Programme no. 123-OP
New evidence and change of practice – a successful(?) implementation process
Ole Olsen*1, Anja Stæhr2
1The Research Unit for General Practice,University of Copenhagen,Copenhagen,Denmark, 2General practice “Bjørch & Sinkjær",Region Sjælland,Holbæk,Denmark
* = Presenting author
Objectives: To investigate whether well-informed Danish general practitioners are prepared to inform low risk pregnant women about the possibility of planning a home birth and to explore issues important for their decision making.
Background: Observational studies of increasingly better quality suggest that planned home birth can be as safe as planned hospital birth, with less intervention, fewer complications, and better breast feeding. In Denmark home birth is an option within the public health care system, but very few general practitioners tell their pregnant women about this option.
Results: Six and a half of the seven GPs were willing to hand out the leaflet and keep a simple log book of the process. The study is on-going. Several issues important in the decision making process have been identified by the first presenter but await the collaborative negotiations with the second presenter before presentation. The results from the analysis will be presented at the conference.
Material/Methods: Audio-recorded semi-structured dialogues with a purposive sample of seven (or more) general practitioners in greater Copenhagen. During the dialogues ample time was deliberately kept open for participants to speak about their thoughts while, at first, a condensed but flexible version of the evidence in the updated Cochrane review on home birth was presented; second, the general project plan to invite GPs to hand out the leaflet about home birth from the local hospital or health authority to their pregnant women was presented and the leaflet shown. The involved GPs were not pressed for a decision as to whether they would personally participate in the project. The audio-recorded dialogues lasted 10-50 minutes, were transcribed, and analysed by Systematic Text Condensation inspired by Giorgi's approach, searching for issues describing themes of importance in the participants' decision making. The analysis was conducted as collaborative negotiations between the two presenters. Number of GPs that accepted to hand out the leaflet was counted.
Conclusion: Well-informed general practitioners are prepared to inform low risk pregnant women about the evidence and the possibility of planning a home birth. In addition to the stronger evidence ample time for dialogue was needed in order to make a difference in clinical practice.
Points for discussion:
1. Any comments on the issues brought up by the GPs?
2. How could (and should?) the dissemination and implementation process be speeded up?