Evaluating the feasibility and efficacy of adding a "contraceptive vital sign" to help spur preconception counseling and safe prescribing of teratogenic medications (drugs known to cause congenital malformations) in primary care, researchers found a contraceptive vital sign improves documentation of pregnancy intentions and contraception in a manner that is acceptable to patients, but had little effect on the rate of family planning counseling and prescribing of potentially teratogenic medications.
Specifically, the randomized controlled trial that included data on more than 2,304 women found documentation of contraception increased from 23 percent to 57 percent in the intervention group but remained 28 percent in the control group.
For visits involving a teratogenic prescription, documentation increased from 14 percent to 48 percent in the intervention group and decreased from 29 percent to 26 percent in the control group. Provision of new family planning services increased only minimally, however, including among visits with potentially teratogenic prescriptions.
When women with documented nonuse of contraception were prescribed potential teratogens, family planning services were provided to only 7 percent.
The authors conclude that because the majority of potentially teratogenic medications are prescribed by primary care physicians, ongoing efforts are needed to ensure these patients receive preconception counseling and family planning services.
They note that although the intervention was designed to limit primary care physicians' liability when a potential teratogen was prescribed, it may have inadvertently increased liability when contraceptive nonuse was explicitly documented alongside a potential teratogenic prescription.
Promoting Safe Prescribing in Primary Care With a Contraceptive Vital Sign: A Cluster-Randomized Controlled Trial By Eleanor Bimla Schwarz, MD, MS, et al