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Updated: May 13, 2026
A Murine Model of Group B Streptococcus Vaginal Colonization
Published on: November 16, 2016
Academic detailing and adherence to guidelines for Group B streptococci prenatal screening: a randomized controlled
Jussara M Silva1, Airton T Stein, Holger J Schünemann
1Department of Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil. jussaramunareto@gmail.com
Insights
Academic detailing significantly increased Group B Streptococcus (GBS) screening rates among pregnant women compared to direct mail or no intervention. This intervention is key for improving adherence to GBS screening guidelines.
Area of Science:
- Obstetrics and Gynecology
- Infectious Disease Prevention
- Healthcare Quality Improvement
Background:
- Clinical practice guidelines advocate universal prenatal screening for Group B Streptococcus (GBS).
- Early onset neonatal GBS infection is preventable with intrapartum antibiotic prophylaxis.
- Physician adherence to GBS screening guidelines requires effective interventions.
Purpose of the Study:
- To evaluate the effectiveness of academic detailing (AD) for obstetricians in promoting GBS screening.
- To compare AD with direct mail (DM) and no intervention (control) on GBS screening rates.
Main Methods:
- A randomized controlled trial involving 241 obstetricians in Porto Alegre, Brazil.
- Obstetricians were randomized into direct mail, academic detailing, and control groups.
- GBS screening data were collected for 3 months pre- and post-intervention via a private health insurance database.
Main Results:
- The AD group showed a higher proportion of pregnant women screened for GBS (25.4%) compared to DM (15.9%) and control (17.7%) groups (P=0.023).
- Analysis of vaginal deliveries revealed significantly higher screening in the AD group (75%) versus DM (41.9%) and control (30.4%) groups (P<0.001).
Conclusions:
- Academic detailing effectively increased the prevalence of GBS screening among pregnant women in the studied population.
- AD represents a successful strategy for enhancing adherence to GBS screening protocols.
Background:
Clinical practice guidelines (CPGs) recommend universal prenatal screening for Group B Streptococcus (GBS) to identify candidates for intrapartum antibiotic prophylaxis to prevent early onset neonatal GBS infection. Interventions to promote physician adherence to these guidelines are imperative. This study examined the effectiveness of academic detailing (AD) of obstetricians, compared with CPG mailshot and no intervention, on the screening of pregnant women for GBS.
Methods:
A randomized controlled clinical trial was conducted in the medical cooperative of Porto Alegre, Brazil. All obstetricians who assisted in a delivery covered by private health insurance managed by the cooperative in the 3 months preceding the study (n = 241) were invited to participate. The obstetricians were randomized to three groups: direct mail (DM, n = 76), AD (n = 76) and control (C, n = 89, no intervention). Those in the DM group were sent guidelines on GBS. The AD group received the guidelines and an educational visit detailing the guidelines, which was conducted by a trained physician. Data on obstetrician age, gender, time since graduation, whether patients received GBS screening during pregnancy, and obstetricians who requested screening were collected for all participant obstetricians for 3 months before and after the intervention, using database from the private health insurance information system.
Results:
Three months post-intervention, the data showed that the proportion of pregnant women screened for GBS was higher in the AD group (25.4%) than in the DM (15.9%) and C (17.7%) groups (P = 0.023). Similar results emerged when the three groups were taken as a cluster (pregnant women and their obstetricians), but the difference was not statistically significant (Poisson regression, P = 0.108). Additionally, when vaginal deliveries were analyzed separately, the proportion screened was higher in the AD group (75%) than in the DM group (41.9%) and the C group (30.4%) (chi-square, P < 0.001).
Conclusions:
The results suggest that AD increased the prevalence of GBS screening in pregnant women in this population.
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