Academic detailing and adherence to guidelines for Group B streptococci prenatal screening: a randomized controlled trial

Abstract

BackgroundClinical practice guidelines (CPGs) recommend universal prenatal screening for Group B Streptococcus (GBS) to identify candidates for intrapartum antibiotic prophylaxis to prevent early onset neonatal GBS infection. Interventions to promote physician adherence to these guidelines are imperative. This study examined the effectiveness of academic detailing (AD) of obstetricians, compared with CPG mailshot and no intervention, on the screening of pregnant women for GBS.MethodsA randomized controlled clinical trial was conducted in the medical cooperative of Porto Alegre, Brazil. All obstetricians who assisted in a delivery covered by private health insurance managed by the cooperative in the 3 months preceding the study (n = 241) were invited to participate. The obstetricians were randomized to three groups: direct mail (DM, n = 76), AD (n = 76) and control (C, n = 89, no intervention). Those in the DM group were sent guidelines on GBS. The AD group received the guidelines and an educational visit detailing the guidelines, which was conducted by a trained physician. Data on obstetrician age, gender, time since graduation, whether patients received GBS screening during pregnancy, and obstetricians who requested screening were collected for all participant obstetricians for 3 months before and after the intervention, using database from the private health insurance information system.ResultsThree months post-intervention, the data showed that the proportion of pregnant women screened for GBS was higher in the AD group (25.4%) than in the DM (15.9%) and C (17.7%) groups (P = 0.023). Similar results emerged when the three groups were taken as a cluster (pregnant women and their obstetricians), but the difference was not statistically significant (Poisson regression, P = 0.108). Additionally, when vaginal deliveries were analyzed separately, the proportion screened was higher in the AD group (75%) than in the DM group (41.9%) and the C group (30.4%) (chi-square, P < 0.001).ConclusionsThe results suggest that AD increased the prevalence of GBS screening in pregnant women in this population.

Streptococcus agalactiae in pregnant women in Brazil: prevalence, serotypes, and antibiotic resistance

“…One effort to improve adherence to universal GBS screening is simply to provide information to doctors. When detailed information is provided to obstetricians, there is an improvement in the number of women screened for GBS, although more long-term research is needed [65].…”

Implementation of clinical guidelines in Brazil: should academic detailing be used?

“…In Brazil, Silva et al . conducted a randomized controlled clinical trial to evaluate the usefulness of academic detailing with increasing prenatal Group B Streptococcus screening in a hospital in accordance to a Clinical Guideline.…”

Effectiveness of educational outreach visits compared with usual guideline dissemination to improve family physician prescribing—an 18-month open cluster-randomized trial

“…Given the control group was also exposed to the same guidelines, it is also possible the intervention was not so effective when used as an add-on to existing dissemination strategies. However, passive dissemination of guidelines had been shown to be inferior to educational outreach visits and multifaceted interventions that included educational outreach [ 38 , 39 ]. The Portuguese context may have been important regarding the effects of the intervention, as primary care physicians are government employed, their performance is monitored through quality and spending indicators, and the National Health Directorate’s position on guidelines is normative in nature [ 13 ].…”