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UBC Theses and Dissertations

Evaluation of perinatal clinical practice guidelines in British Columbia Sawchuck, Diane J.


The purpose of this study was to evaluate processes and outcomes of the perinatal guideline program at the British Columbia Reproductive Care Program (BCRCP). The study was conducted in two parts to determine the level of awareness and utilization of perinatal guidelines in British Columbia and to examine population outcomes between April l, 2000, and March 31, 2003, related to specific guidelines. In the first part, a survey was developed and distributed by mail to a random sample of hospital and community health nurses, and a convenience sample of managers, registered midwives, and physicians providing perinatal care in British Columbia. The degree to which care providers were aware of perinatal guidelines and used them in their practice, and the extent to which policies and mechanisms related to supporting the implementation of these guidelines within organizations was examined. In addition, the facilitators and barriers to guideline implementation at both the individual and the organizational level were examined, and predictors of guideline use were explored. The second part of this research project consisted of a retrospective cohort study using maternal and fetal/newborn [i.e. foetal/newborn] outcome indicators derived from the BCRCP Perinatal Database Registry for the period between April 1, 2000 and March 31, 2003. Specific maternal and fetal/newborn outcome indicators were examined for five guidelines including (1) Vaginal Birth after Previous Caesarean Birth, (2) Postterm Pregnancy (3) Induction of Labour, (4) Fetal Health Surveillance in Labour, and (5) Delivery of Singleton Term Breech. This study examined perinatal outcomes that would be expected if clinical practitioners were following the guideline, and did not measure significant relationships between guideline use and population outcomes. Results were compiled from 313 of the 1,206 surveys circulated (response rate 26%) and indicated a very high level of awareness of the guidelines (92% of respondents) and supportive, positive attitudes towards the current guideline program. Over 50% of the respondents indicated that they used the guidelines at least every 3 months, and use varied between professional groups and between guideline topic areas. Three significant predictors of guideline use emerged: guidelines being readily available (OR, 7.8; 95% CI, 2.9-21.1), an eagerness for the uptake of new information (OR, 3.2; 95% CI, 1.8-5.7), and time to read guidelines (OR, 1.9; 95% CI, 1.1-3.5). Recommendations from respondents to improve utilization of perinatal guidelines included making guidelines more readily accessible, making the guideline binder more user-friendly, and facilitating guideline awareness and use among the physician group. The majority (85%) of facilities where respondents worked had aligned their facility policies and procedures with guideline content. However, facilities with <500 births/year had a greater probability of not adopting guidelines into their facility policies and procedures (RR, 2.4; 95% CI, 1.25-4.73) and were more likely to not have guidelines readily available, compared to facilities with >500 births/year (RR, 2.7; 95% CI, 1.07-4.47). The findings for two guidelines: Fetal Health Surveillance in Labour and Delivery of Singleton Term Breech suggested outcomes as would be expected with appropriate guideline use. For the guidelines Vaginal Birth after Previous Caesarean Birth, Postterm Pregnancy, and Induction of Labour, the maternal-newborn findings were not in the direction suggested with appropriate guideline use. The findings emphasize the need for guidelines to contain clear outcome objectives and baseline measures so that they may be effectively utilized in evaluating population health outcomes.

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