ABSTRACT
BACKGROUND
The majority of women prescribed category D or X medications may not receive adequate contraceptive counseling or a reliable contraceptive method. Physicians who prescribe potentially teratogenic medications have a responsibility to provide women with contraceptive counseling, a method of highly-effective contraception, or both.
OBJECTIVE
Investigate the knowledge, beliefs and barriers of primary care physicians toward providing adequate contraception to women taking potential teratogens.
DESIGN & PARTICIPANTS
Self-administered confidential survey of primary care internal medicine physicians at an urban, academic medical center.
MEASUREMENTS
Knowledge of potential teratogenic medications and contraceptive failure rates was assessed. Participants’ beliefs about adequacy of their medical education, practice limitations and attitudes toward improving provision of contraception to women on potential teratogens were assessed.
RESULTS
One hundred and ten physicians responded (57.3%). Nearly two-thirds (62.3%) of participants had cared for reproductive aged women taking category D or X medications in the past year. The mean percent of correctly identified category D or X medications was 58.4% (SD 22.1%). The mean percent correct for knowledge of published contraceptive failure rates was 64.6% (SD 23.1%). Most respondents (87.6%) felt it is the responsibility of primary care physicians to provide contraception. Time constraints were reported to be somewhat or very limiting by 61.3% and over half felt medical school (63.2%) or residency (58.1%) inadequately prepared them to prescribe or counsel about contraceptives.
CONCLUSIONS
Primary care physicians commonly encounter reproductive age women taking category D or X medications, but may lack sufficient knowledge and time to counsel about potential teratogens and contraception to prevent fetal exposure to these drugs.
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References
Petrini J, Damus K, Russell R, Poschman K, Davidoff MJ, Mattison D. Contribution of birth defects to infant mortality in the United States. Teratology. 2002;66(Suppl 1):S3–6.
Yoon PW, Olney RS, Khoury MJ, Sappenfield WM, Chavez GF, Taylor D. ontribution of birth defects and genetic diseases to pediatric hospitalizations. A population-based study. Arch Pediatr Adolesc Med. 1997;151(11):1096–103.
Cunningham GF, Leveno KL, Bloom SL, Hauth JC, Gilstrap LC, Williams KDW. Obstetrics, 22nd Edition. 22nd ed. New York: McGraw-Hill Professional; 2005:1600.
Jones RK, Zolna MR, Henshaw SK, Finer LB. Abortion in the United States: incidence and access to services, 2005. Perspect Sex Reprod Health. 2008;40(1):6–16.
Schwarz EB, Maselli J, Norton M, Gonzales R. Prescription of teratogenic medications in United States ambulatory practices. Am J Med. 2005;118(11):1240–9.
Schwarz EB, Postlethwaite DA, Hung YY, Armstrong MA. Documentation of contraception and pregnancy when prescribing potentially teratogenic medications for reproductive-age women. Ann Intern Med. 2007;147(6):370–6.
Andrade SE, Gurwitz JH, Davis RL, et al. Prescription drug use in pregnancy. Am J Obstet Gynecol. 2004;191(2):398–407.
Lee E, Maneno MK, Smith L, et al. National patterns of medication use during pregnancy. Pharmacoepidemiol Drug Saf. 2006;15(8):537–45.
Andrade SE, Raebel MA, Morse AN, et al. Use of prescription medications with a potential for fetal harm among pregnant women. Pharmacoepidemiol Drug Saf. 2006;15(8):546–54.
VanGeest JB, Johnson TP, Welch VL. Methodologies for improving response rates in surveys of physicians: a systematic review. Eval Health Prof. 2007;30(4):303–21.
Verispan V. Top prescriptions dispensed in 2007.
Clinical Pharmacology. Gold Standard, Inc., Tampa, FL; 2009. www.jgim.org) was developed with experts in survey design and methodology. Specialists in the fields of contraception, pharmacology, teratology and primary care internal medicine assisted with the content and assessed the survey for face validity. It was then pretested among members of the internal medicine department at our institution, modified to reflect suggested changes from these reviewers, and then it was transferred to an electronic format using a web-based survey service http://www.clinicalpharmacology.com. Accessed November 20, 2009.
