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- Title
Do obstetricians apply the national guidelines? A vignette-based study assessing practices for the prevention of preterm birth.
- Authors
Rousseau, A; Azria, E; Baumann, S; Deneux‐Tharaux, C; Senat, MV; Deneux-Tharaux, C; Senat, M V
- Abstract
<bold>Objective: </bold>To describe spontaneous preterm birth prevention practices self-reported before and after the dissemination of relevant guidelines, and to identify personal and organisational factors associated with adherence.<bold>Design: </bold>A repeated cross-sectional vignette-based survey study.<bold>Setting: </bold>French obstetricians.<bold>Population: </bold>French obstetricians practicing in public or private maternity units.<bold>Methods: </bold>Before and after the dissemination of the 2017 French guidelines on the prevention of spontaneous preterm birth, participants were asked to complete a web-based self-administered questionnaire based on two clinical vignettes. Vignette 1 focused on respondents' attitudes towards strict bed rest, cerclage, and progesterone treatment for women with a short cervix in mid-trimester; vignette 2 focused on attitudes towards strict bed rest and maintenance tocolysis after successful tocolysis for preterm labour. A mixed quantitative and qualitative analysis was conducted.<bold>Main Outcome Measures: </bold>Non-adherence to guidelines for the prevention of spontaneous preterm birth in responses to each vignette.<bold>Results: </bold>We obtained complete responses from 286 obstetricians before and 282 obstetricians after guideline dissemination, including 145 obstetricians participating in both. After dissemination, 51.4% of obstetricians self-reported non-adherent practices for vignette 1 and 22.3% of obstetricians self-reported non-adherent practices for vignette 2. No improvement was observed after dissemination. The quantitative analysis identified factors associated with non-adherence, including older age and practice in non-university or small hospitals, whereas the qualitative analysis highlighted barriers to implementation, including fear of change, habits, work overload, and lack of time.<bold>Conclusions: </bold>Adherence to guidelines was generally low, with practices unmodified by their dissemination. Improvement is required, especially regarding applicability.<bold>Tweetable Abstract: </bold>Adherence to guidelines to prevent spontaneous preterm birth was generally low and remained unmodified after guideline dissemination.
- Subjects
PREMATURE labor; OBSTETRICIANS; BED rest; GUIDELINES; FACTOR analysis; PREMATURE infants; CROSS-sectional method; QUESTIONNAIRES; PHYSICIANS
- Publication
BJOG: An International Journal of Obstetrics & Gynaecology, 2020, Vol 127, Issue 4, p467
- ISSN
1470-0328
- Publication type
journal article
- DOI
10.1111/1471-0528.16039