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Bringing more evidence into contraceptive counseling: Building a new provider tool to tailor predictions of contraceptive outcomes to patient sub-populations

Caroline Moreau, MD, MPH, PhD, Bloomberg School of Public Health, Johns Hopkins University

Project abstract

Background and objective: Misperceptions about patients' susceptibility to pregnancy and the health risks related to each contraceptive option represent critical barriers to evidence-based practices. Epidemiological modelling of population risk factors and health outcomes is increasingly used to inform health decision support instruments comparing health events related to different medical strategies. Such an instrument has yet to be developed to promote evidence-based contraceptive decisions tailored to the needs of specific women. This project will construct a contraceptive decision support tool that quantifies risks for adverse outcomes (cardiovascular events, pelvic inflammatory disease, ectopic pregnancy) related to contraceptive choices customized to a woman's age and co-morbid conditions like obesity, smoking and hypertension.

Methods: The project will supplement existing estimates of contraceptive failures, pregnancy complications and contraceptive adverse events with original analysis of insurance claims databases. Bringing this information together in a single model will inform the subsequent construction of a web-based decision support tool that will be tested by 40 clinicians from different specialties, who will be recruited from the Johns Hopkins Health Care System to identify additional functions and revisions needed for future use in patient counseling, and ultimately, by contraception users themselves.

Expected outcome: The proposed project lays the foundations for developing a new generation of contraceptive decision support tools for providers and for contraceptive users. Synthesizing and bolstering current evidence into a format more useful for the medical community could improve contraceptive choices and outcomes—but establishing the impact of the tool would be the topic of subsequent studies.

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