Counseling about medication-induced birth defects with clinical decision support in primary care
BACKGROUND: We evaluated how computerized clinical decision support (CDS) affects the counseling women receive when primary care physicians (PCPs) prescribe potential teratogens and how this counseling affects women's behavior.
METHODS: Between October 2008 and April 2010, all women aged 18-50 years visiting one of three community-based family practice clinics or an academic general internal medicine clinic were invited to complete a survey 5-30 days after their clinic visit. Women who received prescriptions were asked if they were counseled about teratogenic risks or contraception and if they used contraception at last intercourse.
RESULTS: Eight hundred one women completed surveys; 27% received a prescription for a potential teratogen. With or without CDS, women prescribed potential teratogens were more likely than women prescribed safer medications to report counseling about teratogenic risks. However, even with CDS 43% of women prescribed potential teratogens reported no counseling. In multivariable models, women were more likely to report counseling if they saw a female PCP (odds ratio: 1.97; 95% confidence interval: 1.26-3.09). Women were least likely to report counseling if they received angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Women who were pregnant or trying to conceive were not more likely to report counseling. Nonetheless, women who received counseling about contraception or teratogenic risks were more likely to use contraception after being prescribed potential teratogens than women who received no counseling.
CONCLUSIONS: Physician counseling can reduce risk of medication-induced birth defects. However, efforts are needed to ensure that PCPs consistently inform women of teratogenic risks and provide access to highly effective contraception.
Errataetall: |
CommentIn: J Womens Health (Larchmt). 2013 Oct;22(10):795-6. - PMID 24044697 |
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Medienart: |
E-Artikel |
Erscheinungsjahr: |
2013 |
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Erschienen: |
2013 |
Enthalten in: |
Zur Gesamtaufnahme - volume:22 |
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Enthalten in: |
Journal of women's health (2002) - 22(2013), 10 vom: 03. Okt., Seite 817-24 |
Sprache: |
Englisch |
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Beteiligte Personen: |
Schwarz, Eleanor Bimla [VerfasserIn] |
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Links: |
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Themen: |
Evaluation Study |
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Anmerkungen: |
Date Completed 06.02.2014 Date Revised 21.10.2021 published: Print-Electronic CommentIn: J Womens Health (Larchmt). 2013 Oct;22(10):795-6. - PMID 24044697 Citation Status MEDLINE |
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doi: |
10.1089/jwh.2013.4262 |
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funding: |
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Förderinstitution / Projekttitel: |
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PPN (Katalog-ID): |
NLM229890458 |
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500 | |a CommentIn: J Womens Health (Larchmt). 2013 Oct;22(10):795-6. - PMID 24044697 | ||
500 | |a Citation Status MEDLINE | ||
520 | |a BACKGROUND: We evaluated how computerized clinical decision support (CDS) affects the counseling women receive when primary care physicians (PCPs) prescribe potential teratogens and how this counseling affects women's behavior | ||
520 | |a METHODS: Between October 2008 and April 2010, all women aged 18-50 years visiting one of three community-based family practice clinics or an academic general internal medicine clinic were invited to complete a survey 5-30 days after their clinic visit. Women who received prescriptions were asked if they were counseled about teratogenic risks or contraception and if they used contraception at last intercourse | ||
520 | |a RESULTS: Eight hundred one women completed surveys; 27% received a prescription for a potential teratogen. With or without CDS, women prescribed potential teratogens were more likely than women prescribed safer medications to report counseling about teratogenic risks. However, even with CDS 43% of women prescribed potential teratogens reported no counseling. In multivariable models, women were more likely to report counseling if they saw a female PCP (odds ratio: 1.97; 95% confidence interval: 1.26-3.09). Women were least likely to report counseling if they received angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Women who were pregnant or trying to conceive were not more likely to report counseling. Nonetheless, women who received counseling about contraception or teratogenic risks were more likely to use contraception after being prescribed potential teratogens than women who received no counseling | ||
520 | |a CONCLUSIONS: Physician counseling can reduce risk of medication-induced birth defects. However, efforts are needed to ensure that PCPs consistently inform women of teratogenic risks and provide access to highly effective contraception | ||
650 | 4 | |a Evaluation Study | |
650 | 4 | |a Journal Article | |
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650 | 4 | |a Research Support, U.S. Gov't, P.H.S. | |
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700 | 1 | |a Parisi, Sara M |e verfasserin |4 aut | |
700 | 1 | |a Handler, Steven M |e verfasserin |4 aut | |
700 | 1 | |a Koren, Gideon |e verfasserin |4 aut | |
700 | 1 | |a Shevchik, Grant |e verfasserin |4 aut | |
700 | 1 | |a Fischer, Gary S |e verfasserin |4 aut | |
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