Empowering patients or general practitioners? A randomised clinical trial to improve quality in reproductive health care in Belgium.
BACKGROUND
Evidence-based clinical guidelines on contraceptive use were developed and distributed among all Flemish general practitioners (GPs) in Belgium.


OBJECTIVE
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).


METHODS
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).


CONCLUSIONS
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.
Department of Primary and Interdisciplinary Care, Faculty of Medicine, University of Antwerp, Antwerp-Wilrijk, Belgium. lieve.peremans@ua.ac.be
Lieve
L
Peremans
Jan Joost
JJ
Rethans
Veronique
V
Verhoeven
Samuel
S
Coenen
Luc
L
Debaene
Herman
H
Meulemans
Joke
J
Denekens
Paul
P
Van Royen
D000328:Adult; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D001530:Belgium; D020000:Decision Support Systems, Clinical; D005260:Female; D006284:Health Plan Implementation; D006801:Humans; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D010358:Patient Participation / Q000523:psychology*; D010821:Physicians, Family / Q000523:psychology*; D011209:Power, Psychological; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care; D034121:Reproductive Health Services / Q000592:standards*