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


METHODS
Pragmatic randomised controlled trial. Participating practices were randomised to a group that received the guidelines and a control group.


METHODS
82 general practices in Grampian region.


METHODS
100 couples referred by general practitioners receiving the guideline and 100 couples referred by control general practitioners.


METHODS
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%, p < 0.01); examine both partners (female partner, 68% v 52%, p < 0.05; male partner 39% v 13%, p < 0.01); and investigate both partners (day 21 progesterone, 72% v 41%, p < 0.001; semen analysis, 51% v 41%, p > 0.05). Improvements were greater when general practitioners used the disease specific reminder.


CONCLUSIONS
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.
Emslie
C
C
Department of Obstetrics and Gynaecology, University of Aberdeen.
Grimshaw
J
J
Templeton
A
A
D000293:Adolescent; D000328:Adult; D005194:Family Practice / Q000592:standards*; D005260:Female; D006801:Humans; D007246:Infertility / Q000628:therapy*; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D010808:Physical Examination; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation; D006113:United Kingdom