Choosing the right contraceptive method – development of a
clinical pathway
A Mendelin
Grünenthal GmbH, Aachen, Germany
A first
International Belara® Advisory Board Meeting has been initiated (11/ 2005) to
improve contraceptive management in clinical practice by conceiving an
innovative methodology to guide gynaecologists in their decisions making in
contraception. For this purpose the advisory board started its work on clinical
pathways in contraception.
Clinical pathways are broadly well accepted tools,
helping physicians to implement clinical guidelines into their day to day
practise. This workshop tries to give guidance to doctors to reflect their daily
routine procedures in contraception on professional level and to support them to
make clinical decisions more effective in terms of finding optimized and
individual contraceptive strategies for women. To our knowledge such tools
momentarily do not exist or exist only in a rudimentary version. Efficacy data
from clinical and highly controlled studies, often displayed in “evidence
based guidelines” have to be connected with the professional’s subjective
experience of effectiveness in daily practice. Professional’s and patient’s
subjective experiences of effectiveness in clinical practice have to be
evaluated, formulated as educated guesses and integrated into guidelines.
Clinical pathways can help to integrate and weight that guideline content in the
clinical decision process of daily routine practice. They can help to reflect
the effectiveness of such content in its regards to contraceptive effectiveness,
safety, manageability, tolerability, etc.. All these are quality criteria which
are more crucial in contraception because gynaecologists are not facing patients
who suffer from a disease, but healthy women who come to ask for a contraceptive
method. Therefore, given the importance of women’s individual expectancies and
needs in contraception therapeutic choices, a clinical pathway giving room for
reflection of individual choices based on evidence is definitely much more
relevant and effective in contraception than stricter guidelines or basic
decision trees which are mainly ignored.