Promoting safe prescribing in primary care with a contraceptive vital sign: A cluster-randomized controlled trial

Eleanor Schwarz, Sara M. Parisi, Sanithia L. Williams, Grant J. Shevchik, Rachel Hess

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

PURPOSE Routine assessment of women's pregnancy intentions and contraceptive use-a so-called contraceptive vital sign-may help primary care physicians identify patients who need preconception or contraceptive counseling and be of particular benefi t when teratogenic medications are prescribed. METHODS We conducted a cluster-randomized controlled trial to evaluate the effect of a contraceptive vital sign on primary care documentation of contraceptive use and change in primary care physicians' provision of family planning services. Academic internists in the intervention group (n = 26) were provided with information on their female patients' pregnancy intentions and contraceptive use immediately before visits; internists in the control group (n = 27) received only standard intake information. Data were abstracted from the electronic health record for 5,371 visits by 2,304 women aged 18 to 50 years. RESULTS Documentation of contraception increased from baseline, from 23% to 57% in the intervention group, but remained 28% in the control group, a change of +77.4 (95% confi dence interval [CI], 70.7 to 84.1) adjusted percentage points in the former vs +3.1 (95% CI, 1.2 to 5.0) in the latter (P <.001). 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, a change of +61.5 (95% CI, 35.8 to 87.1) adjusted percentage points in the former vs -0.3 (95% CI, -4.3 to 3.6) in the latter (P <.001). Provision of new family planning services increased only minimally with this intervention, however. When women with documented nonuse of contraception were prescribed potential teratogens, only 7% were provided family planning services. CONCLUSIONS A contraceptive vital sign improves documentation of contraceptive use; however, ongoing efforts are needed to improve provision of preconception and contraceptive services.

Original languageEnglish (US)
Pages (from-to)516-522
Number of pages7
JournalAnnals of Family Medicine
Volume10
Issue number6
DOIs
StatePublished - Jan 1 2012
Externally publishedYes

Fingerprint

Vital Signs
Contraceptive Agents
Primary Health Care
Randomized Controlled Trials
Documentation
Family Planning Services
Primary Care Physicians
Contraception
Control Groups
Teratogens
Pregnancy
Electronic Health Records
Prescriptions
Counseling

Keywords

  • Contraception
  • Health services research
  • Preconception care
  • Primary healthcare
  • Teratogens

ASJC Scopus subject areas

  • Family Practice

Cite this

Promoting safe prescribing in primary care with a contraceptive vital sign : A cluster-randomized controlled trial. / Schwarz, Eleanor; Parisi, Sara M.; Williams, Sanithia L.; Shevchik, Grant J.; Hess, Rachel.

In: Annals of Family Medicine, Vol. 10, No. 6, 01.01.2012, p. 516-522.

Research output: Contribution to journalArticle

Schwarz, Eleanor ; Parisi, Sara M. ; Williams, Sanithia L. ; Shevchik, Grant J. ; Hess, Rachel. / Promoting safe prescribing in primary care with a contraceptive vital sign : A cluster-randomized controlled trial. In: Annals of Family Medicine. 2012 ; Vol. 10, No. 6. pp. 516-522.
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N2 - PURPOSE Routine assessment of women's pregnancy intentions and contraceptive use-a so-called contraceptive vital sign-may help primary care physicians identify patients who need preconception or contraceptive counseling and be of particular benefi t when teratogenic medications are prescribed. METHODS We conducted a cluster-randomized controlled trial to evaluate the effect of a contraceptive vital sign on primary care documentation of contraceptive use and change in primary care physicians' provision of family planning services. Academic internists in the intervention group (n = 26) were provided with information on their female patients' pregnancy intentions and contraceptive use immediately before visits; internists in the control group (n = 27) received only standard intake information. Data were abstracted from the electronic health record for 5,371 visits by 2,304 women aged 18 to 50 years. RESULTS Documentation of contraception increased from baseline, from 23% to 57% in the intervention group, but remained 28% in the control group, a change of +77.4 (95% confi dence interval [CI], 70.7 to 84.1) adjusted percentage points in the former vs +3.1 (95% CI, 1.2 to 5.0) in the latter (P <.001). 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, a change of +61.5 (95% CI, 35.8 to 87.1) adjusted percentage points in the former vs -0.3 (95% CI, -4.3 to 3.6) in the latter (P <.001). Provision of new family planning services increased only minimally with this intervention, however. When women with documented nonuse of contraception were prescribed potential teratogens, only 7% were provided family planning services. CONCLUSIONS A contraceptive vital sign improves documentation of contraceptive use; however, ongoing efforts are needed to improve provision of preconception and contraceptive services.

AB - PURPOSE Routine assessment of women's pregnancy intentions and contraceptive use-a so-called contraceptive vital sign-may help primary care physicians identify patients who need preconception or contraceptive counseling and be of particular benefi t when teratogenic medications are prescribed. METHODS We conducted a cluster-randomized controlled trial to evaluate the effect of a contraceptive vital sign on primary care documentation of contraceptive use and change in primary care physicians' provision of family planning services. Academic internists in the intervention group (n = 26) were provided with information on their female patients' pregnancy intentions and contraceptive use immediately before visits; internists in the control group (n = 27) received only standard intake information. Data were abstracted from the electronic health record for 5,371 visits by 2,304 women aged 18 to 50 years. RESULTS Documentation of contraception increased from baseline, from 23% to 57% in the intervention group, but remained 28% in the control group, a change of +77.4 (95% confi dence interval [CI], 70.7 to 84.1) adjusted percentage points in the former vs +3.1 (95% CI, 1.2 to 5.0) in the latter (P <.001). 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, a change of +61.5 (95% CI, 35.8 to 87.1) adjusted percentage points in the former vs -0.3 (95% CI, -4.3 to 3.6) in the latter (P <.001). Provision of new family planning services increased only minimally with this intervention, however. When women with documented nonuse of contraception were prescribed potential teratogens, only 7% were provided family planning services. CONCLUSIONS A contraceptive vital sign improves documentation of contraceptive use; however, ongoing efforts are needed to improve provision of preconception and contraceptive services.

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