Safe Prescribing for Women of Reproductive Age
Safe Prescribing for Women of Reproductive Age
Along with the multiple other tasks inherent to primary care, it is primary care providers who often bear the chief responsibility for guiding such decision-making as the majority of teratogenic medications are commonly used in primary care practice. In the NAMCS study, the most commonly prescribed potential teratogens were anxiolytics, anticonvulsants, antibiotics and HMG CoA reductase inhibitors ('statins'). Of the approximately 12 million category D or X medications prescribed to women of childbearing age in this study, primary care physicians prescribed 45% of these medications, followed by dermatologists and psychiatrists.
Importantly, these groups of physicians may have limited training in addressing medication teratogenicity, preconception counseling and contraceptive care. Indeed, ample data suggest that physicians in the USA are not consistently providing these services. In the NAMCS analysis, for example, only 20% of women of childbearing age who were prescribed a teratogenic medication received contraceptive counseling or provision. In another study of a large health maintenance organization, only half of the women receiving Class D or X medications were documented to have received contraceptive counseling or prescription contraceptive. Many general physicians have limited training in identifying teratogenic medications, investigating fertility intentions and counseling patients about appropriate contraception. In a qualitative study, primary care providers identified numerous barriers to counseling about teratogenic medications. These included a dearth of reliable information sources on teratogenic medications, lack of time for thorough patient counseling, lack of reimbursement for contraceptive and preconception counseling and uncertainty about patients' pregnancy plans.
The Challenge for Providers
Along with the multiple other tasks inherent to primary care, it is primary care providers who often bear the chief responsibility for guiding such decision-making as the majority of teratogenic medications are commonly used in primary care practice. In the NAMCS study, the most commonly prescribed potential teratogens were anxiolytics, anticonvulsants, antibiotics and HMG CoA reductase inhibitors ('statins'). Of the approximately 12 million category D or X medications prescribed to women of childbearing age in this study, primary care physicians prescribed 45% of these medications, followed by dermatologists and psychiatrists.
Importantly, these groups of physicians may have limited training in addressing medication teratogenicity, preconception counseling and contraceptive care. Indeed, ample data suggest that physicians in the USA are not consistently providing these services. In the NAMCS analysis, for example, only 20% of women of childbearing age who were prescribed a teratogenic medication received contraceptive counseling or provision. In another study of a large health maintenance organization, only half of the women receiving Class D or X medications were documented to have received contraceptive counseling or prescription contraceptive. Many general physicians have limited training in identifying teratogenic medications, investigating fertility intentions and counseling patients about appropriate contraception. In a qualitative study, primary care providers identified numerous barriers to counseling about teratogenic medications. These included a dearth of reliable information sources on teratogenic medications, lack of time for thorough patient counseling, lack of reimbursement for contraceptive and preconception counseling and uncertainty about patients' pregnancy plans.