Comparing physician and administrator responses to cesarean section guidelines and actual practice.
BACKGROUND
A cross-sectional study was conducted in 1996 to determine to what extent hospitals have adopted guidelines to improve the appropriate use of cesarean section (C-section); discover attitudes of obstetricians toward C-section guidelines; and explore how physician attitudes toward guidelines interact with organizational features.


METHODS
The study consisted of two components: (1) Telephone interviews with hospital administrators from Michigan hospitals providing obstetric care (response rate: 100%); these interviews were intended to determine whether guidelines were in use and the processes for their development and implementation. (2) A self-administered mail survey assessing the attitudes of 266 Michigan obstetricians (response rate: 57%), intended to assess their attitudes toward the content and effects of C-section guidelines.


RESULTS
Twenty-nine percent of hospitals were using C-section guidelines, according to reports from hospital administrators. Mean C-section rates were not significantly different between hospitals using guidelines and those not using guidelines (23.2% and 22.4%, p = 0.49). More than 80% of physicians felt that the guidelines were supported by the literature and were applicable in daily practice, and agreed with their ideas about C-section performance, and 67% reported that guidelines would have no or minimal effect on their practice. However, only 55% of physicians and administrators agreed on the presence or absence of guidelines at their hospital (kappa = 0.09).


CONCLUSIONS
Physicians appear to agree with guidelines and believe they are already following them, despite high C-section rates. Physicians' attitudes toward guidelines are not necessarily a reflection of actual practice. If C-section guidelines are to decrease excessive C-section rates, stronger, more integrated implementation strategies are needed.
Sonnad
S S
SS
Department of Internal Medicine, University of Michigan Health System, Ann Arbor, USA. seema@umich.edu
Moyer
C A
CA
Bernstein
S J
SJ
D001291:Attitude of Health Personnel; D002585:Cesarean Section / Q000592:standards / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D003625:Data Collection; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008824:Michigan; D009774:Obstetrics; D016134:Organizational Policy; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy