The first contraception consult in general practice: how can we improve the quality for adolescents?


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

for adolescents.

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.

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