Trussell J. Contraceptive failure in the United States. Contraception. 2004;70(2):89–96.
Akl EA, Maroun N, Klocke RA, Montori V, Schunemann HJ. Electronic mail was not better than postal mail for surveying residents and faculty. J Clin Epidemiol. 2005;58(4):425–9.
Boyer KK, Olson JR, Calantone R, Jackson J. Print versus electronic surveys: a comparison of two data collection methodologies. J Oper Manag. 2002;20(Issue 4):357–73.
Weisman CS, Maccannon DS, Henderson JT, Shortridge E, Orso CL. Contraceptive counseling in managed care: preventing unintended pregnancy in adults. Womens Health Issues. 2002;12(2):79–95.
Bates DW. Preventing medication errors: a summary. Am J Health Syst Pharm. 2007;64(14 Suppl 9):S3–9. quiz S24–26.
Chaudhry B, Wang J, Wu S, et al. Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Ann Intern Med. 2006;144(10):742–52.
El-Kareh R, Gandhi TK, Poon EG, et al. Trends in primary care clinician perceptions of a new electronic health record. J Gen Intern Med. 2009;24(4):464–8.
FDA. Pregnant Women to Benefit from Better Information. FDA Consumer Health Information [2008; http://www.fda.gov/downloads/ForConsumers/ConsumerUpdates/UCM143746.pdf Accessed November 20, 2009.
Honein MA, Lindstrom JA, Kweder SL. Can we ensure the safe use of known human teratogens?: The iPLEDGE test case. Drug Saf. 2007;30(1):5–15.
Lagoy CT, Joshi N, Cragan JD, Rasmussen SA. Medication use during pregnancy and lactation: an urgent call for public health action. J Womens Health (Larchmt). 2005;14(2):104–9.
Code of Federal Regulations, Title 21, Vol 4, 21 CFR201.57; 2001.
Physicians Desk Reference, 57th edition. Montvale, NJ: Thomson PDR; 2004.
Teratology public affairs committee position paper: pregnancy labeling for prescription drugs: ten years later. Birth Defects Res A Clin Mol Teratol. 2007;79(9):627–30.
Buhimschi CS, Weiner CP. Medications in pregnancy and lactation: part 1. Teratology. Obstet Gynecol. 2009;113(1):166–88.
Buhimschi CS, Weiner CP. Medications in pregnancy and lactation: part 2. Drugs with minimal or unknown human teratogenic effect. Obstet Gynecol. 2009;113(2 Pt 1):417–32.
Trussell J. Contraceptive efficacy. In: Hatcher RA, Trussel J, Stewart F, et al., eds. Contraceptive Technology Eighteenth revised edition. New York: Ardent Media; 2004.
Acknowledgements
Funded by a grant supplied by a generous anonymous donor. This research was presented at the Fellowship in Family Planning National Conference in Chicago, May, 2009. We would like to thank the faculty and staff of the Research and Education for Academic Achievement (REACH) Network and the Northwestern University Clinical and Translational Sciences Institute (NUCATS) for their support during this project (grant UL1RR025741).
This research could not have been completed without the assistance of Charlie Zei and Jason Thompson, research assistant and programmer, respectively.
Conflicts of Interest
David Eisenberg has received honoraria and consulting fees from Bayer Schering Pharma and Haymarket Media. Catherine Stika has received a grant from Boehringer Ingelheim and has a grant pending from Biosante Pharma.
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Dr. Eisenberg was a fellow at Northwestern University when this research was conducted, but he is now on faculty at the Washington University School of Medicine
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Appendix: Written version of survey (PDF 164 kb)
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Eisenberg, D.L., Stika, C., Desai, A. et al. Providing Contraception for Women Taking Potentially Teratogenic Medications: A Survey of Internal Medicine Physicians’ Knowledge, Attitudes and Barriers. J GEN INTERN MED 25, 291–297 (2010). https://doi.org/10.1007/s11606-009-1215-2
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DOI: https://doi.org/10.1007/s11606-009-1215-2