Empowering patients or general practitioners? A randomised clinical trial to improve quality in reproductive health care in Belgium

Lieve Peremans*, Jan Joost Rethans, Veronique Verhoeven, Samuel Coenen, Luc Debaene, Herman Meulemans, Joke Denekens, Paul Van Royen

*Corresponding author for this work

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Background Evidence-based clinical guidelines on contraceptive use were developed and distributed among all Flemish general practitioners (GPs) in Belgium. Objectives 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). Method 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 = 6.601 and 24.82 [SD = 5.65], respectively). Conclusion 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.
Original languageEnglish
Pages (from-to)280-289
JournalEuropean Journal of Contraception and Reproductive Health Care
Issue number4
Publication statusPublished - Aug 2010


  • Adolescents
  • Contraception
  • Consultation
  • Standardised patient
  • Computer decision support
  • Empowered patient

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