title: Trends in procedures for infertility and caesarean sections: was NICE disinvestment guidance implemented? NICE recommendation reminders.
abstract: BACKGROUND
  National Institute for Health and Clinical Excellence (NICE) clinical guidelines and subsequent NICE issued 'recommendation reminders' advocate discontinuing two fertility procedures and caesarean sections in women with hepatitis. We assess whether NICE guidance in 2004 and recommendation reminders were associated with a change in the rate of clinical procedures performed.
  
  
  METHODS
  Routine inpatient Hospital Episode Statistics (HES) data were extracted from the HES database for 1st April 1998 to 31st March 2010 using OPCS procedure codes for varicocele operations in infertile men, endometrial biopsies in infertile women and caesarean sections in women with hepatitis B or C. We used Joinpoint regression to identify points in time when the trend in procedure rates changed markedly, to identify any influence of the release of NICE guidance.
  
  
  RESULTS
  Between 1998-2010, planned caesarean sections in women with and without hepatitis B or C increased yearly (annual percentage change (APC) 4.9%, 95% CI 2.1% to 7.7%) in women with hepatitis, compared with women without (APC 4.0% [95% CI 2.7% to 5.3%] up to 2001, APC -0.6% [95% CI -2.8% to 1.8%] up to 2004 and 1.3% [95% CI 0.8% to 1.8%] up to 2010). In infertile women under 40 years of age, endometrial biopsies for investigation of infertility increased, APC 6.0% (95% CI 3.6% to 8.4%) up to 2003, APC 1.5% (95% CI -4.3% to 7.7%) to 2007 followed by APC 12.8% (95% CI 1.0% to 26.0%) to 2010. Varicocele procedures remained relatively static between 1998 and 2010 (APC -0.5%, 95% CI -2.3% to 1.3%).
  
  
  CONCLUSIONS
  There was no decline in use of the three studied procedures, contrary to NICE guidance, and no change in uptake associated with the timing of NICE guidance or recommendation reminders. 'Do not do' recommendation reminders may be ineffective at improving clinical practice or achieving disinvestment.
authors: School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK. charlotte.chamberlain@bristol.ac.uk
authors: Charlotte A
authors: CA
authors: Chamberlain
authors: Richard M
authors: RM
authors: Martin
authors: John
authors: J
authors: Busby
authors: Rebecca
authors: R
authors: Gilbert
authors: David J
authors: DJ
authors: Cahill
authors: William
authors: W
authors: Hollingworth
mesh_terms: D000047:Academies and Institutes; D000328:Adult; D001706:Biopsy / Q000706:statistics & numerical data; D002585:Cesarean Section / Q000706:statistics & numerical data* / Q000639:trends; D016208:Databases, Factual; D004717:Endometrium / Q000473:pathology; D005260:Female; D019983:Guideline Adherence / Q000458:organization & administration*; D006509:Hepatitis B / Q000150:complications; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D007247:Infertility, Female / Q000601:surgery*; D007248:Infertility, Male / Q000601:surgery*; D008297:Male; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D017010:Reminder Systems; D013222:State Medicine; D006113:United Kingdom; D014646:Varicocele / Q000601:surgery
references: Fertil Steril. 2004 Nov;82(5):1264-72
references: 15533340
references: J Public Health (Oxf). 2009 Dec;31(4):541-5
references: 19321518
references: BJU Int. 2007 Nov;100(5):1040-9
references: 17784890
references: Stat Med. 2000 Feb 15;19(3):335-51
references: 10649300
references: Worldviews Evid Based Nurs. 2004;1(3):198-9
references: 17163898
references: Int J Technol Assess Health Care. 2010 Jul;26(3):317-22
references: 20584361
references: Med J Aust. 2009 Mar 2;190(5):269-73
references: 19296794
references: Virol J. 2008 Aug 28;5:100
references: 18755018
references: Med Care. 2001 Aug;39(8 Suppl 2):II2-45
references: 11583120
references: Int J Technol Assess Health Care. 2009 Jul;25(3):262-71
references: 19619344
references: Eur Arch Otorhinolaryngol. 2012 Sep;269(9):2053-6
references: 22139468
references: Lancet. 2003 Oct 11;362(9391):1225-30
references: 14568747
references: Health Technol Assess. 2004 Feb;8(6):iii-iv, 1-72
references: 14960256
references: Br Dent J. 2012 Sep;213(5):E8
references: 22955790
references: BMJ. 2004 Oct 30;329(7473):999
references: 15514342