Contraceptive Services/Primary Care to Prevent Birth Defects

描述（由申请人提供）：每年有150，000名婴儿（占美国出生婴儿总数的1% - 3%）出生时患有某种形式的身体或精神先天缺陷。由于有时需要使用导致出生缺陷的药物治疗妇女，医生必须向妇女提供有关药物风险和避孕选择的咨询。在最近对1998-2000年全国门诊医疗调查的分析中，我发现全科医生为45%使用潜在致畸药物的妇女提供门诊护理，但很少（不到20%的时间）提供避孕咨询。许多全科医生不提供这种咨询的原因尚不清楚。我寻求一个K23奖，以加强我的能力，制定有效的干预措施，以防止出生缺陷所造成的不适当使用致畸药物的育龄妇女。具体来说，我建议对北方加州Kaiser Permanente药房服务的650，000名育龄女性进行一项回顾性队列研究，以确定在不使用高效避孕措施的情况下最常开出哪些潜在致畸药物（目标1）;对可能导致不安全处方致畸药物的初级保健医生的知识差距进行横断面研究（目标2）;并评估先前实施的基于诊所的干预措施的效果，以提高医生对约190，000名育龄妇女中患者避孕做法对致畸药物不安全处方的认识（目标3）。为了实现这些目标，我组建了一个指导委员会，其专业知识涵盖流行病学和普通医学（Grady和Gonazales博士）以及妇科学（达尼博士）的相关学科。此外，我还有生殖流行病学专家的科学顾问（卡迈克尔博士），生殖社会科学（Joffe博士），患者安全（Wachter博士），测量仪器设计（Dr. Stewart），生物统计学（Vittinghoff博士），风险评估（宾德曼博士），并使用凯撒永久数据库他们的指导，以及由K23奖促进的重点培训和研究计划，将使我能够实现在以患者为导向的临床研究中发展独立职业生涯的目标，重点是促进避孕服务的提供，以限制不良的生育结果，同时推进国家排雷中心的使命，确保每个人出生时都是健康的和需要的。

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.