Physicians' prevention practices and incidence of neonatal group B streptococcal disease in 2 Canadian regions.
BACKGROUND
The impact of expert guidelines on the prevention of neonatal group B streptococcal (GBS) disease has not been studied in Canada. Our aim was to determine physician practices with regard to this condition before and after publication of Canadian guidelines and to monitor concurrent trends in the incidence of neonatal GBS disease.


METHODS
We used repeat cross-sectional surveys, distributed by mail to all family practitioners and obstetricians attending deliveries in Alberta and in the Metropolitan Toronto and Peel region, Ontario, in 1994, 1995 and 1997, to document prevention practices. Audits were conducted for a subset of respondents to confirm reported practices. Population-based surveillance involving all microbiology laboratories in both regions for 1995-1998 was used to document rates of neonatal disease.


RESULTS
The overall survey response rates were as follows: for 1994, 1128/1458 (77%); for 1995, 1054/1450 (73%); and for 1997, 1030/1421 (72%). During 1995 and 1997, significantly more obstetric care providers were screening at least 75% of pregnant women in their practices than had been the case in 1994 (747/916 [82%] and 693/812 [85%] v. 754/981 [77%]; p < 0.001). The percentage of obstetric care providers who reported practice that conformed completely with any of 3 consensus prevention strategies increased from 10% in 1994 to 29% in 1997 (p < 0.001). There was a concurrent overall significant decrease in incidence of neonatal GBS disease during the same period.


CONCLUSIONS
The adoption by Canadian obstetric care providers of neonatal GBS prevention practices recommended by expert groups was slow but improved significantly over time. These findings highlight the difficulties associated with achieving compliance with diverse and frequently changing recommendations. However, the associated incidence of neonatal GBS disease, which was low or declining, suggests that efforts to disseminate current GBS prevention guidelines have been moderately successful.
Department of Paediatrics, University of Calgary, Calgary, Alta. dele.davies@crhs-health.ab.ca
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Davies
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Adair
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Schuchat
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Low
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Sauve
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McGeer
D000416:Alberta / Q000453:epidemiology; D003430:Cross-Sectional Studies; D019317:Evidence-Based Medicine; D005194:Family Practice / Q000706:statistics & numerical data* / Q000639:trends; D019983:Guideline Adherence / Q000706:statistics & numerical data* / Q000639:trends; D019538:Health Care Surveys; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007255:Information Services; D008137:Longitudinal Studies; D008403:Mass Screening / Q000706:statistics & numerical data; D008485:Medical Audit; D009774:Obstetrics / Q000706:statistics & numerical data* / Q000639:trends; D009864:Ontario / Q000453:epidemiology; D011159:Population Surveillance; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data* / Q000639:trends; D012307:Risk Factors; D013290:Streptococcal Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control*; D013292:Streptococcus agalactiae; D011795:Surveys and Questionnaires