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 language | English (US) |
|---|---|
| Pages (from-to) | 516-522 |
| Number of pages | 7 |
| Journal | Annals of Family Medicine |
| Volume | 10 |
| Issue number | 6 |
| DOIs | |
| State | Published - Jan 1 2012 |
| Externally published | Yes |
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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 journal › Article
}
TY - JOUR
T1 - Promoting safe prescribing in primary care with a contraceptive vital sign
T2 - A cluster-randomized controlled trial
AU - Schwarz, Eleanor
AU - Parisi, Sara M.
AU - Williams, Sanithia L.
AU - Shevchik, Grant J.
AU - Hess, Rachel
PY - 2012/1/1
Y1 - 2012/1/1
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.
KW - Contraception
KW - Health services research
KW - Preconception care
KW - Primary healthcare
KW - Teratogens
UR - http://www.scopus.com/inward/record.url?scp=84869231749&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84869231749&partnerID=8YFLogxK
U2 - 10.1370/afm.1404
DO - 10.1370/afm.1404
M3 - Article
C2 - 23149528
AN - SCOPUS:84869231749
VL - 10
SP - 516
EP - 522
JO - Annals of Family Medicine
JF - Annals of Family Medicine
SN - 1544-1709
IS - 6
ER -