Kersten Fleur A M, Hermens Rosella P G M, Braat Didi D M, Hoek Annemieke, Mol Ben Willem J, Goddijn Mariëtte, Nelen Willianne L D M
* Dit is een bewerking van een onderzoek gepubliceerd in Human Reproduction (2015;30(1):71-80), met als titel 'Overtreatment in couples with unexplained infertility'. Afgedrukt met toestemming.
Ned Tijdschr Geneeskd. 2015;159:A8689.
To assess adherence to expectant management of 6-12 months in couples with unexplained subfertility, as recommended by the Dutch Networkguideline Subfertility.
A retrospective cohort study in 25 clinics.
Couples were eligible to participate if they were diagnosed with unexplained subfertility and had a good prognosis of natural conception within one year (>30%), for these couples the network guideline recommends an expectant management. Outcomes measures are overtreatment, i.e. couples that started treatment within six months, and three quality indicators: 1) prognosis not calculated, 2) no correct expectant management advised, 3) starting treatment too soon despite a correct advise. Data collection was obtained from medical records. Multilevel regression analyses were performed to investigate associations of overtreatment with patient and clinic characteristics.
We included 544 couples. Overtreatment occurred in 36% (N=198). In 34% (N=186) of all couples no prognosis was calculated (1), and in 42% (N=230) of all couples expectant management was not advised correctly (2). When a correct expectant management of six to twelve months was advised, 16% (N=51) started treatment too soon anyway. Overtreatment occurred more frequently in childless couples, a higher female age, and a longer duration of infertility.
Our findings show that developing and publishing guideline recommendations on expectant management is not enough and that overtreatment still occurs frequently. To improve future care the next step is to evaluate a tailored implementation strategy to improve adherence to the recommendations on expectant management by the Dutch Networkguideline Subfertility.
按照荷兰不孕症网络指南的建议，评估不明原因亚生育夫妇对6至12个月期待管理的依从性。
在25家诊所进行的一项回顾性队列研究。
如果夫妇被诊断为不明原因亚生育且一年内自然受孕预后良好（>30%），则有资格参与，对于这些夫妇，网络指南建议采用期待管理。结局指标为过度治疗，即夫妇在六个月内开始治疗，以及三个质量指标：1）未计算预后，2）未给出正确的期待管理建议，3）尽管给出了正确建议但过早开始治疗。数据收集自医疗记录。进行多水平回归分析以研究过度治疗与患者及诊所特征之间的关联。
我们纳入了544对夫妇。36%（N = 198）发生了过度治疗。在所有夫妇中，34%（N = 186）未计算预后（1），42%（N = 230）的夫妇未得到正确的期待管理建议（2）。当建议进行6至12个月的正确期待管理时，仍有16%（N = 51）的夫妇过早开始治疗。无子女夫妇、女性年龄较大以及不孕持续时间较长时，过度治疗更频繁发生。
我们的研究结果表明，制定和发布关于期待管理的指南建议是不够的，过度治疗仍然频繁发生。为改善未来的医疗服务，下一步是评估一种量身定制的实施策略，以提高对荷兰不孕症网络指南中期待管理建议的依从性。
