Academic detailing and adherence to guidelines for Group B streptococci prenatal screening: a randomized controlled trial.

BACKGROUND: Clinical practice guidelines (CPGs) recommend universal prenatal screening for Group B Streptococcus (GBS) to identify candidates for intrapartum antibiotic prophylaxis to prevent early onset neonatal GBS infection. Interventions to promote physician adherence to these guidelines are imperative. This study examined the effectiveness of academic detailing (AD) of obstetricians, compared with CPG mailshot and no intervention, on the screening of pregnant women for GBS. METHODS: A randomized controlled clinical trial was conducted in the medical cooperative of Porto Alegre, Brazil. All obstetricians who assisted in a delivery covered by private health insurance managed by the cooperative in the 3 months preceding the study (n = 241) were invited to participate. The obstetricians were randomized to three groups: direct mail (DM, n = 76), AD (n = 76) and control (C, n = 89, no intervention). Those in the DM group were sent guidelines on GBS. The AD group received the guidelines and an educational visit detailing the guidelines, which was conducted by a trained physician. Data on obstetrician age, gender, time since graduation, whether patients received GBS screening during pregnancy, and obstetricians who requested screening were collected for all participant obstetricians for 3 months before and after the intervention, using database from the private health insurance information system. RESULTS: Three months post-intervention, the data showed that the proportion of pregnant women screened for GBS was higher in the AD group (25.4%) than in the DM (15.9%) and C (17.7%) groups (P = 0.023). Similar results emerged when the three groups were taken as a cluster (pregnant women and their obstetricians), but the difference was not statistically significant (Poisson regression, P = 0.108). Additionally, when vaginal deliveries were analyzed separately, the proportion screened was higher in the AD group (75%) than in the DM group (41.9%) and the C group (30.4%) (chi-square, P < 0.001). CONCLUSIONS: The results suggest that AD increased the prevalence of GBS screening in pregnant women in this population.

Development and preliminary validation of a measure for assessing staff perspectives on the quality of clinical group supervision.

BACKGROUND: In the UK clinical supervision is regarded as an essential process supporting quality improvement within the clinical governance framework, and the Royal College of Speech and Language Therapists regards it as a tool for promoting critical reflective practice. There is limited evidence of the impact on practice or improvements in healthcare quality, and the need for an evaluation instrument specifically tailored to group supervision. AIMS: To develop a measure for assessing staff perspectives on the quality of clinical group supervision and its impact on the quality of care. METHODS & PROCEDURES: A self-completion questionnaire was devised to measure staff perceptions of purpose, process and impact of clinical group supervision. Items were developed through an inductive process of consultation, peer and literature review. The questionnaire's content validity was assessed. The questionnaire was then administered to 57 subjects who had received approximately 1 year of clinical supervision to evaluate acceptability, factor structure and convergent validity. OUTCOMES & RESULTS: Response rates were 91% (52/57). Principal component factor analysis suggested a three-factor structure, the first three factors accounting for 72.4% of the total variance. Items loaded appropriately onto purpose, process and impact. These three dimensions were positively and moderately correlated. Internal consistency reliability (Cronbach's alpha = 0.86) indicated that the 14 items could be regarded as a scale. The overall CSEQ score was positively correlated with a single question assessing 'general opinion' about the CS program (Spearman's rho = 0.79, p < 0.001) giving evidence for convergent validity. CONCLUSIONS: The questionnaire is concise, easy to complete and simple to analyse, and appears to be a reliable and valid measure of staff perceptions of quality of clinical group supervision. Further studies with larger sample sizes and including other groups of health professionals are needed to confirm the validity and reliability of the CSEQ.

Effects of the home environment on unintentional domestic injuries and related health care attendance in infants.

AIMS: To examine the effects of the home environment on unintentional domestic injuries and related health care attendance in infants from deprived families. METHODS: Ten mechanisms that caused unintentional domestic injury during the first year were investigated in a population-based study of 1-year-old children in southern Brazil. Odds ratios of injury-related health care attendance were estimated by number of injury mechanisms reported. Variation in number of mechanisms (in the whole sample) and odds ratios of care attendance (in children with reported injuries) were estimated for socioeconomic and psychosocial variables. RESULTS: Among all children (394) 86% had injuries; 10.9% care attendance and 0.5% hospitalisation were reported, and 14.5% presented dental trauma. Injury-related care attendance increased with the number of injury mechanisms (linear trend OR = 1.34, 95% CI = 1.09-1.66). In multivariable linear regression, injury mechanisms increased with the number of home hazards (p = 0.047) and decreased with duration of exclusive breastfeeding (p = 0.039), maternal involvement-responsiveness (p = 0.037) and mother's paid work (p = 0.018). Injury-related health care attendance among children with reported injuries was positively associated with maternal involvement-responsiveness (OR = 2.27, 95% CI = 1.11-4.67) and home organization (OR = 2.25, 95% CI = 1.09-4.65). CONCLUSION: Injury control can benefit from policy and practice that improve housing, reduce home hazards and promote breastfeeding, maternal bonds, safety practices and injury care.

Social inequalities in maternal opinion of child development in southern Brazil.

AIMS AND METHODS: Concurrent validity of maternal opinion of child development was estimated in a cross-sectional, population-based survey of 6-59-mo children (n=3025), using a standard measure devised from the Denver Developmental Screening Test. RESULTS: Sensitivity, specificity and negative predictive value increased with maternal education and family income. Positive predictive value was higher in low-income families and children with impairments, low birthweight and long hospital stays. CONCLUSION: Children at social and clinical risk should be assessed more carefully, even if maternal report is normal or advanced.