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      Counseling of Female Veterans About Risks of Medication-Induced Birth Defects

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          ABSTRACT

          BACKGROUND

          Medications that may increase risk of birth defects if used during pregnancy or immediately preconception are dispensed to approximately half of female Veterans who fill prescriptions at a VA pharmacy.

          OBJECTIVE

          To assess receipt of counseling about risk of medication-induced birth defects among female Veterans of reproductive age and to examine Veterans’ confidence that their healthcare provider would counsel them about teratogenic risks.

          DESIGN AND PARTICIPANTS

          Cross-sectional analysis of data provided by 286 female Veterans of Operation Iraqi Freedom and/or Operation Enduring Freedom who completed a mailed survey between July 2008 and October 2010.

          MAIN MEASURES

          We examined associations between demographic, reproductive, and health service utilization variables and female Veterans' receipt of counseling and confidence that they would receive such counseling.

          KEY RESULTS

          The response rate was 11 %; the large majority (89 %) of responding female Veterans reported use of a prescription medication in the last 12 months. Most (90 %) of the 286 female Veterans who reported medication use were confident that they would be told by their healthcare provider if a medication might cause a birth defect. However, only 24 % of women who received prescription medications reported they had been warned of teratogenic risks. Female Veterans who used medications that are known to be teratogenic were not more likely than women using other medications to report having been warned about risks of medication-induced birth defects, and fewer were confident that their health care providers would provide teratogenic risk counseling when needed.

          CONCLUSIONS

          Female Veterans may not receive appropriate counseling when medications that can cause birth defects are prescribed.

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          Most cited references 24

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          Update on overall prevalence of major birth defects--Atlanta, Georgia, 1978-2005.

           David Shay (2008)
          Major structural or genetic birth defects affect approximately 3% of births in the United States, are a major contributor to infant mortality, and result in billions of dollars in costs for care. Although the causes of most major birth defects are unknown, concerns have been raised that certain factors, such as an increase in the prevalence of diabetes among women, might result in increased prevalence of birth defects over time. This report updates previously published data from the Metropolitan Atlanta Congenital Defects Program (MACDP), the oldest population-based birth defects surveillance system in the United States with active case ascertainment. For the period 1978-2005, CDC assessed the overall prevalence of major birth defects and their frequency relative to selected maternal and infant characteristics. The MACDP results indicated that the prevalence of major birth defects in metropolitan Atlanta, Georgia, remained stable during 1978-2005 but varied by maternal age and race/ethnicity, birthweight, and gestational age. Tracking the overall prevalence of major birth defects can identify subgroups that are affected disproportionately; additional measures focused on these subgroups might improve preconception care and care during pregnancy to prevent birth defects.
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            Prescription drug use in pregnancy.

            The purpose of this study was to provide information on the prevalence of the use of prescription drugs among pregnant women in the United States. A retrospective study was conducted with the use of the automated databases of 8 health maintenance organizations that are involved in the Health Maintenance Research Network Center for Education and Research on Therapeutics. Women who delivered of an infant in a hospital from January 1, 1996, through December 31, 2000, were identified. Prescription drug use according to therapeutic class and the United States Food and Drug Administration risk classification system was evaluated, with the assumption of a gestational duration of 270 days, with three 90-day trimesters of pregnancy, and with a 90-day period before pregnancy. Nonprescription drug use was not assessed. During the period 1996 through 2000, 152,531 deliveries were identified that met the criteria for study. For 98,182 deliveries (64%), a drug other than a vitamin or mineral supplement was prescribed in the 270 days before delivery: 3595 women (2.4%) received a drug from category A; 76,292 women (50.0%) received a drug from category B; 57,604 women (37.8%) received a drug from category C; 7333 women (4.8%) received a drug from category D, and 6976 women (4.6%) received a drug from category X of the United States Food and Drug Administration risk classification system. Overall, 5157 women (3.4%) received a category D drug, and 1653 women (1.1%) received a category X drug after the initial prenatal care visit. Our finding that almost one half of all pregnant women received prescription drugs from categories C, D, or X of the United States Food and Drug Administration risk classification system highlights the importance of the need to understand the effects of these medications on the developing fetus and on the pregnant woman.
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              Linking primary care performance to outcomes of care.

              Substantial research links many of the defining characteristics of primary care to important outcomes; yet little is known about the relative importance of each characteristic, and several characteristics have not been examined. These analyses evaluate the relationship between seven defining elements of primary care (accessibility, continuity, comprehensiveness, integration, clinical interaction, interpersonal treatment, and trust) and three outcomes (adherence to physician's advice, patient satisfaction, and improved health status). Data were derived from a cross-sectional observational study of adults employed by the Commonwealth of Massachusetts (N = 7204). All patients completed a validated questionnaire, the Primary Care Assessment Survey. Regression methods were used to examine the association between each primary care characteristic (11 summary scales measuring 7 elements of care) and each outcome. Physicians' comprehensive ("whole person") knowledge of patients and patients' trust in their physician were the variables most strongly associated with adherence, and trust was the variable most strongly associated with patients' satisfaction with their physician. With other factors equal, adherence rates were 2.6 times higher among patients with whole-person knowledge scores in the 95th percentile compared with the 5th percentile (44.0% adherence vs 16.8% adherence, P < .001). The likelihood of complete satisfaction was 87.5% for those with 95th percentile trust scores compared with 0.4% for patients with 5th percentile trust scores (P < .001). The leading correlates of self-reported health improvements were integration of care, thoroughness of physical examinations, communication, comprehensive knowledge of patients, and trust (P < .001). Patients' trust in their physician and physicians' knowledge of patients are leading correlates of three important outcomes of care. The results are noteworthy in the context of pervasive changes in our nation's health care system that are widely viewed as threatening to the quality of physician-patient relationships.
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                Author and article information

                Affiliations
                [ ]Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
                [ ]Yale University School of Medicine, New Haven, CT USA
                [ ]Center for Health Equity Research and Promotion, VA Pittsburgh, Pittsburgh, PA USA
                [ ]Women Health Services, VA Central Office, Washington, DC USA
                [ ]VA Connecticut Healthcare System, West Haven, CT USA
                [ ]VA Central Western Massachusetts Healthcare System, Leeds, MA USA
                [ ]University of Massachusetts Medical School, Worcester, MA USA
                [ ]Department of Medicine, University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA 15213 USA
                Contributors
                +1-412-5869836 , +1-412-6924838 , schwarzeb@upmc.edu
                Journal
                J Gen Intern Med
                J Gen Intern Med
                Journal of General Internal Medicine
                Springer-Verlag (New York )
                0884-8734
                1525-1497
                27 June 2013
                27 June 2013
                July 2013
                : 28
                : Suppl 2
                : 598-603
                23807071
                3695268
                2240
                10.1007/s11606-012-2240-0
                © Society of General Internal Medicine 2012
                Categories
                Original Research
                Custom metadata
                © Society of General Internal Medicine 2013

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