title: Promoting safe prescribing in primary care with a contraceptive vital sign: a cluster-randomized controlled trial.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  A contraceptive vital sign improves documentation of contraceptive use; however, ongoing efforts are needed to improve provision of preconception and contraceptive services.
authors.affiliation: Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA. schwarzeb@upmc.edu
authors.forename: Eleanor Bimla
authors.initials: EB
authors.lastname: Schwarz
authors.forename: Sara M
authors.initials: SM
authors.lastname: Parisi
authors.forename: Sanithia L
authors.initials: SL
authors.lastname: Williams
authors.forename: Grant J
authors.initials: GJ
authors.lastname: Shevchik
authors.forename: Rachel
authors.initials: R
authors.lastname: Hess
mesh_terms: D000293:Adolescent; D000328:Adult; D003268:Contraception Behavior / Q000706:statistics & numerical data*; D004282:Documentation; D005193:Family Planning Services / Q000706:statistics & numerical data*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy; D055656:Prescriptions; D011320:Primary Health Care; D015397:Program Evaluation; D013723:Teratogens; D055815:Young Adult
chemical_list: D013723:Teratogens