A randomised controlled trial of a tailored multifaceted strategy to promote implementation of a clinical guideline on induced abortion care
Open accessAbstract
Objective To evaluate the effectiveness and efficiency of a tailored multifaceted strategy, delivered by a national clinical effectiveness programme, to implement a guideline on induced abortion. Design Cluster randomised controlled trial. Setting and participants All 26 hospital gynaecology units in Scotland providing induced abortion care. Intervention Following the identification of barriers to guideline implementation, intervention units received a package comprising audit and feedback, unit educational meetings, dissemination of structured case records and promotion of a patient information booklet. Control units received printed guideline summaries alone. Main outcome measures Compliance with five key guideline recommendations (primary outcomes) and compliance with other recommendations, patient satisfaction and costs of the implementation strategy (secondary outcomes). Results No effect was observed for any key recommendation: appointment with a gynaecologist within five days of referral (odds ratio 0.89; 95% confidence interval 0.50 to 1.58); ascertainment of cervical cytology history (0.93; 0.36 to 2.40); antibiotic prophylaxis or screening for lower genital tract infection (1.70; 0.71 to 5.99); use of misoprostol as an alternative to gemeprost (1.00; 0.27 to 1.77); and offer of contraceptive supplies at discharge (1.11; 0.48 to 2.53). Median pre‐intervention compliance was near optimal for antibiotic prophylaxis and misoprostol use. No intervention benefit was observed for any secondary outcome. The intervention costs an average of £2607 per gynaecology unit. Conclusions The tailored multifaceted strategy was ineffective. This was possibly attributable to high pre‐intervention compliance and the limited impact of the strategy on factors outside the perceived control of clinical staff.
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The overall risk of bias for Foy 2004 was unclear (4 criteria unclear risk, including randomisation and allocation concealment).
“Risk of bias overall Unclear risk 4 criteria unclear risk, including randomisation and allocation concealment”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Foy 2004
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Self-citation
- Authors
- Foy, R., Penney, G. C., Grimshaw, J. M., Ramsay, C. R., Walker, A. E., MacLennan, G., Stearns, S. C., McKenzie, L., & Glasier, A.
- Affiliations
- University of Edinburgh (GB)
- University of Ottawa (CA)
- University of Aberdeen (GB)
- University of North Carolina at Chapel Hill (US)
- London School of Hygiene & Tropical Medicine (GB)
- Corresponding author
- Foy, R.
- Venue
- BJOG: An International Journal of Obstetrics & Gynaecology
- Publisher
- Wiley
- Published
- 2004-04-26
- Volume
- 111
- Issue
- 7
- Pages
- 726-733
- ISSN
- 0306-5456 (ISSN-L)
- 1470-0328
- 1471-0528
- OpenAlex
- W2011564202
- Cited by
- 44
- References
- 18
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 5 · 2023: 2 · 2022: 1 · 2021: 1 · 2020: 1 · 2018: 1 · 2017: 3 · 2016: 1 · 2015: 2 · 2013: 4 · 2012: 3
- FWCI
- 6.40
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Locations
- BJOG An International Journal of Obstetrics & Gynaecology (publishedVersion)
- PubMed (publishedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Keywords
- abortion, guideline implementation, audit and feedback, misoprostol, antibiotic prophylaxis, cervical cytology, contraceptive provision, patient satisfaction, implementation costs
- MeSH terms
- Abortion, Induced, Adult, Aftercare, Cost-Benefit Analysis, Female, Humans, Patient Education as Topic, Pregnancy, Pregnancy Outcome, Prenatal Care, Practice Guidelines as Topic
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