Treating women of childbearing potential with antiepileptic drugs (AEDs) involves responsibility for fertility-related issues and nutritional requirements. The first international guidelines to assist physicians caring for women with epilepsy (WWE) were presented in 1989 (1). Subsequently in 1999, a review article on the subject was published in the Journal of the Norwegian Medical Association (2). This journal is distributed to 94% of all practicing physicians in Norway.
Despite publication of guidelines, several studies have found the care for WWE to be suboptimal (3–7). Methods of implementation that increase the likelihood of guidelines being used include reminders, interactive educational meetings, audit and feedback, patient-directed interventions, and development of local consensus. It is not known which guideline dissemination and implementation strategies are likely to be efficient under different circumstances (8). We introduced local guidelines and actively pursued their implementation, by using strategies that were feasible within the existing resources in our hospital.
For chronic conditions like epilepsy, the time between the care provided and its outcome can be long, and a poor outcome (e.g., major malformations in offspring or oral contraceptive failure) does not occur every time an error or deficiency occurs in the provision of that care. In this situation, details of practice (process data) provide more sensitive measures of quality than do outcome data (9). Patients' knowledge on WWE issues can serve as a surrogate outcome measure.
The aim of this study was to establish the degree of adherence to guidelines for the care of WWE before and after their active local implementation and assess their impact on the clinical practice by using case-note reviews and a patient questionnaire.