Anesthesia Providers' Knowledge of Medication Interference with Hormonal Contraception: A Multisite Survey.

IF 4.6 2区 医学 Q1 ANESTHESIOLOGY
Anesthesia and analgesia Pub Date : 2025-01-01 Epub Date: 2024-10-04 DOI:10.1213/ANE.0000000000007081
Madeline Whitney, Emily E Sharpe, Monica W Harbell, Skye Buckner-Petty, Molly B Kraus
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引用次数: 0

Abstract

Background: Sugammadex, aprepitant, and fosaprepitant are increasingly used perioperatively. These medications may interfere with the effectiveness of hormonal contraception. This study assessed anesthesia providers' use of sugammadex and aprepitant, their knowledge of interactions with hormonal birth control, and patient counseling practices to identify possible knowledge gaps or opportunities for practice improvement.

Methods: In January 2023, an electronic survey was distributed to all anesthesia providers at Mayo Clinic sites (Mayo Clinic Rochester, Mayo Clinic Arizona, Mayo Clinic Florida, and Mayo Clinic Health System hospitals). The survey included 32 questions assessing providers' use of sugammadex and aprepitant, their knowledge of the medications' interactions with hormonal contraceptives (HC), their perceptions regarding education of these interactions during training, and their perioperative patient counseling practices. The collected data were analyzed using descriptive statistics.

Results: A total of 337 of 1092 (31%) providers completed the survey. While almost all respondents (324; 96%) knew that sugammadex may interfere with oral contraceptive effectiveness, only 158 (47%) knew about aprepitant's potential contraceptive interference. Only 176 providers (52%) knew the recommended duration for alternative contraceptive methods after use after sugammadex, and 119 providers (35%) knew the recommended duration after aprepitant exposure. Most respondents considered the interference of these perioperative drugs with HCs to be clinically relevant (sugammadex, 217, 64%; aprepitant, 191, 58%). Despite the common belief that the decision between these medications and alternatives should be shared between provider and patient, most providers reported rarely engaging in such shared decision-making (SDM) in practice. Most providers recognized the need for preoperative discussions on sugammadex (280, 83%) and aprepitant (257, 76%), yet 184 providers (73%) never or rarely discussed contraception use before surgery for aprepitant, and 135 (36%) never or rarely did so for sugammadex. Lastly, many providers believed that the interference between sugammadex, aprepitant, and HC was poorly taught during training.

Conclusions: The results of this study highlight the need for increased education and awareness among anesthesia providers regarding drug interactions with HCs during the perioperative period. To facilitate SDM, it is imperative that providers discuss alternative medications and the potential need for additional contraception methods after drug administration and communicate the risks with patients preoperatively to enable informed and SDM. The patient's preferences should be accounted for, especially if they are unwilling or unable to use an alternative contraceptive for 7 to 30 days, thereby avoiding the complexities and burdens of altering birth control methods.

麻醉师对药物干扰荷尔蒙避孕的认识:多地点调查。
背景:舒格迈司、阿普昔坦和福沙昔坦越来越多地在围手术期使用。这些药物可能会干扰激素避孕的效果。本研究评估了麻醉服务提供者对舒格迈司和阿瑞匹坦的使用情况、他们对与激素避孕药相互作用的了解以及患者咨询做法,以确定可能存在的知识差距或改进实践的机会:2023 年 1 月,我们向梅奥诊所(罗切斯特梅奥诊所、亚利桑那梅奥诊所、佛罗里达梅奥诊所和梅奥诊所医疗系统医院)的所有麻醉医师发放了一份电子调查问卷。调查包括 32 个问题,评估医疗服务提供者对苏甘麦角和阿普瑞坦的使用情况、他们对药物与激素避孕药(HC)相互作用的了解、他们对培训期间有关这些相互作用的教育的看法以及他们围手术期患者咨询的做法。收集到的数据采用描述性统计方法进行分析:在 1092 名医疗服务提供者中,共有 337 人(31%)完成了调查。几乎所有受访者(324 人;96%)都知道舒降之可能会干扰口服避孕药的效果,但只有 158 人(47%)知道阿瑞匹坦可能会干扰避孕药的效果。只有 176 名医疗服务提供者(52%)知道使用舒降之后备用避孕方法的建议持续时间,119 名医疗服务提供者(35%)知道阿瑞匹坦暴露后的建议持续时间。大多数受访者认为这些围术期药物对 HCs 的干扰与临床相关(苏格麦迪,217 人,64%;阿培司坦,191 人,58%)。尽管医护人员和患者普遍认为应共同决定使用这些药物还是替代药物,但大多数医护人员表示在实践中很少参与此类共同决策 (SDM)。大多数医疗服务提供者认识到术前讨论舒格迈司(280 人,83%)和阿普瑞坦(257 人,76%)的必要性,但 184 名医疗服务提供者(73%)从未或很少在术前讨论阿普瑞坦的避孕问题,135 名医疗服务提供者(36%)从未或很少在术前讨论舒格迈司的避孕问题。最后,许多医疗服务提供者认为,在培训过程中,关于苏加麦司、阿普瑞坦和 HC 之间的相互影响的内容讲得很差:本研究的结果突出表明,有必要加强麻醉服务提供者对围术期药物与 HCs 相互作用的教育和认识。为促进 SDM,麻醉医师必须在用药后与患者讨论替代药物和额外避孕方法的潜在需求,并在术前与患者沟通风险,以实现知情和 SDM。应考虑患者的偏好,尤其是如果他们不愿意或无法在 7 至 30 天内使用替代避孕药物,从而避免改变节育方法所带来的复杂性和负担。
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来源期刊
Anesthesia and analgesia
Anesthesia and analgesia 医学-麻醉学
CiteScore
9.90
自引率
7.00%
发文量
817
审稿时长
2 months
期刊介绍: Anesthesia & Analgesia exists for the benefit of patients under the care of health care professionals engaged in the disciplines broadly related to anesthesiology, perioperative medicine, critical care medicine, and pain medicine. The Journal furthers the care of these patients by reporting the fundamental advances in the science of these clinical disciplines and by documenting the clinical, laboratory, and administrative advances that guide therapy. Anesthesia & Analgesia seeks a balance between definitive clinical and management investigations and outstanding basic scientific reports. The Journal welcomes original manuscripts containing rigorous design and analysis, even if unusual in their approach.
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