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Rheumatologists Rarely Prescribe Contraception Despite Concern for Reproductive Care
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Although rheumatologists feel responsible for providing some family planning and reproductive care for their patients, many feel apprehensive about managing complicated pregnancies, do not prescribe contraception or refer patients to gynecologists for contraceptive care, according to survey results published in Arthritis Care & Research.
“Our findings underscored that rheumatologists recognize the importance of family planning care, but are burdened by many competing priorities and responsibilities,” Mehret Birru Talabi, MD, PhD, assistant professor of medicine at the University of Pittsburgh, told Healio Rheumatology. “They are also burdened by the fact that few consensus guidelines exist for helping to manage women’s diseases and medications in the pre-pregnancy period and during pregnancy.”
To evaluate the perspectives and practices of rheumatologists regarding family planning and reproductive care for woman of reproductive-age with rheumatic diseases, Talabi and colleagues conducted and analyzed interviews with 12 rheumatologists based in the United States. Participants were members of the American College of Rheumatology identified through investigator networks.
The semi-structured, hour-long interviews were administered between Oct 2017 and January 2018, and included questions on attitudes and practices regarding family planning, as well as barriers and facilitators of providing such care, and the information needs and preferences related to patients who may become pregnant. The researchers continued conducting interviews until “theme saturation,” they wrote, defined as the point at which no new information or ideas were received; Talabi and colleagues noted that this occurred after the 10th interview. For this reason, the researchers deemed a sample of 12 rheumatologists to be sufficient.
According to the researchers, there were six themes that were common across the interviews. First, participating rheumatologists expressed a sense of responsibility for providing some form of family planning or reproductive care. However, they added that they were hesitant to offer such care, citing concerns over respecting the patients’ autonomy as well as their own anxiety regarding managing high-risk pregnancies. The researchers also found that rheumatologists are reluctant to prescribe contraception, but desire more access to resources to help guide family planning and reproductive health care.
In addition, rheumatologists recognize the benefits of collaborating with gynecologists to help care for the needs of patients with rheumatic diseases who may become pregnant. According to Talabi and colleagues, patient-initiated conversations were seen as a facilitator of family planning care among rheumatologists, while a perceived lack of guidelines and competing clinical priorities were cited as barriers.
“We found that rheumatologists were interested in providing limited family planning counseling and reproductive health care to patients, but some may have assumed that other providers, such as primary care physicians and gynecologists, are providing the remaining aspects of family planning care — contraception care would be an example,” Talabi said. “However, other studies suggest that many women with rheumatic diseases do not receive comprehensive family planning care from any health provider.”
According to Talabi, rheumatologists may want to consider increasing referrals to gynecologists or primary care physicians for family planning, or otherwise begin asking their patients about their pregnancy intentions.
“It will be important to consider feasible ways to integrate family planning care or counseling into the office setting, without adding to physician burden,” she said. “It will also be important to consider ways to integrate the upcoming ACR reproductive guidelines into clinical practice, in such a way that it supports rheumatologists in providing more consistent and evidence-based reproductive health care to patients.” – by Jason Laday
Disclosure: Talabi reports grant funding from the Agency for Healthcare Research and Quality. Please see the study for all other relevant financial disclosures.
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