Development of clinical guidelines in a health district: an attempt to find consensus.

Abstract

OBJECTIVE--To formulate consensus based guidelines for antenatal care in a health district. DESIGN--Prospective formulation of draft guidelines by a working group of consultant obstetricians and general practitioners with an obstetric interest, canvassing opinions of all GPs in the district by questionnaire, and revision and final circulation of the guidelines. SETTING--One health district. SUBJECTS--All 160 GPs in the district and members of the working party. MAIN MEASURES--Questionnaire responses to specific proposals within the draft guidelines for managing anaemia, antepartum haemorrhage, and hypertension. RESULTS--136 GPs responded (response rate 85%); responders and nonresponders did not differ in age, sex, or presence on obstetric list. Overall they favoured more conservative management than suggested in the guidelines. For example, only 38% (44/116) prescribed iron routinely and 34% (38/113) referred to hospital for haemoglobin concentration of