Skip to main content
Erschienen in: Journal of General Internal Medicine 4/2010

01.04.2010 | Original Article

Providing Contraception for Women Taking Potentially Teratogenic Medications: A Survey of Internal Medicine Physicians’ Knowledge, Attitudes and Barriers

verfasst von: David L. Eisenberg, MD, MPH, Catherine Stika, MD, Ami Desai, MD, David Baker, MD, Kathleen J. Yost, Phd

Erschienen in: Journal of General Internal Medicine | Ausgabe 4/2010

Einloggen, um Zugang zu erhalten

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.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
2.
Zurück zum Zitat 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.PubMed 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.PubMed
3.
Zurück zum Zitat Cunningham GF, Leveno KL, Bloom SL, Hauth JC, Gilstrap LC, Williams KDW. Obstetrics, 22nd Edition. 22nd ed. New York: McGraw-Hill Professional; 2005:1600. Cunningham GF, Leveno KL, Bloom SL, Hauth JC, Gilstrap LC, Williams KDW. Obstetrics, 22nd Edition. 22nd ed. New York: McGraw-Hill Professional; 2005:1600.
4.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
5.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
6.
Zurück zum Zitat 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.PubMed 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.PubMed
7.
Zurück zum Zitat Andrade SE, Gurwitz JH, Davis RL, et al. Prescription drug use in pregnancy. Am J Obstet Gynecol. 2004;191(2):398–407.CrossRefPubMed Andrade SE, Gurwitz JH, Davis RL, et al. Prescription drug use in pregnancy. Am J Obstet Gynecol. 2004;191(2):398–407.CrossRefPubMed
8.
Zurück zum Zitat Lee E, Maneno MK, Smith L, et al. National patterns of medication use during pregnancy. Pharmacoepidemiol Drug Saf. 2006;15(8):537–45.CrossRefPubMed Lee E, Maneno MK, Smith L, et al. National patterns of medication use during pregnancy. Pharmacoepidemiol Drug Saf. 2006;15(8):537–45.CrossRefPubMed
9.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
10.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
11.
Zurück zum Zitat Verispan V. Top prescriptions dispensed in 2007. Verispan V. Top prescriptions dispensed in 2007.
12.
Zurück zum Zitat 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. 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.​clinicalpharmaco​logy.​com. Accessed November 20, 2009.
13.
14.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
15.
Zurück zum Zitat 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.CrossRef 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.CrossRef
16.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
17.
Zurück zum Zitat Bates DW. Preventing medication errors: a summary. Am J Health Syst Pharm. 2007;64(14 Suppl 9):S3–9. quiz S24–26.CrossRefPubMed Bates DW. Preventing medication errors: a summary. Am J Health Syst Pharm. 2007;64(14 Suppl 9):S3–9. quiz S24–26.CrossRefPubMed
18.
Zurück zum Zitat 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.PubMed 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.PubMed
19.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
21.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
22.
Zurück zum Zitat 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.CrossRef 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.CrossRef
23.
Zurück zum Zitat Code of Federal Regulations, Title 21, Vol 4, 21 CFR201.57; 2001. Code of Federal Regulations, Title 21, Vol 4, 21 CFR201.57; 2001.
24.
Zurück zum Zitat Physicians Desk Reference, 57th edition. Montvale, NJ: Thomson PDR; 2004. Physicians Desk Reference, 57th edition. Montvale, NJ: Thomson PDR; 2004.
25.
Zurück zum Zitat 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. 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.
26.
Zurück zum Zitat Buhimschi CS, Weiner CP. Medications in pregnancy and lactation: part 1. Teratology. Obstet Gynecol. 2009;113(1):166–88.PubMed Buhimschi CS, Weiner CP. Medications in pregnancy and lactation: part 1. Teratology. Obstet Gynecol. 2009;113(1):166–88.PubMed
27.
Zurück zum Zitat 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.PubMed 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.PubMed
28.
Zurück zum Zitat Trussell J. Contraceptive efficacy. In: Hatcher RA, Trussel J, Stewart F, et al., eds. Contraceptive Technology Eighteenth revised edition. New York: Ardent Media; 2004. Trussell J. Contraceptive efficacy. In: Hatcher RA, Trussel J, Stewart F, et al., eds. Contraceptive Technology Eighteenth revised edition. New York: Ardent Media; 2004.
Metadaten
Titel
Providing Contraception for Women Taking Potentially Teratogenic Medications: A Survey of Internal Medicine Physicians’ Knowledge, Attitudes and Barriers
verfasst von
David L. Eisenberg, MD, MPH
Catherine Stika, MD
Ami Desai, MD
David Baker, MD
Kathleen J. Yost, Phd
Publikationsdatum
01.04.2010
Verlag
Springer-Verlag
Erschienen in
Journal of General Internal Medicine / Ausgabe 4/2010
Print ISSN: 0884-8734
Elektronische ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-009-1215-2

Weitere Artikel der Ausgabe 4/2010

Journal of General Internal Medicine 4/2010 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Reizdarmsyndrom: Diäten wirksamer als Medikamente

29.04.2024 Reizdarmsyndrom Nachrichten

Bei Reizdarmsyndrom scheinen Diäten, wie etwa die FODMAP-arme oder die kohlenhydratreduzierte Ernährung, effektiver als eine medikamentöse Therapie zu sein. Das hat eine Studie aus Schweden ergeben, die die drei Therapieoptionen im direkten Vergleich analysierte.

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Bei schweren Reaktionen auf Insektenstiche empfiehlt sich eine spezifische Immuntherapie

Insektenstiche sind bei Erwachsenen die häufigsten Auslöser einer Anaphylaxie. Einen wirksamen Schutz vor schweren anaphylaktischen Reaktionen bietet die allergenspezifische Immuntherapie. Jedoch kommt sie noch viel zu selten zum Einsatz.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.