Prevention of neonatal group B streptococcal infection: approaches of physicians in Winnipeg, Man.
OBJECTIVE
To determine how family physicians in Winnipeg, Man, approach prevention of neonatal group B streptococcal (GBS) infection, what influences their decisions, and whether their decisions differ from those of local obstetricians.


METHODS
Population-based survey.


METHODS
Family physicians' and obstetricians' practices in Winnipeg.


METHODS
Eighty-five physicians and residents with hospital labour floor privileges.


METHODS
Individual approaches to prevention of neonatal GBS infection, factors influencing choice of approach, and perceptions of neonatal GBS disease and universal prenatal GBS screening.


RESULTS
About 66% of family physicians and their residents followed the Society of Obstetricians and Gynaecologists of Canada's (SOGC) guidelines for universal GBS screening and intrapartum antibiotic prophylaxis of all GBS carriers. This was significantly fewer than the 87% of obstetricians who followed these guidelines (P = .026). Obstetricians were more likely than family physicians to cite the literature as influencing their approach to neonatal GBS prevention (P < .001). Family physicians were more likely to cite the influence of peers and colleagues (P = .04). The incidence of neonatal GBS and its associated mortality were overestimated by 61% and 55% of obstetricians, and 66% and 57% of family physicians, respectively. Despite concerns about the risks and costs of universal GBS screening and intrapartum antibiotic prophylaxis, 92% of obstetricians and 79% of family physicians thought that the benefits of universal screening outweighed the concerns. About 24% of obstetricians and 30% of family physicians were theoretically willing to expose more than 10,000 women to intrapartum prophylactic antibiotics to prevent a single neonatal GBS-related death.


CONCLUSIONS
Family physicians were less likely than obstetricians to follow current SOGC guidelines for prevention of neonatal GBS disease. This could reflect a different perspective on patient care. Family physicians want patients to be involved in screening decisions based on full disclosure of potential harm and benefit.
Konrad
Gerald
G
Department of Family Medicine, University of Manitoba, Winnipeg. gkonrad@sbgh.mb.ca
Hauch
Susan
S
Pylypjuk
Christy
C
D019072:Antibiotic Prophylaxis; D001291:Attitude of Health Personnel; D002353:Carrier State / Q000453:epidemiology / Q000517:prevention & control*; D015331:Cohort Studies; D005194:Family Practice / Q000379:methods; D005260:Female; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D017053:Infection Control; D008297:Male; D008350:Manitoba / Q000453:epidemiology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control*; D011295:Prenatal Care / Q000379:methods; D018570:Risk Assessment; D013290:Streptococcal Infections / Q000453:epidemiology / Q000517:prevention & control*; D013292:Streptococcus agalactiae / Q000187:drug effects / Q000302:isolation & purification*