A randomized controlled trial of direct access for laparoscopic sterilization

Area of Science:

• Reproductive Health
• Health Services Research
• Surgical Procedures

Background:

• Direct access services aim to streamline patient care pathways.
• Evaluating new models for gynecological procedures is crucial for healthcare efficiency.

Purpose of the Study:

• To establish and assess a direct access service for laparoscopic sterilization.
• To compare patient and provider outcomes between direct and routine referral for sterilization.

Main Methods:

• A pragmatic randomized controlled trial involving 232 women undergoing sterilization.
• Assessed outcomes included waiting times, patient/doctor satisfaction, complications, costs, and preferences.

Main Results:

• No inappropriate direct referrals occurred; waiting times were reduced in the direct access group.
• Patient and doctor satisfaction remained high in both groups, with no difference in complications or costs.
• Patients preferred routine referral, valuing information over shorter waiting times; only 31% were suitable for direct referral.

Conclusions:

• Patients preferred traditional routine referral despite medical support for direct access.
• Restrictive criteria may hinder direct access uptake, necessitating careful service planning.
• Methodological insights were gained for trials at the primary-secondary care interface.