Morrison J, Carroll L, Watt G, Cameron I, Grimshaw J, Twaddle S; International Society of Technology Assessment in Health Care. Meeting.

Annu Meet Int Soc Technol Assess Health Care Int Soc Technol Assess Health Care Meet. 1999; 15: 75.

Department of General Practice, University of Glasgow, Glasgow, UK.

PURPOSE: It has been suggested that the management of infertility could be improved by the use of clinical guidelines. This study aimed to develop and evaluate guidelines for the management and referral of patients with infertility by general practitioners in Glasgow. METHOD: Guidelines were developed using consensus but informed by the evidence, by a group representing all parties involved in their use including a patient representative. General practices in Glasgow were randomised by practice size and location into intervention and control groups. The intervention practices were given the guidelines and invited to meetings to discuss their use before the study began. The control practices received the guidelines at the end of the period of data collection. All referrals to the five NHS hospitals in Glasgow where infertility is managed were collected for one year. Pre-referral management of infertility in general practice was investigated by a questionnaire sent to the GP immediately after the referral was made. Information on management during the year after referral was obtained by hospital case-note review and follow-up questionnaire to the GPs at one year. Patient satisfaction was obtained by questionnaire at one year after referral. The economic implications of using the guidelines were also evaluated. RESULTS: 598 out of 621 (96.3%) of GPs in Glasgow participated. 712 referrals were collected. The median referral rates per 1000 women aged 20-44 were similar in the two groups (3.25 intervention group, 3.27 control group). 83.9% of GPs responded to the pre-referral questionnaire. Intervention GPs were significantly more likely to have checked midluteal progesterone levels (Odds ratio 1.72, 95% C.I. 1.02,3.42) and there was a trend for other parameters to have been checked more often. Hospital case-notes were available for 88.7% of the referrals. 85.4% of GPs responded to the follow-up questionnaire. The main areas covered in follow-up consultations were emotional support, reassurrance and information about hospital procedures. 56% of patients responded and most were satisfied with the care in general practice and hospital but they wanted more information and support. CONCLUSIONS: The guidelines produced a modest improvement in pre-referral management of infertility in general practice. Management decisions in general practice are affected by multiple factors, only some of which can be influenced by guidelines.

Publication Types:

• Meeting Abstracts

Keywords:

• Data Collection
• Evaluation Studies
• Family Practice
• Female
• Guidelines as Topic
• Humans
• Infertility
• Male
• Physicians, Family
• Practice Guidelines as Topic
• Questionnaires
• Referral and Consultation
• methods
• standards
• hsrmtgs

Other ID:

• HTX/20602375

UI: 102194064

From Meeting Abstracts