Davies H D, Adair C E, Schuchat A, Low D E, Sauve R S, McGeer A
Department of Paediatrics, University of Calgary, Calgary, Alta.
CMAJ. 2001 Feb 20;164(4):479-85.
The impact of expert guidelines on the prevention of neonatal group B streptococcal (GBS) disease has not been studied in Canada. Our aim was to determine physician practices with regard to this condition before and after publication of Canadian guidelines and to monitor concurrent trends in the incidence of neonatal GBS disease.
We used repeat cross-sectional surveys, distributed by mail to all family practitioners and obstetricians attending deliveries in Alberta and in the Metropolitan Toronto and Peel region, Ontario, in 1994, 1995 and 1997, to document prevention practices. Audits were conducted for a subset of respondents to confirm reported practices. Population-based surveillance involving all microbiology laboratories in both regions for 1995-1998 was used to document rates of neonatal disease.
The overall survey response rates were as follows: for 1994, 1128/1458 (77%); for 1995, 1054/1450 (73%); and for 1997, 1030/1421 (72%). During 1995 and 1997, significantly more obstetric care providers were screening at least 75% of pregnant women in their practices than had been the case in 1994 (747/916 [82%] and 693/812 [85%] v. 754/981 [77%]; p < 0.001). The percentage of obstetric care providers who reported practice that conformed completely with any of 3 consensus prevention strategies increased from 10% in 1994 to 29% in 1997 (p < 0.001). There was a concurrent overall significant decrease in incidence of neonatal GBS disease during the same period.
The adoption by Canadian obstetric care providers of neonatal GBS prevention practices recommended by expert groups was slow but improved significantly over time. These findings highlight the difficulties associated with achieving compliance with diverse and frequently changing recommendations. However, the associated incidence of neonatal GBS disease, which was low or declining, suggests that efforts to disseminate current GBS prevention guidelines have been moderately successful.
在加拿大，尚未对专家指南在预防新生儿B族链球菌（GBS）疾病方面的影响进行研究。我们的目的是确定在加拿大指南发布之前和之后医生针对这种情况的做法，并监测新生儿GBS疾病发病率的同期趋势。
我们采用重复横断面调查，于1994年、1995年和1997年通过邮件分发给在艾伯塔省以及安大略省大多伦多地区和皮尔地区接生的所有家庭医生和产科医生，以记录预防措施。对一部分受访者进行审核，以确认所报告的措施。利用1995 - 1998年对两个地区所有微生物实验室进行的基于人群的监测来记录新生儿疾病的发生率。
总体调查回复率如下：1994年为1128/1458（77%）；1995年为1054/1450（73%）；1997年为1030/1421（72%）。在1995年和1997年期间，与1994年相比，显著更多的产科护理提供者在其诊疗过程中对至少75%的孕妇进行了筛查（747/916 [82%]和693/812 [85%]对754/981 [77%]；p < 0.001）。报告的做法完全符合3种共识预防策略中任何一种的产科护理提供者的比例从1994年的10%增加到了1997年的29%（p < 0.001）。同期新生儿GBS疾病的发病率总体上显著下降。
加拿大产科护理提供者采用专家组推荐的新生儿GBS预防措施的速度较慢，但随着时间的推移有显著改善。这些发现凸显了在遵守多样且频繁变化的建议方面存在的困难。然而，新生儿GBS疾病的相关发病率较低或呈下降趋势，这表明传播当前GBS预防指南的努力取得了一定程度的成功。
