UPTAKE OF META-ANALYTICAL OVERVIEWS OF EFFECTIVE CARE IN ENGLISH OBSTETRIC UNITS

Objective To establish the current availability of meta-analytical ove rviews of effective care in perinatal medicine, in the form of Effecti ve Care in Pregnancy and Childbirth and the Oxford Database of Perinat al Trials, in English obstetric units and to find out how obstetrician s without either one keep up to date. Design Standardised telephone qu estionnaire. Subjects The consultant obstetrician deemed to be the Roy al College of Obstetricians and Gynaecologists' administrative contact in each of the 24 teaching hospitals, and in 74 of 173 (43 %) distric t general hospitals in England. Main outcome measures Knowledge and us e of Effective Care and the Oxford Database in the obstetric unit. Res ults Thirty-seven percent of units did not have access to either Effec tive Care or the Oxford Database, with significant differences between district general hospitals and teaching hospitals in lack of availabi lity (33/74 (45 %) versus 3/24 (12 %) respectively, P = 0.02). Effecti ve Care was available in 51 % of district general hospitals and 79 % o f teaching hospitals, compared with the availability of the Oxford Dat abase which was only available in 16 % and 62 %, respectively. Reasons given for not obtaining either included non-awareness, expense, and p erceived lack of need. The consultants with neither Effective Care nor the Oxford Database claimed to keep up to date by various methods, us ually as information from colleagues. Conclusions These results reflec t both inefficient dissemination of medical knowledge in obstetrics an d the reluctance of obstetricians to consider adapting their practice as a result of evidence from meta-analyses of randomised controlled tr ials. Although Effective Care is more widely available than the Oxford Database, its datedness renders it inferior to the database as a mean s of facilitating effective care in obstetrics.