Subsequent to the thalidomide tragedy, teratogen information services were developed in response to the public and health professionals need for evidence-based information regarding the safety/risk of exposures to drugs, chemicals, radiation and infectious diseases etc, during pregnancy and lactation. The vast majority of these services are telephone information lines, with a minority who see the women in a clinic setting [1
]. Because of the paucity of this type of information, several of the centers, often in collaboration with other services around the world, also began to carry out outcome studies on the safety/risk of various exposures, which have been and continue to be published in peer reviewed journals. Over the years as a group, they have also sought ways of improving how this research is carried out [2
]. This collaborative research has added substantially to the evidence based information, culminating over the years in a relatively large body of research in this field, which in turn can be transferred to the women and their health care providers [3
The Motherisk Program is a teratogen information service that has been operating at The Hospital for Sick Children in Toronto, Canada since 1985. Over the years there has been a steady increase in the number of calls to our service per year, with 31,000 in 2002. Adding to this number of documented calls, there are approximately 12,000 callers per year who listen to our recorded information and do not patch through to a counselor, thus bringing up the overall total number of calls the service receives to approximately 43,000 calls per year. We also see between 450–500 women per year in our clinic, where a letter is sent to her attending physician following her visit, documenting the evidence based information that was given to her regarding her exposure and any other reproductive risks.
Approximately 3000 of the telephone calls a year are directly from physicians. However, 90% of all the callers have been referred to our line by their physicians, as our service is very well known in Toronto and surrounding areas, as well as a substantial number of calls from the rest of Canada and the US. We have heard from many of our callers that it is standard practice during a pregnant women's first visit to her physician after confirmation of pregnancy, to be given Motherisk's phone number in case she has any questions regarding exposures during pregnancy.
The physicians who call us, have told us that they had heard about us mostly from word of mouth from their colleagues or quite frequently from having read the reviews which are published monthly in The Canadian Family Physician journal as "The Motherisk Update". These reviews evolve from actual questions asked by physicians using our fax service. Recently we published a history of our questions and answers and found that the most common questions physicians ask are in order of frequency: 1) antidepressants, 2) anti-epileptics, 3) antihistamines [13
]. The physicians that call us on the telephone do not receive written information as time constraints do not allow, however if they request documentation, they are referred to our fax service. Most appear to be satisfied with the information they receive over the telephone, because it is rare that there is a request for written information following a telephone call.
There is a relative lack of published research in the literature examining physicians information seeking behavior in general and in particular reproductive toxicology. Studies carried out in the US, Canada, Norway, Australia and Switzerland, found that little had changed in physician information seeking behavior over the years despite the increased access to medical information. In all studied countries, use of electronic means to seek information was low and most physicians relied heavily on word of mouth from their colleagues, their own experience, drug product monographs, textbooks and journals [14
Over the years we have delivered information to thousands of physicians via the telephone, but have never followed up to assess how they perceive the information received, or in turn how they use this information to counsel their pregnant patients. Our objectives were to assess utilization of information received, as well as information seeking behavior, in particular teratogen information.