PURPOSE Routine assessment of women's pregnancy intentions and contraceptive use-a so-called contraceptive vital sign-may help primary care physicians identify patients who need preconception or contraceptive counseling and be of particular benefi t when teratogenic medications are prescribed. METHODSWe conducted a cluster-randomized controlled trial to evaluate the effect of a contraceptive vital sign on primary care documentation of contraceptive use and change in primary care physicians' provision of family planning services. Academic internists in the intervention group (n = 26) were provided with information on their female patients' pregnancy intentions and contraceptive use immediately before visits; internists in the control group (n = 27) received only standard intake information. Data were abstracted from the electronic health record for 5,371 visits by 2,304 women aged 18 to 50 years.RESULTS Documentation of contraception increased from baseline, from 23% to 57% in the intervention group, but remained 28% in the control group, a change of +77.4 (95% confi dence interval [CI], 70.7 to 84.1) adjusted percentage points in the former vs +3.1 (95% CI, 1.2 to 5.0) in the latter (P <.001). For visits involving a teratogenic prescription, documentation increased from 14% to 48% in the intervention group and decreased from 29% to 26% in the control group, a change of +61.5 (95% CI, 35.8 to 87.1) adjusted percentage points in the former vs -0.3 (95% CI, -4.3 to 3.6) in the latter (P <.001). Provision of new family planning services increased only minimally with this intervention, however. When women with documented nonuse of contraception were prescribed potential teratogens, only 7% were provided family planning services.CONCLUSIONS A contraceptive vital sign improves documentation of contraceptive use; however, ongoing efforts are needed to improve provision of preconception and contraceptive services.

Background Whether contraception affects health-related quality of life (HRQoL) is unclear. Study Design Cross-sectional analysis of routine intake data collected from women aged 18–50 years, including the RAND-36 measure of HRQoL, pregnancy intentions, and recent contraceptive use. We used multivariable logistic regression to test the relationship between HRQoL and use of any and specific contraceptives. Physical and mental HRQoL were dichotomized based on U.S. population averages. Models were adjusted for age, race, marital status, education and pregnancy intentions. Results Among the 726 women, those using any form of contraception were more likely to have average or better mental HRQoL than women using no contraception (adjusted odds ratio (aOR)=1.60, 95% confidence interval (CI) 1.01, 2.53). Women using injectable contraception were less likely than those using combined hormonal methods to have average or better physical HRQoL (aOR=0.26, 95% CI 0.09, 0.80) and mental-HRQoL (aOR=0.24, 95% CI 0.06, 0.86). Conclusions Measures of women’s HRQoL differ with contraceptive use.

No abstract

No abstract