Journal of General Internal Medicine

, Volume 27, Issue 7, pp 831–838

Clinical Decision Support to Promote Safe Prescribing to Women of Reproductive Age: A Cluster-Randomized Trial

Authors

    • Division of General Internal MedicineUniversity of Pittsburgh School of Medicine
    • Department of EpidemiologyUniversity of Pittsburgh
    • Department of Obstetrics, Gynecology, and Reproductive SciencesUniversity of Pittsburgh
    • University of Pittsburgh Medical Center
  • Sara M. Parisi
    • Division of General Internal MedicineUniversity of Pittsburgh School of Medicine
  • Steven M. Handler
    • University of Pittsburgh Medical Center
    • Department of Biomedical InformaticsUniversity of Pittsburgh
  • Gideon Koren
    • Motherisk Laboratory, Hospital for Sick Children
  • Elan D. Cohen
    • Division of General Internal MedicineUniversity of Pittsburgh School of Medicine
  • Grant J. Shevchik
    • University of Pittsburgh Medical Center
  • Gary S. Fischer
    • Division of General Internal MedicineUniversity of Pittsburgh School of Medicine
    • University of Pittsburgh Medical Center
Original Research

DOI: 10.1007/s11606-012-1991-y

Cite this article as:
Schwarz, E.B., Parisi, S.M., Handler, S.M. et al. J GEN INTERN MED (2012) 27: 831. doi:10.1007/s11606-012-1991-y

ABSTRACT

BACKGROUND

Potentially teratogenic medications are frequently prescribed without provision of contraceptive counseling.

OBJECTIVE

To evaluate whether computerized clinical decision support (CDS) can increase primary care providers’ (PCPs’) provision of family planning services when prescribing potentially teratogenic medications.

DESIGN

Cluster-randomized trial conducted in one academic and one community-based practice between October of 2008 and April of 2010.

PARTICIPANTS/INTERVENTIONS

Forty-one PCPs were randomized to receive one of two types of CDS which alerted them to risks of medication-induced birth defects when ordering potentially teratogenic medications for women who may become pregnant. The ‘simple’ CDS provided a cautionary alert; the ‘multifaceted’ CDS provided tailored information and links to a structured order set designed to facilitate safe prescribing. Both CDS systems alerted PCPs about medication risk only once per encounter.

MAIN MEASURES

We assessed change in documented provision of family planning services using data from 35,110 encounters and mixed-effects models. PCPs completed surveys before and after the CDS systems were implemented, allowing assessment of change in PCP-reported counseling about the risks of medication-induced birth defects and contraception.

KEY RESULTS

Both CDS systems were associated with slight increases in provision of family planning services when potential teratogens were prescribed, without a significant difference in improvement by CDS complexity (p = 0.87). Because CDS was not repeated, 13% of the times that PCPs received CDS they substituted another potential teratogen. PCPs reported significant improvements in several counseling and prescribing practices. The multifaceted group reported a greater increase in the number of times per month they discussed the risks of medication use during pregnancy (multifaceted: +4.9 ± 7.0 vs. simple: +0.8 ± 3.2, p = 0.03). The simple CDS system was associated with greater clinician satisfaction.

CONCLUSIONS

CDS systems hold promise for increasing provision of family planning services when fertile women are prescribed potentially teratogenic medications, but further refinement of these systems is needed.

KEY WORDS

preconception carecontraceptive counselinghealth ITdecision supportbirth defects

Supplementary material

11606_2012_1991_MOESM1_ESM.doc (172 kb)
ESM 1(DOC 171 kb)

Copyright information

© Society of General Internal Medicine 2012