Promoting Safe Prescribing in Primary Care With a Contraceptive Vital Sign: A Cluster-Randomized Controlled Trial
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 benefit when teratogenic medications are pres...
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Veröffentlicht in: | Annals of family medicine 2012-11, Vol.10 (6), p.516-522 |
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description | 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 benefit 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% confidence 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 |
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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% confidence 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. Conclusion A contraceptive vital sign improves documentation of contraceptive use; however, ongoing efforts are needed to improve provision of preconception and contraceptive services.</description><identifier>ISSN: 1544-1709</identifier><identifier>EISSN: 1544-1717</identifier><identifier>DOI: 10.1370/afm.1404</identifier><identifier>PMID: 23149528</identifier><language>eng</language><publisher>United States: American Academy of Family Physicians</publisher><subject>Adolescent ; Adult ; Contraception Behavior - statistics & numerical data ; Documentation ; Family Planning Services - statistics & numerical data ; Feasibility Studies ; Female ; Humans ; Internal Medicine ; Middle Aged ; Original Research ; Practice Patterns, Physicians' - statistics & numerical data ; Pregnancy ; Prescriptions ; Primary Health Care ; Program Evaluation ; Teratogens ; Young Adult</subject><ispartof>Annals of family medicine, 2012-11, Vol.10 (6), p.516-522</ispartof><rights>Annals of Family Medicine, Inc.</rights><rights>2012 Annals of Family Medicine, Inc. 2012</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c427t-ce73ef4790f6840c5ed1ec66b8cd315b47eed7a171d8bf42d55b2e60506c89923</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3495925/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3495925/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23149528$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Schwarz, Eleanor Bimla, MD, MS</creatorcontrib><creatorcontrib>Parisi, Sara M., MS, MPH</creatorcontrib><creatorcontrib>Williams, Sanithia L., BS</creatorcontrib><creatorcontrib>Shevchik, Grant J., MD</creatorcontrib><creatorcontrib>Hess, Rachel, MD, MS</creatorcontrib><title>Promoting Safe Prescribing in Primary Care With a Contraceptive Vital Sign: A Cluster-Randomized Controlled Trial</title><title>Annals of family medicine</title><addtitle>Ann Fam Med</addtitle><description>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 benefit 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% confidence 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. Conclusion A contraceptive vital sign improves documentation of contraceptive use; however, ongoing efforts are needed to improve provision of preconception and contraceptive services.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Contraception Behavior - statistics & numerical data</subject><subject>Documentation</subject><subject>Family Planning Services - statistics & numerical data</subject><subject>Feasibility Studies</subject><subject>Female</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Middle Aged</subject><subject>Original Research</subject><subject>Practice Patterns, Physicians' - statistics & numerical data</subject><subject>Pregnancy</subject><subject>Prescriptions</subject><subject>Primary Health Care</subject><subject>Program Evaluation</subject><subject>Teratogens</subject><subject>Young Adult</subject><issn>1544-1709</issn><issn>1544-1717</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkUtPxCAUhYnR-E78BYalm45A6cuFiWl8JZNonFGXhNLbEaVlhM4k-uulGR11xQUOh3u-i9ARJSMaZ-RUNu2IcsI30C5NOI9oRrPNdU2KHbTn_SshjLKYbaMdFlNeJCzfRe_3zra2190MT2QD-N6BV05Xw4Huwla30n3gUjrAz7p_wRKXtuudVDDv9RLwk-6lwRM9687wBS7NwvfgogfZ1bbVn1Cv5NaYUE6dluYAbTXSeDj8XvfR49XltLyJxnfXt-XFOFKcZX2kIIuh4VlBmjTnRCVQU1BpWuWqjmlS8QygzmRIWudVw1mdJBWDlCQkVXlRsHgfna9854uqhVrB0LUR81UiYaUW_286_SJmdinigKZgSTA4WRkoZ7130KzfUiIG7CJgFwP2ID3--9da-MP5txkIiZcanFBGd1pJ8wYf4F_twnUBhqDCM0HEZJjcMDjKUkIJz-Mvfl2Uxg</recordid><startdate>20121101</startdate><enddate>20121101</enddate><creator>Schwarz, Eleanor Bimla, MD, MS</creator><creator>Parisi, Sara M., MS, MPH</creator><creator>Williams, Sanithia L., BS</creator><creator>Shevchik, Grant J., MD</creator><creator>Hess, Rachel, MD, MS</creator><general>American Academy of Family Physicians</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>5PM</scope></search><sort><creationdate>20121101</creationdate><title>Promoting Safe Prescribing in Primary Care With a Contraceptive Vital Sign: A Cluster-Randomized Controlled Trial</title><author>Schwarz, Eleanor Bimla, MD, MS ; Parisi, Sara M., MS, MPH ; Williams, Sanithia L., BS ; Shevchik, Grant J., MD ; Hess, Rachel, MD, MS</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c427t-ce73ef4790f6840c5ed1ec66b8cd315b47eed7a171d8bf42d55b2e60506c89923</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Contraception Behavior - statistics & numerical data</topic><topic>Documentation</topic><topic>Family Planning Services - statistics & numerical data</topic><topic>Feasibility Studies</topic><topic>Female</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Middle Aged</topic><topic>Original Research</topic><topic>Practice Patterns, Physicians' - statistics & numerical data</topic><topic>Pregnancy</topic><topic>Prescriptions</topic><topic>Primary Health Care</topic><topic>Program Evaluation</topic><topic>Teratogens</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Schwarz, Eleanor Bimla, MD, MS</creatorcontrib><creatorcontrib>Parisi, Sara M., MS, MPH</creatorcontrib><creatorcontrib>Williams, Sanithia L., BS</creatorcontrib><creatorcontrib>Shevchik, Grant J., MD</creatorcontrib><creatorcontrib>Hess, Rachel, MD, MS</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Annals of family medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Schwarz, Eleanor Bimla, MD, MS</au><au>Parisi, Sara M., MS, MPH</au><au>Williams, Sanithia L., BS</au><au>Shevchik, Grant J., MD</au><au>Hess, Rachel, MD, MS</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Promoting Safe Prescribing in Primary Care With a Contraceptive Vital Sign: A Cluster-Randomized Controlled Trial</atitle><jtitle>Annals of family medicine</jtitle><addtitle>Ann Fam Med</addtitle><date>2012-11-01</date><risdate>2012</risdate><volume>10</volume><issue>6</issue><spage>516</spage><epage>522</epage><pages>516-522</pages><issn>1544-1709</issn><eissn>1544-1717</eissn><abstract>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 benefit 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% confidence 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. Conclusion A contraceptive vital sign improves documentation of contraceptive use; however, ongoing efforts are needed to improve provision of preconception and contraceptive services.</abstract><cop>United States</cop><pub>American Academy of Family Physicians</pub><pmid>23149528</pmid><doi>10.1370/afm.1404</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Adolescent Adult Contraception Behavior - statistics & numerical data Documentation Family Planning Services - statistics & numerical data Feasibility Studies Female Humans Internal Medicine Middle Aged Original Research Practice Patterns, Physicians' - statistics & numerical data Pregnancy Prescriptions Primary Health Care Program Evaluation Teratogens Young Adult |
title | Promoting Safe Prescribing in Primary Care With a Contraceptive Vital Sign: A Cluster-Randomized Controlled Trial |
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