Promoting Safe Prescribing in Primary Care With a Contraceptive Vital Sign: A Cluster-Randomized Controlled Trial

• Published in: Annals of family medicine 2012-11, Vol.10 (6), p.516-522
• Main Authors: Schwarz, Eleanor Bimla, MD, MS, Parisi, Sara M., MS, MPH, Williams, Sanithia L., BS, Shevchik, Grant J., MD, Hess, Rachel, MD, MS
• Format: Article
• Language: English
• 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
• ISSN: 1544-1709; 1544-1717
• DOI: 10.1370/afm.1404

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