Title
Empowering patients or general practitioners? A randomised clinical trial to improve quality in reproductive health care in Belgium
Author
Faculty/Department
Faculty of Social Sciences. Sociology
Faculty of Medicine and Health Sciences
Publication type
article
Publication
Subject
Human medicine
Source (journal)
European journal of contraception and reproductive health care
Volume/pages
15(2010) :4 , p. 280-289
ISSN
1362-5187
ISI
000280900400008
Carrier
E
Target language
English (eng)
Full text (Publishers DOI)
Affiliation
University of Antwerp
Abstract
Background Evidence-based clinical guidelines on contraceptive use were developed and distributed among all Flemish general practitioners (GPs) in Belgium. Objectives To evaluate the effectiveness of two strategies for implementing a guideline on oral contraceptives in order to enhance the quality of the first contraception consultation in general practice, by either empowering patients or by introducing a computer decision support system (CDSS). Method A random sample of 45 GPs was distributed among three study groups. One group was visited by an empowered patient, one group's electronic medical record was supplemented with a CDSS, and one group served as the control group. Simulated patients (SPs) assessed the performance of GPs in daily practice before and after the interventions, using a validated 48-point checklist. Results The baseline mean score of the 43 GPs was 26.16 (SD = 5.76). The SPs received sufficient information about correct pill usage, but not concerning factors associated with pill failure and drug interaction. After the intervention, the GPs' mean score was 26.39 (SD = 6.86). Only the intervention group with the empowered patient scored significantly better (29.92 [SD = 7.11]). The computer group and control group scored lower (24.36 [SD = 6.60] and 24.82 [SD = 5.65], respectively). Conclusion Developing and distributing an evidence-based guideline did not change GPs' behaviour. However, empowering patients to participate more proactively significantly improved GPs' performance during a contraception consultation. A CDSS did not.
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