Implementation of client versus care-provider strategies to improve external cephalic version rates: a cluster randomized controlled trial

Objective To determine the effectiveness of a client or care‐provider strategy to improve the implementation of external cephalic version. Design Cluster randomized controlled trial. Setting Twenty‐five clusters; hospitals and their referring midwifery practices randomly selected in the Netherlands....

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Veröffentlicht in:Acta obstetricia et gynecologica Scandinavica 2015-05, Vol.94 (5), p.518-526
Hauptverfasser: Vlemmix, Floortje, Rosman, Ageeth N., Rijnders, Marlies E., Beuckens, Antje, Opmeer, Brent C., Mol, Ben W.J., Kok, Marjolein, Fleuren, Margot A.H.
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container_end_page 526
container_issue 5
container_start_page 518
container_title Acta obstetricia et gynecologica Scandinavica
container_volume 94
creator Vlemmix, Floortje
Rosman, Ageeth N.
Rijnders, Marlies E.
Beuckens, Antje
Opmeer, Brent C.
Mol, Ben W.J.
Kok, Marjolein
Fleuren, Margot A.H.
description Objective To determine the effectiveness of a client or care‐provider strategy to improve the implementation of external cephalic version. Design Cluster randomized controlled trial. Setting Twenty‐five clusters; hospitals and their referring midwifery practices randomly selected in the Netherlands. Population Singleton breech presentation from 32 weeks of gestation onwards. Methods We randomized clusters to a client strategy (written information leaflets and decision aid), a care‐provider strategy (1‐day counseling course focused on knowledge and counseling skills), a combined client and care‐provider strategy and care‐as‐usual strategy. We performed an intention‐to‐treat analysis. Main outcome measures Rate of external cephalic version in various strategies. Secondary outcomes were the percentage of women counseled and opting for a version attempt. Results The overall implementation rate of external cephalic version was 72% (1169 of 1613 eligible clients) with a range between clusters of 8–95%. Neither the client strategy (OR 0.8, 95% CI 0.4–1.5) nor the care‐provider strategy (OR 1.2, 95% CI 0.6–2.3) showed significant improvements. Results were comparable when we limited the analysis to those women who were actually offered intervention (OR 0.6, 95% CI 0.3–1.4 and OR 2.0, 95% CI 0.7–4.5). Conclusions Neither a client nor a care‐provider strategy improved the external cephalic version implementation rate for breech presentation, neither with regard to the number of version attempts offered nor the number of women accepting the procedure.
doi_str_mv 10.1111/aogs.12609
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Design Cluster randomized controlled trial. Setting Twenty‐five clusters; hospitals and their referring midwifery practices randomly selected in the Netherlands. Population Singleton breech presentation from 32 weeks of gestation onwards. Methods We randomized clusters to a client strategy (written information leaflets and decision aid), a care‐provider strategy (1‐day counseling course focused on knowledge and counseling skills), a combined client and care‐provider strategy and care‐as‐usual strategy. We performed an intention‐to‐treat analysis. Main outcome measures Rate of external cephalic version in various strategies. Secondary outcomes were the percentage of women counseled and opting for a version attempt. Results The overall implementation rate of external cephalic version was 72% (1169 of 1613 eligible clients) with a range between clusters of 8–95%. Neither the client strategy (OR 0.8, 95% CI 0.4–1.5) nor the care‐provider strategy (OR 1.2, 95% CI 0.6–2.3) showed significant improvements. Results were comparable when we limited the analysis to those women who were actually offered intervention (OR 0.6, 95% CI 0.3–1.4 and OR 2.0, 95% CI 0.7–4.5). Conclusions Neither a client nor a care‐provider strategy improved the external cephalic version implementation rate for breech presentation, neither with regard to the number of version attempts offered nor the number of women accepting the procedure.