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).

DESIGN

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

SETTING

82 general practices in Grampian region.

SUBJECTS

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

MAIN OUTCOME MEASURES

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.

CONCLUSION

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.