title: Using the electronic medical record to refer women taking category D or X medications for teratogen and contraceptive counseling.
abstract: BACKGROUND
  Women taking teratogens may not receive teratogen and contraceptive counseling. The objective of this study is to explore the feasibility of an electronic medical record (EMR) alert and referral system to improve teratogen and contraceptive counseling.
  
  
  METHODS
  We conducted a descriptive study in an academic outpatient setting to evaluate the feasibility of an EMR alert and referral system. Reproductive age women taking category D or X medications seen in family medicine clinics were referred by means of an EMR alert for teratogen and contraceptive counseling. A subset of these women consented to follow-up surveys assessing contraceptive usage before counseling, intended contraceptive method after counseling and satisfaction with the counseling. Participants were contacted at 1 and 3 months to assess contraceptive usage.
  
  
  RESULTS
  A total of 354 women were prescribed category D or X medications by clinicians who received the EMR alert, 170 women were referred, 59 women received counseling, and 33 participants enrolled in the study. One participant did not use any contraception. Among the 32 participants using contraception, 12 (37.5%) used oral contraceptives, 11 (34.4%) used condoms, 3 (9.4%) used withdrawal, 3 (9.4%) used intrauterine devices, 2 (6.3%) used contraceptive rings, and 1 (3.1%) used the diaphragm. After counseling, one-third of participants were considering more effective contraception. Almost all participants strongly agreed or agreed that the counseling was helpful.
  
  
  CONCLUSIONS
  Creating an EMR alert and referral system for women prescribed category X or D medications is feasible. Counseling on teratogen exposure and contraception may improve the acceptability of more effective contraception.
authors.affiliation: Department of Reproductive Medicine, University of California, San Diego, California.
authors.forename: Sheila K
authors.initials: SK
authors.lastname: Mody
authors.affiliation: Department of Family Medicine, University of California, San Diego, California.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Wu
authors.affiliation: Department of Pediatrics, Division of Dysmorphology and Teratology, University of California, San Diego, California.
authors.forename: Marla
authors.initials: M
authors.lastname: Ornelas
authors.affiliation: Department of Pediatrics, Division of Dysmorphology and Teratology, University of California, San Diego, California.
authors.forename: Colleen
authors.initials: C
authors.lastname: Kernahan
authors.affiliation: Department of Pediatrics, Division of Dysmorphology and Teratology, University of California, San Diego, California.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Salas
authors.affiliation: Department of Pediatrics, Division of Dysmorphology and Teratology, University of California, San Diego, California.
authors.forename: Kelly
authors.initials: K
authors.lastname: Kao
authors.affiliation: Department of Pediatrics, Division of Dysmorphology and Teratology, University of California, San Diego, California.
authors.forename: Robert
authors.initials: R
authors.lastname: Felix
authors.affiliation: Department of Pediatrics, Division of Dysmorphology and Teratology, University of California, San Diego, California.
authors.forename: Christina
authors.initials: C
authors.lastname: Chambers
mesh_terms: D003267:Contraception; D003376:Counseling; D004358:Drug Therapy; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D010865:Pilot Projects; D012017:Referral and Consultation; D013723:Teratogens
chemical_list: D013723:Teratogens
keywords: collaboration; contraception; electronic medical records; medication safety; teratogen