Article type
Year
Abstract
Introduction/Objective: In 1993, 69% of breech presentations in the UK were delivered by caesarean section (CS) (RCOG Annual Statistical Return 1993). External cephalic version (ECV) reduces the incidence of breech presentation at term, and thus that of CS.
Methods: 20 hospitals with obstetric units providing a consultant led service in the West Midlands RHA were included. These were randomised into pairs of control and intervention units. A 'lead' consultant was identified in each unit, and those in the intervention group were exposed to a multifaceted intervention comprising a group seminar, written materials and videos. It was anticipated that the lead consultant would use the information and resources provided to encourage their colleagues to offer ECV.
Results: No significant differences were found between the two groups with respect to attitude to the study as a whole and to ECV in particular. The intervention package positively influenced the attitude of the individual consultants in the intervention group towards ECV. It was considered to be of value and had been used as a resource. However, there were no significant changes in unit policy (creating guidelines/a verbally agreed policy/changes in actual clinical practice).
Discussion: Changing clinical practice by implementing evidence-based medicine is a complex event. This study has demonstrated that the use of a multifaceted intervention package is successful in influencing the opinions of individual 'lead' consultants, but this effect may not be translated into meaningful changes in clinical practice throughout.
Methods: 20 hospitals with obstetric units providing a consultant led service in the West Midlands RHA were included. These were randomised into pairs of control and intervention units. A 'lead' consultant was identified in each unit, and those in the intervention group were exposed to a multifaceted intervention comprising a group seminar, written materials and videos. It was anticipated that the lead consultant would use the information and resources provided to encourage their colleagues to offer ECV.
Results: No significant differences were found between the two groups with respect to attitude to the study as a whole and to ECV in particular. The intervention package positively influenced the attitude of the individual consultants in the intervention group towards ECV. It was considered to be of value and had been used as a resource. However, there were no significant changes in unit policy (creating guidelines/a verbally agreed policy/changes in actual clinical practice).
Discussion: Changing clinical practice by implementing evidence-based medicine is a complex event. This study has demonstrated that the use of a multifaceted intervention package is successful in influencing the opinions of individual 'lead' consultants, but this effect may not be translated into meaningful changes in clinical practice throughout.