The first contraception consult in general practice: how can
we improve the quality for adolescents?
L. Peremans1, JJ Rethans2, V.
Verhoeven1, L. Debaene1, P. Van Royen1, J.
of General Practice, University of Antwerp, Belgium,
Lab University of Maastricht, The Netherlands
Introduction: During the consultation the general
practitioner GP has and should use the opportunity to counsel and to give
correct information about different possibilities for contraception. A high
quality contraception consultation with an adolescent is a challenge for every
general practitioner and requires adequate knowledge and communication skills
Objectives: To evaluate the effectiveness of two
implementation strategies (empowered patients and a computer software programme)
for a clinical guideline on oral contraceptives in daily general practice.
Method: In 2002 an evidence-based clinical guideline for
oral contraceptive use was developed and distributed to all Flemish GPs. To
assess the basic performance of GPs we used incognito standardized patients in a
randomised before and after study. On basis of a validated checklist the three
standardized patients score their visits to the GPs and they register the
circumstances and the duration of the consultation. One hundred fifty GPs, using
the same electronic record software system, were invited to participate in the
study. Based on GP’s mean score on the checklist of 24.01/48 (SD=7.01) in a
pilot study in 2003, we calculated that a sample of 45 GPs (with á= 0.05 and
1-â = 80%) for the intervention. The at random selected GPs received a first
visit by a standardized patient.
Five months after the basic assessment of performance one
control and two interventions groups are planned. Both patients and GPs are
blinded for the intervention. One group is visited by an ‘empowered’ patient
and a second group l uses a new update of their computer software, with a ‘contraceptive
consult’ tool included. The third group is a control group.
Results: Forty-three consults could be analysed. Before
the intervention, GPs’ mean score on the checklist was 26.16 (SD=5.76). None
of the GPs took a personal history to exclude sexual transmitted infections and
only one third asked for contra-indications as high blood pressure and cancer.
Less than one fourth asked for use of medication (9/43), diabetes (4/43),
migraine (11/43) and liver disease (10/43). None of the physicians did a
technical examination. The students got enough information about the correct
pill use but hardly on factors associated with pill failure and interactions
with other medication. For 8 GPs the pill prescription corresponded with the
guidelines. In August we will measure GPs’ performance after the intervention
and we will have the results of the intervention.
Conclusion: Developing and distributing guidelines are
not enough to change GPs’ behaviour. For quality improvement of the
contraception consult other interventions, on patients’ and doctors’ side,
should be performed and evaluated.