The impact of national guidelines on EBM implementation in clinical practice: a comparison between the practices in two countries

Abstract

Objective: To determine if the application of guidelines for obstetrical anal sphincter injuries (OASIS) management adopted by professional society in a country improves healthcare compared to a country where the guidelines are not adopted. Materials and Methods: In 2008 and 2016, a questionnaire was sent to every maternity ward in the Czech and Slovak Republics. In 2011, the guidelines for OASIS management were published in the Czech Republic. The authors compared the changes in the management of OASIS in both countries and evaluated the effect of the guidelines on healthcare improvement. Results: In 2008, the current Royal College of Obstetricians and Gynaecologists (RCOG) classification of OASIS was not used by any hospital in both countries. In 2016, the classification was used by 48.8% of hospitals in the Czech Republic and by 11.5% of hospitals in the Slovak Republic. The percentage of hospitals in the Czech Republic which used antibiotic prophylaxis while treating OASIS increased from 87.3% in 2008 to 100% in 2016. In the Slovak Republic, the percentage decreased from 85.7% to 73.1%. Active follow-up increased in the Czech Republic from 40% to 70.8%. In the Slovak Republic, it increased from 33.3% to 38.5%. In 2008, the management according to EBM was not performed by any of centres participating in the survey. In 2016, this percentage increased to 34.1% in the Czech Republic and to 3.8% in the Slovak Republic. Conclusion: The introduction of guidelines improved healthcare more significantly compared to the country where guidelines are not yet adopted.