April 30, 2008 / 9:01 PM / 12 years ago

Peer pressure brings docs up to speed: study

BOSTON (Reuters) - Is your doctor’s practice on the cutting edge of medicine? If not, maybe he or she needs a little peer pressure.

File photo shows a zoomed image of two surgeons performing an operation to implant an artificial heart valve in the operating room of a Berlin hospital August 15, 2003. REUTERS/Fabrizio Bensch

A study at 19 maternity hospitals in Argentina and Uruguay has concluded that many doctors will continue to practice outdated medicine unless they get an aggressive push from their colleagues to embrace the best-available research on delivering babies.

The study, in the New England Journal of Medicine, looked at a persistent problem in medicine — how to get busy doctors to change when the evidence suggests that the old ways may not be the best.

The team, led by Fernando Althabe of the Institute of Clinical Effectiveness and Health Policy in Buenos Aires, examined how quickly obstetricians would stop using episiotomies to widen the vaginal opening for birth and embrace the preventive use of oxytocin-like drugs to help with contractions, both of which, they said, reduce the risk of complications.

Health care workers in nine of the hospitals received seminars discouraging episiotomies and encouraging oxytocin use. Oxytocin can spur on contractions, while studies have shown episiotomies, although popular among doctors, are unnecessary and often cause more harm than good.

After one year, the episiotomy rate was virtually unchanged at about 44 percent and the rate of giving prophylactic oxytocin rose from 2.6 percent at the start of the study to 12.3 percent.

But at 10 other hospitals, where teams of opinion leaders — including doctors, doctors in training and midwives — were actively trained in the guidelines and in techniques to spread the word about them, the rates changed significantly.

After one year, the use of oxytocin skyrocketed from 2.1 percent at the start of the study to 83.6 percent by the end. The episiotomy rates dropped from 41.1 percent down to 29.9 percent.

“This randomized trial, conducted in Latin America, showed that a behavioral intervention can change health care practice,” Althabe and his colleagues concluded.

The group estimated that for every 1,000 vaginal deliveries, the active interventions prevented 13 severe hemorrhages, 100 mild hemorrhages and 109 unnecessary episiotomies.

The fact that drug use increased dramatically but the number of episiotomies did not decline as substantially suggests that getting doctors to adopt a new practice might be easier than eliminating a common, although often-unnecessary, practice, they said.

Editing by Maggie Fox

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