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Should doctors add a birth control "vital sign"?

By Kerry Grens

NEW YORK (Reuters Health) - An effort to develop a birth control "vital sign" measure gets doctors to document women's use of contraception, but it doesn't make them any more likely to include family planning counseling during visits, according to a new study.

The proposed "vital sign" consists of questions about contraception and pregnancy.

"We were hoping that this would be a prompt for much more provision of counseling by clinicians and what we saw was it only minimally affected the type of counseling that women were given," said Dr. Eleanor Schwarz, the lead author of the study and the director of the Women's Health Services Research Unit at the University of Pittsburgh.

"We got better documentation (by doctors), but we can't say that women were better informed," she added.

Unlike blood pressure, heart rate and other vital signs, use of birth control is not often addressed during doctor visits, Schwarz said, but it should be for women of childbearing age.

According to Schwarz's study, published in the Annals of Family Medicine, six percent of pregnancies are exposed to prescription medications that can cause a birth defect, because a large proportion of pregnancies are unplanned and birth control counseling rarely happens during physician visits.

For a year and a half, the patients of all 53 doctors in the study filled out standard intake forms. If the patient said she would like to become pregnant or wouldn't mind becoming pregnant, or if she said that she didn't want to become pregnant but isn't using birth control, the system flagged her form with a note to the doctor that said in bold text: "Consider chance of pregnancy when prescribing."

For a second year and a half, the patients of 26 doctors answered the pregnancy and birth control questions, while the patients of the other 27 doctors continued to fill out the regular form.

The study included about 5,300 office visits made by 2,300 women of childbearing age.

Doctors in the contraceptive vital sign group were much more likely to write down their patients' birth control method during the second half of the study when women answered the pregnancy and contraception questions than when their patients used the standard form.

During the first half of the study, these doctors documented birth control only 23 percent of the time, compared to 78 percent of the time in the second half of the study when their patients filled out the revised intake form.

Doctors whose patients did not provide the birth control vital sign information during both time periods had no change in their documenting practices - about 28 percent of visits contained information on the patient's birth control.

Despite this improvement in documentation by the doctors who received a contraceptive vital sign, there were no changes in the amount of counseling that their patients received.

Even patients who were taking medications with a birth defect warning received no more family planning advice during the time when they answered the pregnancy and birth control questions than when they filled in the standard form.

"Simply providing this information to primary care physicians doesn't seem to make a dramatic change in the rates of their provision of this counseling," Schwarz told Reuters Health.

"Some of that may be because they have other competing clinical responsibilities and they only have so much time in a given visit and they don't have a way to bill for providing contraceptive counseling," she suggested.

PART OF AFFORDABLE CARE ACT

Dr. Melissa Fritsche, a physician at Spartanburg Regional Medical Center in South Carolina, said that's especially true for patients who are taking medications that carry a birth defect risk.

"They often have more complex health histories and physicians often have a time crunch in terms of the number of things they can deal with in a visit," she said.

The U.S. Affordable Care Act makes women with health insurance eligible to receive birth control and contraceptive counseling without any additional co-pays.

Although the vital sign system Schwarz developed was a good first step in getting doctors to pay attention to birth control and to write it down, Fritsche said it will be important to explore a variety of ways to get physicians to prioritize contraceptive counseling.

"I think improving and providing more education to primary care providers about contraceptive options would be also an excellent step," she told Reuters Health.

SOURCE: http://bit.ly/PWJoWY Annals of Family Medicine, November/December 2012.

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