Healthcare providers' use of a concise summary to prescribe for lactating patients.

BACKGROUND: Most breastfeeding individuals take at least one prescription drug, yet limited data from lactation studies are available to inform the safety of these drugs during breastfeeding. As a result, healthcare providers (HCPs) rely on available information about safety of drugs used during pregnancy or on personal experiences to inform prescribing/counseling decisions for breastfeeding individuals. To improve risk communication regarding drugs used during lactation, the U.S. Food and Drug Administration published the Pregnancy and Lactation Labeling Rule (PLLR) in 2015, which added a narrative summary of available risk information to the lactation section of Prescribing Information (PI). Prior studies on labeling in PLLR format revealed that although HCPs found these details valuable, they regarded the narrative as too long to support decision-making during patient encounters. OBJECTIVE: This qualitative study's objective was to assess the utility of adding a concise summary to the Lactation subsection of PI to complement the narrative and succinctly communicate to busy HCPs a drug's risks when used during lactation. The concise summary consisted of a bolded headline, bulleted descriptions of available study findings and potential adverse reactions, and recommendations for risk mitigation. METHODS: Twenty-five online focus groups were conducted with five segments of HCPs to obtain their feedback on the concise summary and discuss their prescribing/counseling decisions for four fictitious prescription drugs including one vaccine. RESULTS: HCPs utilized the concise summary to make initial prescribing/counseling decisions. Many also used the labeling narrative for a comprehensive benefit-risk assessment. CONCLUSION: The findings indicate a need to continue to improve communication about safety of drugs used during lactation, and that the concise summary may help facilitate this communication. The study also highlights the need to educate HCPs about PI limitations when clinical data are lacking and the need to encourage clinical studies to be conducted to support actionable recommendations about use of prescription drugs during lactation.

Zoning, accessory dwelling units, and family caregiving: issues, trends, and recommendations.

This article explores the relationship between zoning regulations and co-residential family caregiving in the United States. It first provides an overview of U.S. housing policies, especially zoning. We then describe major changes in family structure and composition in the United States with their implications for caregiving and discuss how multigenerational housing options, particularly accessory dwelling units (ADUs) in single-family homes, can help support family caregiving. After an overview of zoning policies and actions that inhibit ADU production, we document current trends, incorporating information from a small non-random study of ADU activity we conducted in 2004. Finally, we present recommendations for promoting more multigenerational housing as a supplement to other family support programs (e.g., dependent care assistance, family caregiver payments) and as a source of affordable, supportive housing for those families choosing co-residence as their eldercare solution.