Do clinical guidelines improve general practice management and referral of infertile couples?

Abstract

Objective-To evaluate guidelines for general practice management and referral of infertile couples. Guidelines were implemented with a disease specific reminder at the time of consultation (the guidelines were embedded within a structured infertility management sheet for each couple).Design-Pragmatic randomised controlled trial. Participating practices were randomised to a group that received the guidelines and a control group.Setting-82 general practices in Grampian region. Subjects-100 couples referred by general practitioners receiving the guideline and 100 couples referred by control general practitioners.Main outcome measure-Whether the general practitioner had taken a full sexual history and examined and investigated both partners appropriately.Results-Characteristics of patients referred by study and control general practitioners did not differ significantly at baseline. Compliance with the guidelines increased for all targeted activities. General practitioners in the study group were more likely to take a sexual history (for example, couples' use of fertile period, 85% v 69'/6, p <0.01); examine both partners (female partner, 68% v 52%, p < 0-05; male partner 390/ v 13%, p <0.01); and investigate both partners (day 21 progesterone, 72% v 41%, p< 0 l001; semen analysis, 51% v 41%, p>005). Improvements were greater when general practitioners used the disease specific reminder.Conclusion-Receiving guidelines led to improvements in the process of care of infertile couples within general practice. This effect was enhanced when the guidelines were embedded in a structured infertility management sheet for each couple.

An audit of referral practice for patients with impacted palatal canines and the impact of referral guidelines

“…26 Other randomised clinical trials have shown that implementation of guidelines in medical primary care are variably effective. [27][28][29][30] Furthermore, recent systematic reviews suggest that the effects of audit and feedback in improving professional practice are generally variable. 31,32 These guidelines were developed to address the shortcomings in referral practices identified in the first audit cycle.…”

Re: Outcomes From Treatment of Infertility With Natural Procreative Technology in an Irish General Practice

“…6 However, we strongly disagree with diverting 2 years of an infertility patient's time into a scheme where per-cycle pregnancy rates are unknown and where most patients, even when ideally selected, will quit treatment.…”

“…We chose to follow the recommendations of the Cochrane Collaboration, that outcomes be reported as a pregnancy rates per woman or couple, because repeat cycle data are not statistically independent and are less relevant to the patient. 6,7 More accurate comparisons of outcomes could be made if IVF clinics followed these recommendations.…”

North Carolina College of Emergency Physicians' Guidance Document on Emergency Medical Services

“…Requiring all EMS providers in North Carolina to follow the protocols, procedures, policies, and other relevant sections in the NCCEP document ensures a minimum baseline level of care and helps standardize prehospital care throughout the state. It has been shown that standardizing patient care reduces variation in clinical practice [2][3][4]. This is particularly important in North Carolina because many providers work in multiple EMS agencies throughout the state [5].…”