</description><identifier>ISSN: 0001-6349</identifier><identifier>EISSN: 1600-0412</identifier><identifier>DOI: 10.1111/aogs.12609</identifier><identifier>PMID: 25682778</identifier><identifier>CODEN: AOGSAE</identifier><language>eng</language><publisher>United States: Blackwell Publishing Ltd</publisher><subject>Adolescent ; Adult ; Breech delivery ; breech presentation ; Breech Presentation - therapy ; Cluster Analysis ; Decision Support Techniques ; Directive Counseling ; external cephalic version ; Female ; Humans ; implementation ; Middle Aged ; mode of delivery ; Netherlands ; Outcome Assessment (Health Care) ; Patient Education as Topic ; Pregnancy ; Treatment Outcome ; Version, Fetal ; Young Adult</subject><ispartof>Acta obstetricia et gynecologica Scandinavica, 2015-05, Vol.94 (5), p.518-526</ispartof><rights>2015 Nordic Federation of Societies of Obstetrics and Gynecology</rights><rights>2015 Nordic Federation of Societies of Obstetrics and Gynecology.</rights><rights>Acta Obstetricia et Gynecologica Scandinavica © 2015 Nordic Federation of Societies of Obstetrics and Gynecology</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4319-d83dde419887555f9ded78cb150f69c6117055d9b9c7d764cbb8a1686bbc93873</citedby><cites>FETCH-LOGICAL-c4319-d83dde419887555f9ded78cb150f69c6117055d9b9c7d764cbb8a1686bbc93873</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Faogs.12609$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Faogs.12609$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>315,781,785,1418,27928,27929,45578,45579</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25682778$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Vlemmix, Floortje</creatorcontrib><creatorcontrib>Rosman, Ageeth N.</creatorcontrib><creatorcontrib>Rijnders, Marlies E.</creatorcontrib><creatorcontrib>Beuckens, Antje</creatorcontrib><creatorcontrib>Opmeer, Brent C.</creatorcontrib><creatorcontrib>Mol, Ben W.J.</creatorcontrib><creatorcontrib>Kok, Marjolein</creatorcontrib><creatorcontrib>Fleuren, Margot A.H.</creatorcontrib><title>Implementation of client versus care-provider strategies to improve external cephalic version rates: a cluster randomized controlled trial</title><title>Acta obstetricia et gynecologica Scandinavica</title><addtitle>Acta Obstet Gynecol Scand</addtitle><description>Objective To determine the effectiveness of a client or care‐provider strategy to improve the implementation of external cephalic version. Design Cluster randomized controlled trial. Setting Twenty‐five clusters; hospitals and their referring midwifery practices randomly selected in the Netherlands. Population Singleton breech presentation from 32 weeks of gestation onwards. Methods We randomized clusters to a client strategy (written information leaflets and decision aid), a care‐provider strategy (1‐day counseling course focused on knowledge and counseling skills), a combined client and care‐provider strategy and care‐as‐usual strategy. We performed an intention‐to‐treat analysis. Main outcome measures Rate of external cephalic version in various strategies. Secondary outcomes were the percentage of women counseled and opting for a version attempt. Results The overall implementation rate of external cephalic version was 72% (1169 of 1613 eligible clients) with a range between clusters of 8–95%. Neither the client strategy (OR 0.8, 95% CI 0.4–1.5) nor the care‐provider strategy (OR 1.2, 95% CI 0.6–2.3) showed significant improvements. Results were comparable when we limited the analysis to those women who were actually offered intervention (OR 0.6, 95% CI 0.3–1.4 and OR 2.0, 95% CI 0.7–4.5). Conclusions Neither a client nor a care‐provider strategy improved the external cephalic version implementation rate for breech presentation, neither with regard to the number of version attempts offered nor the number of women accepting the procedure.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Breech delivery</subject><subject>breech presentation</subject><subject>Breech Presentation - therapy</subject><subject>Cluster Analysis</subject><subject>Decision Support Techniques</subject><subject>Directive Counseling</subject><subject>external cephalic version</subject><subject>Female</subject><subject>Humans</subject><subject>implementation</subject><subject>Middle Aged</subject><subject>mode of delivery</subject><subject>Netherlands</subject><subject>Outcome Assessment (Health Care)</subject><subject>Patient Education as Topic</subject><subject>Pregnancy</subject><subject>Treatment