Preventing Teen Pregnancies on Teratogenic Drugs by Quality Improvement and Behavioral Economics.

Autor:	Mruk VM; Divisions of Rheumatology.; Contributed equally as co-first authors., Wise KA; Divisions of Rheumatology.; Pharmacy.; Contributed equally as co-first authors., Driest K; Divisions of Rheumatology., Oberle EJ; Divisions of Rheumatology., Ardoin SP; Divisions of Rheumatology., Yildirim-Toruner C; Department of Pediatrics, Baylor College of Medicine, Houston, Texas.; Division of Rheumatology, Texas Children's Hospital, Houston, Texas., Sivaraman V; Divisions of Rheumatology., Stevens J; Psychology.; Center of Clinical Excellence., McGinnis A; Divisions of Rheumatology.; Center of Clinical Excellence., Gallup J; Divisions of Rheumatology.; Center of Clinical Excellence., Mitchell B; Divisions of Rheumatology.; Center of Clinical Excellence., Lemle S; Divisions of Rheumatology.; Center of Clinical Excellence., Jones S; Divisions of Rheumatology., Maher J; Divisions of Rheumatology., Berlan ED; Adolescent Medicine, Department of Pediatrics, The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio., Barbar-Smiley F; Divisions of Rheumatology.
Jazyk:	angličtina
Zdroj:	Pediatrics [Pediatrics] 2023 Jan 01; Vol. 151 (1).
DOI:	10.1542/peds.2021-054294
Abstrakt:	Background: Adolescents with chronic disease engage in sexual activity similar to their healthy peers, with generally low utilization of contraception. Adolescents with rheumatic diseases prescribed teratogenic medications may be at risk for unplanned pregnancy. Methods: Using structured quality improvement (QI) methods with behavior economic (BE) principles, a multidisciplinary team aimed to implement pregnancy prevention processes for females on high-risk medications. We leveraged BE-inspired interventions including improved accessibility of consents, utilizing distinctly colored consent forms, real-time reminders, peer comparison, and audit and feedback. Our primary aim was to increase the number of days between pregnancies for postmenarcheal females followed in rheumatology clinics who were taking teratogenic medications. Phase 1 focused on annual consenting of female adolescents prescribed teratogenic drugs. Phase 2 emphasized sexual history screening and pregnancy prevention planning at every clinic visit for females ≥12 years on teratogenic medications. Results: We increased the days between pregnancies for female adolescents prescribed teratogenic medications from 52 days to >900 days by using QI methodology with BE strategies. In phase 1, annual consents for postmenarcheal patients on teratogenic medications improved from 0% in 2017 to 95% in 2021. In phase 2, sexual history screening and pregnancy prevention planning at every clinic visit improved from 2% in 2019 to over 78% in 2021. Conclusions: A multiphase, multidisciplinary QI project with integration of behavior economic strategies can improve patient and caregiver counseling to prevent unplanned pregnancies for adolescents on teratogenic medications. (Copyright © 2023 by the American Academy of Pediatrics.)
Databáze:	MEDLINE
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