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Educating Medical Providers Can Change Practices and Improve Care, Study Shows
Posted: 05-01-2008 : RESEARCH TRIANGLE PARK, N.C.
RESEARCH TRIANGLE PARK, N.C. -- A study published in the May 1 issue of the New England Journal of Medicine shows that behavioral interventions for local medical opinion leaders can yield significant and sustained improvements in medical care.
The study included researchers from RTI International; the Institute of Clinical Effectiveness and Health Policy in Buenos Aires, Argentina; the School of Public Health and Tropical Medicine at Tulane University, Louisiana; the University of North Carolina at Chapel Hill; the World Health Organization; and the National Institutes of Health Eunice Kennedy Shriver Institute of Child Health and Human Development (NICHD).
Sponsored by the Global Network for Women's and Children's Health Research, a public-private partnership between the NICHD and the Bill and Melinda Gates Foundation, the study was conducted at 19 hospitals in Argentina and Uruguay.
RTI served as the data coordinating center, helping to create the data collection tools used in the study as well as assisting in collecting, managing and analyzing the data used in coordinating the study's conclusions.
"This study shows clearly that multifaceted behavioral interventions for medical staff can change medical practice and improve outcome for patients," said Tyler Hartwell, senior statistician at RTI and co-author of the study. "Many studies have shown that most episiotomies are not beneficial and that the use of oxytocin can reduce uterine bleeding."
Hartwell said the objective of the study was to change medical staff behavior in order to increase use of oxytocin to prevent postpartum hemorrhage and to reduce the number of episiotomies performed on women in labor.
As a result of the behavior intervention, oxytocin use increased from 2.1 percent to 83 percent, postpartum hemorrhage decreased by as much as 70 percent and episiotomies decreased from 41.1 percent to 29.9 percent at hospitals receiving the intervention.
To conduct the study, RTI researchers helped to create and coordinate the distribution of questionnaires to birth attendants in 10 public maternity hospitals in Argentina and Uruguay. The birth attendants were asked to identify "opinion leaders," at their hospitals -- physicians, midwives and residents that the other birth attendants at the hospitals looked to for professional guidance.
In all, three to six opinion leaders were selected from each of the intervention hospitals. They attended a five-day workshop on how to develop and implement clinical guidelines based on the best scientific evidence available on the management of the third stage of labor -- defined as the period after birth of the baby and before expulsion of the placenta -- and the use of episiotomy at delivery. The remaining nine hospitals were used as controls.
At the end of 18 months, RTI researchers helped compile data on a total of 2,963 vaginal births at the hospitals receiving the instruction, and 2,503 vaginal births in the control hospitals. They found that practices and outcomes at the hospitals participating in the interventions had changed, while practices at the control hospitals remained essentially unchanged.
"Importantly, the behavior changes continued long past the end of the intervention period," Hartwell says. The outcomes were measured both after the 18-month intervention and 12 months after the end of the intervention. After one year, oxytocin use remained high at the hospitals receiving the instruction (73.4 percent) and low in the control hospitals (7.1 percent). Similarly, after a year, the episiotomy rate at hospitals receiving the instruction was 28.1 percent and 45.1 percent in the control hospitals.
Because the change in oxytocin use was much larger than the change in episiotomy use, the researchers suggested that getting health professionals to adopt a new practice may be easier than getting them to eliminate an established practice.
RTI's data coordinating center activities include logistical data management and biostatistical support as well as consultation in the areas of study design.
For more information on the study, the full article is available on the New England Journal of Medicine Web site.
RTI News Media Contacts
Email: news@rti.org
Lisa Bistreich: 919-316-3596
Patrick Gibbons: 919-541-6136
About RTI International
RTI International is one of the world's leading research institutes, dedicated to improving the human condition by turning knowledge into practice. With projects in more than 40 countries and a staff of more than 2,600, RTI offers innovative research and technical solutions to governments and businesses worldwide in the areas of health and pharmaceuticals, education and training, surveys and statistics, advanced technology, democratic governance, economic and social development, energy, and the environment. For more information, visit www.rti.org.
RTI Newsroom
View archived news releases or download related images from the RTI Newsroom. News media and others interested in additional information about this or any topic concerning RTI International should contact the Office of Communications at (919) 316-3596 or news@rti.org.
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