, with answers provided by 93 percent of the women; 58 (7 percent) of the women either did not answer the CVS questions or did not finish the questionnaire.
Intervention physicians were notified by the electronic health record’s decision support software to "consider chance of pregnancy when prescribing" in 110 visits (13.5 percent). For visits involving a potentially teratogenic prescription, documentation of contraception for women visiting intervention-cluster physicians rose from 14.1 percent at baseline to 72.9 percent during the study period. In contrast, 26.6 percent of women visiting control physicians had medical record documentation of contraception at baseline versus 25.5 percent during the study period.
The study was funded in part by AHRQ (HS17093). More details are in "Promoting safe prescribing in primary care with a contraceptive vital sign: A cluster-randomized controlled trial," by Eleanor Bimla Schwarz, M.D., M.S., Sara M. Parisi, M.S., M.P.H., Sanitha L. Williams, B.S., and others in the November/December 2012 Annals of Family Medicine 10(6), pp. 516-522.