Increased Adherence to Prenatal Group B Streptococcal Screening Guidelines Through a Paired Electronic Reminder and Education Intervention

Abstract

The 2010 Centers for Disease Control and Prevention (CDC) update on perinatal group B streptococcal (GBS) prevention advises universal vaginal-rectal GBS screening of pregnant women in the 35th through 37th week of gestation. Because GBS colonization is transient, a test performed more than 5 weeks before delivery may not have sufficient negative predictive value to be clinically useful. Our objective was to increase rates of quality-improved, CDC-adherent GBS screening and decrease repeat screening. A reminder for maternal vaginal-rectal GBS testing was added to the physicians' electronic ordering screen, and family medicine physicians and residents were educated about screening guidelines through standardized, in-person presentations. Retrospective chart review was performed before and after these interventions. Univariate or bivariate analysis was performed for demographic factors, timing of first screen, rates of CDC-adherent screening (the newly defined quality-improved screen and the usual screen), and rates of repeat and unnecessary screens. Multivariate analysis was performed with quality-improved and usual screening as dependent variables. Bivariate analysis showed that post-intervention rates of quality-improved screening increased from 30 to 62 % (P < .001), usual screening increased from 69 to 84 % (P = .005), and repeat GBS screening decreased from 20 to 8 % (P = .007). Multivariate analysis showed increased post-intervention odds of quality-improved screening [odds ratio (OR) 3.59; 95 % CI 2.07-6.34] and usual screening (OR 2.67; 95 % CI 1.40-5.25). Low-cost, reproducible quality improvement interventions (electronic order reminder, educational sessions) have the potential to increase guideline adherence for GBS screening in pregnant women and decrease repeat screening.

Poor Adherence to the Screening-Based Strategy of Group B Streptococcus Despite Colonization of Pregnant Women in Greece

“…This low compliance may be justified by the fact that GBS screening in Germany is not covered by health insurance [15], a problem that does not occur in Greece. Three additional studies from the USA revealed a wide heterogeneity among states: high adherence levels were recorded in Tennessee (84.7%) and Minnesota (88.4%) [16,17], and mediocre in California (69.05%) [18]. Moreover, compared to our results, a higher rate of adherence was observed in Australia (76%) [19].…”

Adherencia a las recomendaciones de prevención de la sepsis neonatal temprana asociada a la colonización por Streptococcus agalactiae en una institución de referencia en Bogotá, Colombia, 2019

“…La adherencia a la recomendación de tamización para EGB es superior a la informada por Ceballos et al en Medellín, Colombia 11 , quienes reportaron tamización en 7,0 % de las gestantes en 2010, antes de la publicación de la guía. En otros países se han reportado adherencias a la tamización que varían del 22,7 % en la cohorte de gestantes alemanas analizada por Kunze et al 17 hasta mayor al 80 % en Estados Unidos y Australia 18 , 19 . La baja tasa de cribado para EGB en la cohorte de Kunze 17 ) fue explicada porque el costo de las pruebas estuvo a cargo de las pacientes, mientras que en Colombia la prueba está cubierta por el sistema de salud y no sería esta la causa de una baja frecuencia de tamización encontrada en el presente estudio, más importante en las pacientes del régimen subsidiado.…”

Demographic conditioning of awareness of prophylaxis against Streptococcus agalactiae (GBS) infections among parturients

“…Primary care doctors were also trained, and presentations for pregnant women were organised. As a result of the program, pregnant women's participation in screening tests increased from 69% to 84%, and the number of repeated tests decreased from 20% to 8% [27].…”