FROM EVIDENCE-BASED CLINICAL PRACTICE GUIDELINES TO CLINICAL PROTOCOLS AND EVIDENCE SUMMARIES.

Abstract

One of the most common problems in hospital care is variability in clinical practice, which has been defined as “inequality in the use of health resources between different geographic areas or healthcare levels, in circumstances in which adaptation of the knowledge and resources of the system should primarily be aimed at meeting individual patient needs” (1). Obstetrics and gynecology as a field of practice has not been immune to this issue. In 2015, for example, removal of ovaries at the time of hysterectomy for benign uterine disease ranged between 50% in the United States, 30% in Australia and 12% in Germany (2). As for cesarean section, Latin America has one of the highest frequencies, with 40% of all deliveries, followed by North America with 30%, Europe with 25%, Asia with 19% and Africa with 7% (3). It is not self-evident that this wide variation in the frequency with which this surgery is performed is due to varying patient needs, but rather to different styles in the practice of medicine. The problem occurs when this variability is associated with poor health outcomes for the population in the form of an increase in adverse events, and unwarranted higher costs, or when it is the result of health inequalities among populations (1). One example of poor results is the association which has been described between elective cesarean delivery and the increase in neonatal respiratory distress syndrome in gestations under 38 weeks and 6 days (4). Therefore, variability in obstetric practice is reflected in higher costs for healthcare services due to increased delivery costs and management of neonatal respiratory distress. As pertains to prophylactic FROM EVIDENCE-BASED CLINICAL PRACTICE GUIDELINES TO CLINICAL PROTOCOLS AND EVIDENCE SUMMARIES