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pubmed:otherAbstract |
PIP: In the UK, recent changes to prescribing oral contraceptives (OCs) have contributed to acute difficulties in providing clinical services, interruptions or discontinuations of audit and research projects of the Royal College of Obstetricians and Gynaecologists' Faculty of Family Planning and Reproductive Health Care, and criticisms of the way its audit unit has handled nationally important information. Professional auditors should consider the problems caused by the sudden change in a long accepted gold standard as an opportunity. The unit has already received audits of the effect of changes concerning the risk of thromboembolism from gestodene and desogestrel containing OCs. Family planning providers need to consider whether their cascade system of information dissemination did not inform them quickly and completely of a necessary change in practice or whether it followed the information system available to clients (i.e., the national press) so that family planning providers are not prepared for consumer reports both qualitatively and quantitatively. Some potentially long-term difficulties have occurred, which probably could not have been avoided regardless. Some clinics had to dispense only a two-months supply of second generation OCs at a time. Problems linked to a large increase in clinic attendances (potentially longer waiting times, counseling time, poorer attendance rates, and possibly more OC discontinuations) will recur at two months and at regular intervals thereafter until new stocks are available to allow staggered follow-up appointments. Thus, the audit unit can refer to its on-going audits for these figures. The most difficult step of the audit cycle is to initiate a change in practice. The audit unit must first acquire data to handle appropriately OC scares from articles in the national press.
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