Increasing contraception use among women receiving teratogenic medications in a rheumatology clinic.

dc.contributor.author

Sadun, Rebecca E

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Wells, Melissa A

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Balevic, Stephen J

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Lackey, Victoria

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Aldridge, Erica J

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Holdgagte, Nicholas

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Mohammad, Samya

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Criscione-Schreiber, Lisa G

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Clowse, Megan EB

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Yanamadala, Mamata

dc.date.accessioned

2022-11-01T19:45:29Z

dc.date.available

2022-11-01T19:45:29Z

dc.date.issued

2018-01

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2022-11-01T19:45:28Z

dc.description.abstract

Teratogenic medications are often prescribed to women of childbearing age with autoimmune diseases. Literature suggests that appropriate use of contraception among these women is low, potentially resulting in high-risk unintended pregnancies. Preliminary review in our clinic showed suboptimal documentation of women's contraceptive use. We therefore designed a quality improvement initiative to target three process measures: documentation of contraception usage and type, contraception counselling and provider action after counselling. We reviewed charts of rheumatology clinic female patients aged 18-45 over the course of 10 months; for those who were on teratogenic medications (methotrexate, leflunomide, mycophenolate and cyclophosphamide), we looked for evidence of documentation of contraception use. We executed multiple plan-do-study-act (PDSA) cycles to develop and evaluate interventions, which centred on interprofessional provider education, modification of electronic medical record (EMR) templates, periodic provider reminders, patient screening questionnaires and frequent feedback to providers on performance. Among eligible patients (n=181), the baseline rate of documentation of contraception type was 46%, the rate of counselling was 30% and interventions after counselling occurred in 33% of cases. Averaged intervention data demonstrated increased provider performance in all three domains: documentation of contraception type increased to 64%, counselling to 45% and provider action to 46%. Of the patients with documented contraceptives, 50% used highly effective, 27% used effective and 23% used ineffective contraception methods. During this project, one unintentional pregnancy occurred in a patient on methotrexate not on contraception. Our interventions improved three measures related to contraception counselling and documentation, but there remains a need for ongoing quality improvement efforts in our clinic. This high-risk population requires increased provider engagement to improve contraception compliance, coupled with system-wide EMR changes to increase sustainability.

dc.identifier

bmjoq-2017-000269

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2399-6641

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2399-6641

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https://hdl.handle.net/10161/26173

dc.language

eng

dc.publisher

BMJ

dc.relation.ispartof

BMJ open quality

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10.1136/bmjoq-2017-000269

dc.subject

ambulatory care

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continuous quality improvement

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implementation science

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pdsa

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women’s health

dc.title

Increasing contraception use among women receiving teratogenic medications in a rheumatology clinic.

dc.type

Journal article

duke.contributor.orcid

Sadun, Rebecca E|0000-0001-7768-3565

duke.contributor.orcid

Balevic, Stephen J|0000-0002-4016-1680

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Clowse, Megan EB|0000-0002-8579-3470

pubs.begin-page

e000269

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3

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Duke

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School of Medicine

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Clinical Science Departments

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Institutes and Centers

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Medicine

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Pediatrics

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Medicine, Geriatrics

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Medicine, Rheumatology and Immunology

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Pediatrics, Rheumatology

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Duke Clinical Research Institute

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Center for the Study of Aging and Human Development

pubs.publication-status

Published

pubs.volume

7

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