Factors Influencing the Evolving Practice of Obstetricians in Eastern Wisconsin: A Survey

ABSTRACT

The purpose of this survey was to ascertain what prompts clinicians in eastern Wisconsin to change their obstetric practice. A survey was mailed to all clinicians doing obstetrics for a nonprofit organization that performs over 11,000 deliveries in 10 hospitals. Of the 185 surveys mailed, 90 (49%) practicing obstetricians returned it. To change their practice, 31% of respondents said they need the American College of Obstetricians and Gynecologists (ACOG) to recommend it; 24% required multiple randomized clinical trials (RCTs) from different centers; 11% thought one RCT was sufficient. Whereas 93% of the respondents will change their practice within 2 years of a new ACOG recommendation, only 67% will do so after an RCT (odds ratio 6.42; 95% confidence intervals 2.46, 16.75). We concluded that ACOG recommendations are more likely to change the practice of clinicians doing obstetrics in eastern Wisconsin than RCTs.

KEYWORDS

ACOG practice bulletins - randomized clinical trials - obstetric practice - surveys

REFERENCES

• 1 Sibai B M, Mercer B M, Schiff E, Friedman S A. Aggressive versus expectant management of severe preeclampsia at 28 to 32 weeks' gestation: a randomized controlled trial.  Am J Obstet Gynecol. 1994;  171 818-822
• 2 Hannah M E, Hannah W J, Hewson S A, Hodnett E D, Saigal S. Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomized multicenter trial. Term Breech Trial Collaborative Group.  Lancet. 2000;  356(9239) 1375-1383
• 3 Meis P J, Klebanoff M, Thom E et al.. Prevention of recurrent preterm delivery by 17 alpha-hydroxyprogesterone caproate.  N Engl J Med. 2003;  348(24) 2379-2385
• 4 American College of Obstetricians and Gynecologists .Reading the medical literature: Applying the evidence to practice. Washington, DC; American College of Obstetricians and Gynecologists 1998
• 5 Chauhan S P, Magann E F, Scott J R, Scardo J A, Hendrix N W, Martin Jr J N. Emergency cesarean delivery for non-reassuring fetal heart rate tracings: compliance with ACOG guidelines.  J Reprod Med. 2003;  48 975-981