2002 Publications

Repke J.T., Power M.L., Holzman G.B., Schulkin J. Hypertension in pregnancy and preeclampsia. Knowledge and clinical practice among obstetrician-gynecologists. Journal of Reproductive Medicine. 47(6):472-6, 2002 Jun.

Objective: To examine the knowledge and practice patterns of obstetrician-gynecologists concerning management of hypertensive disorders of pregnancy. Study Design: Surveys were mailed to 1,116 fellows of the American College of Obstetrics and Gynecology; 416 of them constituted the Collaborative Ambulatory Research Network. Seven hundred more were chosen at random. The survey contained questions on physician and patient demography and on knowledge and practice patterns concerning management of various hypertensive disorders during pregnancy. Results: A total of 401 completed surveys were analyzed. There was no difference between respondents and nonrespondents in either sex ratio (P = .410) or age (46.9 +/- 0.4 versus 48.1 +/- 0.4 years, P = .131). Most respondents (84.5%) would manage mild preeclampsia on an outpatient basis, and most (58.6%) usually managed preeclampsia independently. There was considerable variation in clinical practice. For example, about one of four respondents (27.4%) do not use seizure prophylaxis during labor in mild preeclampsia. Among physicians who do utilize magnesium sulfate for seizure prophylaxis, the mean standard loading dose was 4.5 +/- .1 g intravenously. More than half the respondents (54.9%) would employ preeclampsia prevention procedures. Most respondents (74.6%) said that there is a role for management of severe preeclampsia remote from term. Intrauterine growth restriction would be used as an indication for immediate delivery by 60.6% of respondents; female physicians were more likely to use intrauterine growth retardation as an indication for immediate delivery (chi 2 = 5.7, P = .017).

Troccoli K., Pollard H.3rd., McMahon M., Foust E., Erickson K., Schulkin J. Human immunodeficiency virus counseling and testing practices among North Carolina providers. Obstetrics & Gynecology. 100(3):420-7, 2002 Sep.

Objective: To estimate the percentage of prenatal care providers who offer human immunodeficiency virus (HIV) testing to pregnant women, investigate how strongly testing is encouraged, and explore testing barriers. Methods: Between January 2001 and March 2001, we sent surveys to 1381 prenatal care providers in North Carolina, comprised of obstetricians, family physicians who practice obstetrics, and nurse-midwives. A total of 653 questionnaires were returned. Results: Overall, 95.5% of providers who responded reported recommending HIV testing to all pregnant patients. Only 69.2% strongly recommend testing, with obstetricians (73.4%) and family physicians (70.1%) doing so at higher rates than nurse-midwives (55.9%). Almost all respondents (96.9%) strongly recommend testing for women they perceive to be high risk, whereas 39.7% strongly recommend testing to women who have had an HIV test in the past 6 months. When women refuse testing, 48.1% of practitioners inquire about the reason, and 28.2% reoffer the test at a future prenatal appointment. The most significant testing barriers were treating an HIV-positive woman (18.4%) and informing a patient she is HIV positive (14.8%). Respondents report that low literacy and culturally appropriate patient education materials would be most helpful to them. Conclusion: Among respondents, most prenatal care providers report that they recommend HIV testing to all pregnant women. However, many respondents base their decision about how strongly to recommend HIV testing on an assessment of the woman's risk for HIV exposure. Significant barriers to offering HIV testing were associated with managing an HIV-positive patient. Providers were most in need of patient education materials.

Farquhar C.M., Kofa E., Power M.L., Zinberg S., Schulkin J. Clinical practice guidelines as educational tools for obstetrician-gynecologists. Journal of Reproductive Medicine. 47(11):897-902, 2002 Nov.

Objective: To examine the awareness of and attitudes toward clinical practice guidelines (CPGs) produced by the American College of Obstetricians and Gynecologists (ACOG) among its fellows and to identify factors that would enhance the perceived value of the CPGs. Study Design: A questionnaire survey on clinical practice guidelines sent to 1,000 practicing fellows of ACOG. Results: Four hundred sixty-two fellows (46.2%) responded. Virtually all (98%) were aware of ACOG CPGs; 61% stated that an ACOG CPG had changed their practice. Far fewer (6-56%) were aware of CPGs from other organizations; 71.9% were aware of all eight ACOG CPGs that were added in 2000 (range, 83.3-90%). Important factors that would enhance the value of CPGs to the respondents were CPGs that were up to date, had demonstrated improved outcomes, were evidence based and were produced by ACOG. Barriers to use were CPGs without summaries, CPGs not specific to the fellows' settings, CPGs not taking patient cost into account and patient requests for different procedures. Conclusion: The widespread awareness by ACOG fellows of CPGs produced by ACOG demonstrates the potential importance of specialty societies in disseminating CPGs. The data suggest that important characteristics of CPGs are being up to date, being evidence based, containing a summary and providing patient education materials.