BMJ 1998;317:1041-1046 ( 17 October )

Papers

Randomised trial of educational visits to enhance use of systematic reviews in 25 obstetric units

Editorial by Keirse

Jeremy C Wyatt, senior research fellow, ^a Sarah Paterson-Brown, consultant obstetrician, ^b Richard Johanson, senior lecturer in obstetrics, ^c Douglas G Altman, head, ^a Michael J Bradburn, statistician, ^a Nicholas M Fisk, professor. ^b

^a Imperial Cancer Research Fund Medical Statistics Group, Centre for Statistics in Medicine, Institute of Health Sciences, Headington, Oxford OX3 7LF, ^b Institute for Obstetrics and Gynaecology, Imperial College School of Medicine, Queen Charlotte's and Chelsea Hospital, London W6 0XG, ^c Academic Department of Obstetrics and Gynaecology, City General Hospital, Stoke on Trent ST4 6QG

Correspondence to: Dr J C Wyatt, Health Knowledge Management Programme, School of Public Policy, University College London, London WC1E 7HN jeremy.wyatt{at}ucl.ac.uk

Objective To evaluate the effectiveness of an educational visit to help obstetricians and midwives select and use evidence from a Cochrane database containing 600 systematic reviews.
Design Randomised single blind controlled trial with obstetric units allocated to an educational visit or control group.
Setting 25 of the 26 district general obstetric units in two former NHS regions.
Subjects The senior obstetrician and midwife from each intervention unit participated in educational visits. Clinical practices of all staff were assessed in 4508 pregnancies.
Intervention Single informal educational visit by a respected obstetrician including discussion of evidence based obstetrics, guidance on implementation, and donation of Cochrane database and other materials.
Main outcome measures Rates of perineal suturing with polyglycolic acid, ventouse delivery, prophylactic antibiotics in caesarean section, and steroids in preterm delivery, before and 9 months after visits, and concordance of guidelines with review evidence for same marker practices before and after visits.
Results Rates varied greatly, but the overall baseline mean of 43% (986/2312) increased to 54% (1189/2196) 9 months later. Rates of ventouse delivery increased significantly in intervention units but not in control units; there was no difference between the two types of units in uptake of other practices. Pooling rates from all 25 units, use of antibiotics in caesarean section and use of polyglycolic acid sutures increased significantly over the period, but use of steroids in preterm delivery was unchanged. Labour ward guidelines seldom agreed with evidence at baseline; this hardly improved after visits. Educational visits cost £860 each (at 1995 prices).
Conclusions There was considerable uptake of evidence into practice in both control and intervention units between 1994 and 1995. Our educational visits added little to this, despite the informal setting, targeting of senior staff from two disciplines, and donation of educational materials. Further work is needed to define cost effective methods to enhance the uptake of evidence from systematic reviews and to clarify leadership and roles of senior obstetric staff in implementing the evidence.

Key messages There was marked variation in four common obstetric practices known to improve patient outcomes in 25 district general obstetric units across south east England in both 1994 and 1995 Labour ward guidelines in the 25 units showed little concordance with Cochrane review evidence in 1994 and 1995 The gap between Cochrane review evidence and clinical practice narrowed in 1995, but 46% (1010) of 2196 pregnant women studied were still not managed according to current evidence Educational visits to senior staff led to a significant but clinically modest uptake of evidence from systematic reviews in only one of the four practices studied Reducing practice variations and improving clinical knowledge management by helping clinicians to locate, select, and implement systematic review evidence remain important challenges for the NHS

---

© BMJ 1998
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Related Articles

Value of educational visits in obstetrics

Jane Pannikar, Andrew Farkas, Richard Edmondson, and Philip Banfield
BMJ 1999 318: 1143. [Extract] [Full Text]

Getting clinicians to use evidence from systematic reviews is difficult
BMJ 1998 317: 0. [Full Text]

Changing practice in maternity care

Marc J N C Keirse
BMJ 1998 317: 1027-1028. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Kunz, R, Wegscheider, K, Guyatt, G, Zielinski, W, Rakowsky, N, Donner-Banzhoff, N, Muller-Lissner, S (2007). Impact of short evidence summaries in discharge letters on adherence of practitioners to discharge medication. A cluster-randomised controlled trial. Qual Saf Health Care 16: 456-461 [Abstract] [Full text]  
• Davey, P. (2006). The potential role of computerized decision support systems to improve empirical antibiotic prescribing. J Antimicrob Chemother 58: 1105-1106 [Abstract] [Full text]  
• Chaillet, N., Dube, E., Dugas, M., Audibert, F., Tourigny, C., Fraser, W. D., Dumont, A. (2006). Evidence-Based Strategies for Implementing Guidelines in Obstetrics: A Systematic Review.. Obstet Gynecol 108: 1234-1245 [Abstract] [Full text]  
• Gorin, S. S., Ashford, A. R., Lantigua, R., Hossain, A., Desai, M., Troxel, A., Gemson, D. (2006). Effectiveness of Academic Detailing on Breast Cancer Screening among Primary Care Physicians in an Underserved Community. J Am Board Fam Med 19: 110-121 [Abstract] [Full text]  
• Allen, R. E., Hanson, R. W. Jr (2005). Episiotomy in Low-Risk Vaginal Deliveries. J Am Board Fam Med 18: 8-12 [Abstract] [Full text]  
• Campbell, M. K, Elbourne, D. R, Altman, D. G (2004). CONSORT statement: extension to cluster randomised trials. BMJ 328: 702-708 [Full text]  
• Westbrook, J. I., Gosling, A. S., Coiera, E. (2004). Do Clinicians Use Online Evidence to Support Patient Care? A Study of 55,000 Clinicians. J. Am. Med. Inform. Assoc. 11: 113-120 [Abstract] [Full text]  
• Howden, N. L. S., Weber, A. M., Meyn, L. A. (2004). Episiotomy Use Among Residents and Faculty Compared With Private Practitioners. Obstet Gynecol 103: 114-118 [Abstract] [Full text]  
• Grol, R. (2001). Improving the Quality of Medical Care: Building Bridges Among Professional Pride, Payer Profit, and Patient Satisfaction. JAMA 286: 2578-2585 [Abstract] [Full text]  
• Rogers, S., Humphrey, C., Nazareth, I., Lister, S., Tomlin, Z., Haines, A. (2000). Designing trials of interventions to change professional practice in primary care: lessons from an exploratory study of two change strategies. BMJ 320: 1580-1583 [Full text]  
• Wyatt, J. C, Paterson-Brown, S., Fisk, N. M, Johanson, R., Altman, D. G, Bradburn, M. (1999). Randomised trials useful to find best methods of enhancing clinical practice. BMJ 318: 1353-1353 [Full text]  
• Bauchner, H. (1999). Evidence-based Medicine: A New Science or an Epidemiologic Fad?. Pediatrics 103: 1029-1031 [Full text]  
• Pannikar, J., Farkas, A., Edmondson, R., Banfield, P. (1999). Value of educational visits in obstetrics. BMJ 318: 1143c-1143 [Full text]  
• Keirse, M. J N C (1998). Changing practice in maternity care. BMJ 317: 1027-1028 [Full text]  

Rapid Responses:

Read all Rapid Responses

Systematic reviews in obstetrics

Richard Edmondson
bmj.com, 23 Oct 1998 [Full text]

Educational visits to enhance the use of systematic reviews in obstetrics

Philip Banfield
bmj.com, 30 Oct 1998 [Full text]