Contraceptive Services/Primary Care to Prevent Birth Defects

描述（由申请人提供）：每年有15万名婴儿（占美国新生儿总数的1% - 3%）出生时患有某种形式的身体或精神缺陷。由于有时有必要使用导致出生缺陷的药物治疗妇女，医生必须就药物风险和避孕选择向妇女提供咨询。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（少于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。我希望获得K23奖，以加强我制定有效干预措施的能力，以防止育龄妇女因不当使用致畸药物而导致出生缺陷。具体而言，我建议对北加州Kaiser Permanente药房服务的65万名育龄妇女进行回顾性队列研究，以确定哪些潜在致畸药物最常在未使用高效避孕措施的情况下开处方（目的1）；对可能导致致畸药物处方不安全的初级保健医生的知识差距进行横断面研究（目标2）；并评估先前实施的一项临床干预措施的效果，该干预措施旨在提高医生对约19万名育龄妇女中不安全的致畸药物处方患者避孕做法的认识（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的相关学科。Grady和Gonazales)和妇科（Dr. Darney）。此外，我还有生殖流行病学（Carmichael博士）、生殖社会科学（Joffe博士）、患者安全（Wachter博士）、调查仪器设计（Stewart博士）、生物统计学（vittinghoff博士）、风险评估（Bindman博士）和Kaiser Permanente数据库使用（Shaber博士）方面的专家顾问。他们的指导，以及由K23奖推动的重点培训和研究计划，将使我能够实现我的目标，即在面向患者的临床研究中发展独立的职业生涯，重点是促进避孕服务的提供，以限制不良的出生结果，同时进一步推进NICHD的使命，确保每个人都出生健康和需要。

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.