Abstract
OBJECTIVE--To formulate consensus based guidelines for antenatal care in a health district. DESIGN--Prospective formulation of draft guidelines by a working group of consultant obstetricians and general practitioners with an obstetric interest, canvassing opinions of all GPs in the district by questionnaire, and revision and final circulation of the guidelines. SETTING--One health district. SUBJECTS--All 160 GPs in the district and members of the working party. MAIN MEASURES--Questionnaire responses to specific proposals within the draft guidelines for managing anaemia, antepartum haemorrhage, and hypertension. RESULTS--136 GPs responded (response rate 85%); responders and nonresponders did not differ in age, sex, or presence on obstetric list. Overall they favoured more conservative management than suggested in the guidelines. For example, only 38% (44/116) prescribed iron routinely and 34% (38/113) referred to hospital for haemoglobin concentration of < or = 10 g/l; 10% referred women unnecessarily for oedema unassociated with proteinuria; and 20% managed active bleeding progressing to old brown staining as an urgent admission. The guidelines were revised according to the relative weight of the views obtained. CONCLUSION--Establishing guidelines is mainly a political process. Canvassed views influenced guidelines most when internal disagreement existed within the working party. IMPLICATIONS AND ACTION--Regular revising of the guidelines is planned, which, in conjunction with repeating the questionnaire to monitor changing practice, will allow a long term district wide clinical review.
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Selected References
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- Armstrong D., Griffin G. A. Patterns of work in general practice in the Bromley health district. J R Coll Gen Pract. 1987 Jun;37(299):264–266. [PMC free article] [PubMed] [Google Scholar]
- Eddy D. M. Clinical decision making: from theory to practice. Designing a practice policy. Standards, guidelines, and options. JAMA. 1990 Jun 13;263(22):3077–3084. doi: 10.1001/jama.263.22.3077. [DOI] [PubMed] [Google Scholar]
- Fink A., Kosecoff J., Chassin M., Brook R. H. Consensus methods: characteristics and guidelines for use. Am J Public Health. 1984 Sep;74(9):979–983. doi: 10.2105/ajph.74.9.979. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Grol R. National standard setting for quality of care in general practice: attitudes of general practitioners and response to a set of standards. Br J Gen Pract. 1990 Sep;40(338):361–364. [PMC free article] [PubMed] [Google Scholar]
- Kosecoff J., Kanouse D. E., Rogers W. H., McCloskey L., Winslow C. M., Brook R. H. Effects of the National Institutes of Health Consensus Development Program on physician practice. JAMA. 1987 Nov 20;258(19):2708–2713. [PubMed] [Google Scholar]
- Scott E. A., Black N. When does consensus exist in expert panels? J Public Health Med. 1991 Feb;13(1):35–39. doi: 10.1093/oxfordjournals.pubmed.a042575. [DOI] [PubMed] [Google Scholar]