Outcome</subject><subject>Version, Fetal</subject><subject>Young Adult</subject><issn>0001-6349</issn><issn>1600-0412</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU1vFSEUhonR2Gt14w8wJG6MyVSYDz7cNY1eG5vbxI-4JAycqVRmuAJTW3-Cv1rm3rYLF7KBA8_7wuFF6DklR7SMNzpcpCNaMyIfoBVlhFSkpfVDtCKE0Io1rTxAT1K6LFXNW_EYHdQdEzXnYoX-nI5bDyNMWWcXJhwGbLwrJb6CmOaEjY5QbWO4chYiTjnqDBcOEs4Bu3E5AAzXGeKkPTaw_a69MzvxYrfQ6S3WxXROBSobkw2j-w0WmzDlGLwvyxyd9k_Ro0H7BM9u50P09f27LycfqrPz9enJ8Vll2obKyorGWmipFIJ3XTdIC5YL09OODEwaRiknXWdlLw23nLWm74WmTLC-N7IRvDlEr_a-5fE_Z0hZjS4Z8F5PEOakKONNw5nYoS__QS_DvHS6o2rO6pbVhXq9p0wMKUUY1Da6UccbRYlaElJLQmqXUIFf3FrO_Qj2Hr2LpAB0D_xyHm7-Y6WOz9ef70yrvcaVT76-1-j4Q5VmeKe-bdblhs2ndiM-qnXzFzqyrVI</recordid><startdate>201505</startdate><enddate>201505</enddate><creator>Vlemmix, Floortje</creator><creator>Rosman, Ageeth N.</creator><creator>Rijnders, Marlies E.</creator><creator>Beuckens, Antje</creator><creator>Opmeer, Brent C.</creator><creator>Mol, Ben W.J.</creator><creator>Kok, Marjolein</creator><creator>Fleuren, Margot A.H.</creator><general>Blackwell Publishing Ltd</general><general>John Wiley &amp; 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Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Acta obstetricia et gynecologica Scandinavica</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Vlemmix, Floortje</au><au>Rosman, Ageeth N.</au><au>Rijnders, Marlies E.</au><au>Beuckens, Antje</au><au>Opmeer, Brent C.</au><au>Mol, Ben W.J.</au><au>Kok, Marjolein</au><au>Fleuren, Margot A.H.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Implementation of client versus care-provider strategies to improve external cephalic version rates: a cluster randomized controlled trial</atitle><jtitle>Acta obstetricia et gynecologica Scandinavica</jtitle><addtitle>Acta Obstet Gynecol Scand</addtitle><date>2015-05</date><risdate>2015</risdate><volume>94</volume><issue>5</issue><spage>518</spage><epage>526</epage><pages>518-526</pages><issn>0001-6349</issn><eissn>1600-0412</eissn><coden>AOGSAE</coden><abstract>Objective To determine the effectiveness of a client or care‐provider strategy to improve the implementation of external cephalic version. Design Cluster randomized controlled trial. Setting Twenty‐five clusters; hospitals and their referring midwifery practices randomly selected in the Netherlands. Population Singleton breech presentation from 32 weeks of gestation onwards. Methods We randomized clusters to a client strategy (written information leaflets and decision aid), a care‐provider strategy (1‐day counseling course focused on knowledge and counseling skills), a combined client and care‐provider strategy and care‐as‐usual strategy. We performed an intention‐to‐treat analysis. Main outcome measures Rate of external cephalic version in various strategies. Secondary outcomes were the percentage of women counseled and opting for a version attempt. Results The overall implementation rate of external cephalic version was 72% (1169 of 1613 eligible clients) with a range between clusters of 8–95%. Neither the client strategy (OR 0.8, 95% CI 0.4–1.5) nor the care‐provider strategy (OR 1.2, 95% CI 0.6–2.3) showed significant improvements. Results were comparable when we limited the analysis to those women who were actually offered intervention (OR 0.6, 95% CI 0.3–1.4 and OR 2.0, 95% CI 0.7–4.5). Conclusions Neither a client nor a care‐provider strategy improved the external cephalic version implementation rate for breech presentation, neither with regard to the number of version attempts offered nor the number of women accepting the procedure.</abstract><cop>United States</cop><pub>Blackwell Publishing Ltd</pub><pmid>25682778</pmid><doi>10.1111/aogs.12609</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record>
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subjects Adolescent
Adult
Breech delivery
breech presentation
Breech Presentation - therapy
Cluster Analysis
Decision Support Techniques
Directive Counseling
external cephalic version
Female
Humans
implementation
Middle Aged
mode of delivery
Netherlands
Outcome Assessment (Health Care)
Patient Education as Topic
Pregnancy
Treatment Outcome
Version, Fetal
Young Adult
title Implementation of client versus care-provider strategies to improve external cephalic version rates: a cluster randomized controlled trial
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