Contraceptive Services/Primary Care Prevent Birth Defect

避孕服务/初级保健预防出生缺陷

• 批准号: 7014153
• 负责人: ELEANOR Bimla SCHWARZ
• 金额: $ 12.63万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-08-09 至 2011-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7014153
• 关键词: behavioral /social science research tag; congenital disorders; contraceptives; disease /disorder prevention /control; embryo /fetus drug adverse effect; female; health care personnel performance; health care service evaluation; health services research tag; human data; human subject; managed care; medical records; patient care personnel relations; patient oriented research; primary care physician; questionnaires; teratogens; women' s health

DESCRIPTION (provided by applicant): Each year, 150,000 infants (1% - 3% of all U.S. births) are born with some form of physical or mental birth defect. As it is sometimes necessary to treat women with medications that cause birth defects, physicians must counsel women about medication risks and contraceptive options. In a recent analysis of the 1998-2000 National Ambulatory Medical Care Surveys, I found that generalist physicians provide ambulatory care to 45% of women using potentially teratogenic medications, but rarely (less than 20% of the time) provide contraceptive counseling. The reasons why many generalist physicians do not provide this counseling are not known. I seek a K23 award to strengthen my abilities to develop effective interventions to prevent birth defects resulting from inappropriate use of teratogenic medications by women of childbearing age. Specifically, I propose to conduct a retrospective cohort study of 650,000 women of reproductive age served by Northern California Kaiser Permanente pharmacies to identify which potentially teratogenic medications are most frequently prescribed without use of highly effective contraception (Aim 1); to conduct a cross sectional study of gaps in knowledge of primary care physicians that may contribute to unsafe prescription of teratogenic medications (Aim 2); and to evaluate the effect of a previously implemented clinic-based intervention to increase physician awareness of patients' contraceptive practices on unsafe prescription of teratogenic medications among approximately 190,000 women of childbearing age (Aim 3). To achieve these aims, I have assembled a mentoring committee whose expertise spans the relevant disciplines of epidemiology and general medicine (Drs. Grady and Gonazales) and gynecology (Dr. Darney). In addition, I have scientific advisors with expertise in reproductive epidemiology (Dr. Carmichael), reproductive social science (Dr. Joffe), patient safety (Dr. Wachter), survey instrument design (Dr. Stewart), biostatistics (Dr.Vittinghoff), risk assessment (Dr. Bindman), and use of the Kaiser Permanente databases (Dr. Shaber).Their mentorship, as well as a focused training and research plan facilitated by a K23 award, will enable me to achieve my goal of developing an independent career in patient-oriented clinical research, focused on facilitating contraceptive service provision to limit adverse birth outcomes, while furthering the NICHD's mission of ensuring that every person is born healthy and wanted.

描述（由申请人提供）：每年，有15万个婴儿（占所有美国出生的1％ - 3％）出生于某种形式的身体或精神先天缺陷。由于有时需要用导致先天缺陷的药物治疗妇女，因此医生必须就药物风险和避孕措施咨询妇女。在对1998 - 2000年国家门诊医疗保健调查的最新分析中，我发现通才医生使用潜在的致病性药物为45％的妇女提供门诊护理，但很少（少于20％的时间）提供避孕咨询。许多通才医生不提供这种咨询的原因尚不清楚。我寻求K23奖，以增强我的能力开发有效的干预措施，以防止因不适当使用育龄妇女使用伤明药而导致的出生缺陷。具体而言，我建议对北加州凯撒（Kaiser Permanente）药房服务的650,000名生殖年龄妇女进行回顾性队列研究，以确定哪种潜在的致畸药物是最常见的，而无需使用高效的避孕措施（AIM 1）；对初级保健医师知识的差距进行横断面研究，这可能有助于不安全的致畸药物处方（AIM 2）；并评估先前实施的基于诊所的干预措施的影响，以提高医师对患者避孕习惯的认识对约190,000名育龄妇女在约190,000名育龄女性中的不安全处方（AIM 3）。为了实现这些目标，我组建了一个指导委员会，该委员会的专业知识涵盖了流行病学和通用医学的相关学科（Grady和Gonazales博士）和妇科学（Darney博士）。 In addition, I have scientific advisors with expertise in reproductive epidemiology (Dr. Carmichael), reproductive social science (Dr. Joffe), patient safety (Dr. Wachter), survey instrument design (Dr. Stewart), biostatistics (Dr.Vittinghoff), risk assessment (Dr. Bindman), and use of the Kaiser Permanente databases (Dr. Shaber).Their mentorship, as well as a focused training and由K23奖项促进的研究计划将使我能够实现自己的目标，即在以患者为导向的临床研究中开发独立的职业，重点是促进避孕服务提供，以限制不良的出生结果，同时进一步进一步确保每个人都能确保每个人都健康且想要健康。