Counseling about medication-induced birth defects with clinical decision support in primary care.
BACKGROUND
We evaluated how computerized clinical decision support (CDS) affects the counseling women receive when primary care physicians (PCPs) prescribe potential teratogens and how this counseling affects women's behavior.


METHODS
Between October 2008 and April 2010, all women aged 18-50 years visiting one of three community-based family practice clinics or an academic general internal medicine clinic were invited to complete a survey 5-30 days after their clinic visit. Women who received prescriptions were asked if they were counseled about teratogenic risks or contraception and if they used contraception at last intercourse.


RESULTS
Eight hundred one women completed surveys; 27% received a prescription for a potential teratogen. With or without CDS, women prescribed potential teratogens were more likely than women prescribed safer medications to report counseling about teratogenic risks. However, even with CDS 43% of women prescribed potential teratogens reported no counseling. In multivariable models, women were more likely to report counseling if they saw a female PCP (odds ratio: 1.97; 95% confidence interval: 1.26-3.09). Women were least likely to report counseling if they received angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Women who were pregnant or trying to conceive were not more likely to report counseling. Nonetheless, women who received counseling about contraception or teratogenic risks were more likely to use contraception after being prescribed potential teratogens than women who received no counseling.


CONCLUSIONS
Physician counseling can reduce risk of medication-induced birth defects. However, efforts are needed to ensure that PCPs consistently inform women of teratogenic risks and provide access to highly effective contraception.
1 Division of General Internal Medicine, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania.
Eleanor Bimla
EB
Schwarz
Sara M
SM
Parisi
Steven M
SM
Handler
Gideon
G
Koren
Grant
G
Shevchik
Gary S
GS
Fischer
D000014:Abnormalities, Drug-Induced; D000293:Adolescent; D000328:Adult; D003376:Counseling; D020000:Decision Support Systems, Clinical; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005193:Family Planning Services; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D010353:Patient Education as Topic; D058007:Physicians, Primary Care; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy; D011320:Primary Health Care / Q000379:methods*; D013723:Teratogens; D055815:Young Adult
D013723:Teratogens