Use of prescription medications with a potential for fetal harm among pregnant women

PURPOSE

To estimate the prevalence of use of prescription drugs with a potential for fetal harm among pregnant women in the United States.

METHODS

A retrospective study was conducted using the automated databases of eight health maintenance organizations involved in the HMO Research Network Center for Education and Research on Therapeutics (CERT). Women who delivered an infant from January 1996 to December 2000 were identified. The frequency of use of prescription drugs with a potential for fetal harm was based upon the expert review of a clinical teratologist and the U.S. Food and Drug Administration (FDA) risk classification system, assuming a gestational duration of 270 days.

RESULTS

Among the 114 165 women with no documentation of a diagnosis suggesting potential pre-term birth or dispensing of ovulation stimulants in the 270 days before delivery, 1305 (1.1%) received a teratogenic drug during the 270 days before delivery, based upon the expert review of a clinical teratologist. A larger proportion of women received U.S. FDA category D or X drugs (5.8%; N = 6600). However, the general patterns of use were similar, with higher use in early pregnancy compared to later trimesters. The proportion of women dispensed a teratogen during pregnancy was substantially higher among women who received a teratogen in the 90 days before pregnancy compared to women who did not (adjusted RR = 38.9, 95%CI, 33.5, 45.3).

CONCLUSIONS

Our results suggest that further efforts directed at physicians to counsel women or at the women themselves about the potential risks of particular medications appear warranted.

Burns follow-up: an innovative application of telemedicine

We assessed the efficiency and effectiveness of burn consultations via telemedicine. The Regions Hospital Burn Center completed 87 follow-up visits with 40 patients via telemedicine from March 1997 to August 1998. These consultations involved burn physicians, occupational therapists and a clinical psychologist. Patients were seen at 15 telemedicine sites in six states (Minnesota, Iowa, Montana, North and South Dakota, and Wisconsin). Telemedicine burn consultations were cost-effective for the patient, but were more time consuming for the physician and therapist. As remote sites become more familiar with preparing patients for teleconsultations, telemedicine will become more efficient for the physician while remaining cost-effective for the patient.

Exemplary programs on midlife women's health issues in managed care settings

OBJECTIVE

To identify exemplary programs on midlife women's health issues that have been developed and implemented in managed care settings.

METHODS

Members of The American Association of Health Plans (AAHP) were invited by mail to submit information on their exemplary programs on midlife women's health issues. AAHP and HealthPartners Research Foundation established 12 criteria by which to evaluate the programs submitted. Following telephone interviews with representatives of eligible programs, they were asked to complete an extensive survey about their successful practices. The Women's Health Task Force of AAHP then reviewed and evaluated every program submission and selected 4 model programs on midlife issues for women.

RESULTS

The 4 model programs included the use of health assessment questionnaires to assist providers in identifying risk areas and patients' needs for information; group educational sessions focusing on midlife issues related to lifestyle and hormone replacement therapy; a module-based curriculum syllabus; and an osteoporosis disease management program. All groups utilize multidisciplinary teams to develop and promote educational programs.

CONCLUSIONS

As study findings add to our knowledge of menopause treatment approaches and as new information and products become available, some managed care plans are using innovative channels of communication to keep women informed.