Valproate use in women aged 15-44 years: Observational study in general practice

BackgroundValproate is a known teratogen. In April 2018, the Medicines and Healthcare products Regulatory Agency (MHRA) restricted use in women and banned use in pregnancy, except for epilepsy with no other effective treatment. To date, there is limited information on valproate prescribing within primary care.AimTo characterise valproate prescribing to women of childbearing age, recorded advice or general practitioner prescribed contraception and recorded pregnancies.Design & settingA cross-sectional study of patients from all 141 general practices across three Clinical Commissioning Groups in East London.MethodWomen aged 15-44 years prescribed valproate between 1/10/2017-1/1/2020 were included. Exclusion criteria were early menopause, sterilisation procedures or hysterectomy. Pseudonymised data on valproate indication, pregnancy, pre-conception and contraception advice were retrospectively extracted from general practice consultation data. Data were analysed by quarter using univariate statistics.ResultsOf the total 1,042,463 registered patients, 344 women aged 15–44 years were prescribed valproate during the study period; 14 were excluded. There were 10 pregnancies during possible valproate exposure; one was terminated. During the study period, the number of women prescribed valproate significantly decreased (P=0.003). The pregnancy rate decreased from 9.9/1000 on valproate before the MHRA April 2018 warning, to an average of 2.8/1000 afterwards. Recorded pre-conception/contraception advice increased by 79%, from 24% to 43%, of women prescribed valproate.ConclusionWith continued pregnancies in women aged 15-44 years prescribed valproate, patient education and foetal outcomes remain ongoing concerns. Further improvements are needed to ensure women make informed reproductive choices and safeguard future pregnancies from valproate exposure.

You just got to eat healthy: the topic of CAM in the general practice consultation

New Zealand research suggests that CAM use by GPs has decreased, while referral to CAM practitioners by GPs has increased, and that patients often do not tell their health practitioners when they are using CAM. The New Zealand Medical Council has developed guidelines for GPs who use CAM. However, there is no research in New Zealand that looks at how patients and GPs respond to CAM issues in the consultation. This paper uses data collected for two research projects on doctor-patient interaction. For this research, consultations between 105 patients and nine GPs were video-recorded. In this data set, all doctors but one were 'orthodox' and to some degree reserved judgement on CAM, albeit remaining cautious in how they made this evident. Patients on the other hand demonstrated a variety of strategies to get CAM on the agenda, and GPs were careful to couch any criticism in such a way as to protect the 'face' of patients.

You just got to eat healthy: the topic of CAM in the general practice consultation

New Zealand research suggests that CAM use by GPs has decreased, while referral to CAM practitioners by GPs has increased, and that patients often do not tell their health practitioners when they are using CAM. The New Zealand Medical Council has developed guidelines for GPs who use CAM. However, there is no research in New Zealand that looks at how patients and GPs respond to CAM issues in the consultation. This paper uses data collected for two research projects on doctor-patient interaction. For this research, consultations between 105 patients and nine GPs were video-recorded. In this data set, all doctors but one were 'orthodox' and to some degree reserved judgement on CAM, albeit remaining cautious in how they made this evident. Patients on the other hand demonstrated a variety of strategies to get CAM on the agenda, and GPs were careful to couch any criticism in such a way as to protect the 'face' of patients.