Article Figures & Data
Figures
- Figure 1
Flow diagram describing physician clusters and patient encounters from the time of recruitment to analysis.
- Figure 2
Change in proportion of visits with medical record documentation of contraception before and after introduction of the contraceptive vital sign.
Notes: Contraceptive vital sign data and electronic health record data were collected between October 1, 2008, and April 14, 2010. Baseline electronic health record data from the 17 months before introduction of the contraceptive vital sign were used for comparison. In generalized linear mixed-effects models, there was a greater increase in documentation of contraception in the intervention group compared with the control group, both for all visits (P <.001) and visits that involved prescription of potentially teratogenic medications (P <.001). Hormonal or more effective methods = pill, patch, ring, injection, intrauterine devices, subdermal contraceptiveimplants, and vasectomies. Women who had been sterilized were excluded. Not sexually active = women who reported no sex with a man in past 3 months.
Tables
The Article in Brief
Eleanor Bimla Schwarz , and colleagues
Background A "contraceptive vital sign" (routine intake assessment of women�s pregnancy intentions and contraceptive use) could help spur preconception counseling and safe prescribing of teratogenic medications (drugs known to cause congenital malformations). This study evaluates the feasibility and efficacy of using a contraceptive vital sign in primary care.
What This Study Found A contraceptive vital sign improves documentation of pregnancy intentions and contraception in a manner that is acceptable to patients but has little effect on the rate of family planning counseling and prescribing of potentially teratogenic medications. Specifically, the study of more than 2,304 women found documentation of contraception increased from 23% to 57% in the intervention group but remained 28% in the control group. For visits involving a teratogenic prescription, documentation increased from 14% to 48% in the intervention group and decreased from 29% to 26% in the control group. Provision of new family planning services increased only minimally, however, including among visits with potentially teratogenic prescriptions. When women with documented nonuse of contraception were prescribed potential teratogens, family planning services were provided to only 7%.
Implications
- Because most potentially teratogenic medications are prescribed by primary care clinicians, ongoing efforts are needed to ensure these patients receive preconception counseling and family planning services.
- The authors note that although the intervention was designed to limit primary care physicians' liability when a potential teratogen was prescribed, it may have inadvertently increased liability when contraceptive nonuse was explicitly documented alongside a potential teratogenic prescription.
