The impact of nonclinical factors on repeat cesarean section

Article Abstract:

The most common type of hospital surgery in the US is the cesarean section. There were 967,000 cesarean sections performed in the US in 1988, representing almost 25 percent of all births. The rate of cesarean section has quadrupled within the past 20 years, raising concerns about current obstetric practice. Thirty-six percent of cases were repeat cesarean sections, and only about 13 percent of women who underwent a previous cesarean section had a subsequent vaginal birth. Cesarean section contributes to increased health care costs and may often be clinically unnecessary. Higher rates of cesarean section have been associated with hospitals that operate for profit; patients with private insurance; increasing hospital size; higher socioeconomic status; and the presence of a neonatal intensive care unit. Thus, several clinical and nonclinical factors influence trends in medical practice. The influence of nonclinical factors. based on health care setting, on the use of repeat cesarean section was assessed in California hospitals. Among 45,425 births to women who had a previous cesarean section, only 11 percent were vaginal births. The rate of repeat cesarean section varied according to: hospital ownership (ranging from 4.9 percent for proprietary hospitals to 29.2 for the University of California hospital); hospital teaching level (ranging from 7.0 percent for non-teaching hospitals to 23.3 percent for teaching hospitals); payment source (ranging from 8.1 percent among women with private insurance to 25.2 percent among women receiving indigent services); and obstetric volume (with rates ranging from 5.4 percent in low-volume hospitals to 16.6 percent in high-volume hospitals). These findings suggest that nonclinical factors do affect decision-making and contribute to the variable rates of repeat cesarean section. (Consumer Summary produced by Reliance Medical Information, Inc.)

Social aspects, Economic aspects, Causes of, Practice, Hospitals, Gynecologic and obstetric, Gynecologic and obstetric hospitals

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Alternative strategies for controlling rising cesarean section rates

Article Abstract:

In the past two decades, deliveries by cesarean section have increased substantially, from 5.5 percent of deliveries in 1970 to 24.4 percent in 1987. Cesarean section is now the most frequently performed operation in the United States. In 1980, experts at the National Institutes of Health stated that the rising rate of cesareans was a matter of concern; since that time it has risen further. Both patients and health professionals are challenging the trend, suggesting that the risks of the procedure may outweigh the benefits in many cases. Six strategies for reducing the cesarean section rate are described and evaluated. The strategy that has been used most so far is physician education and peer evaluation; activities include use of professional guidelines stating when to perform cesareans and programs that require doctors to consult with a colleague before deciding on a surgical delivery. Structured programs within individual hospitals that actively discourage unnecessary cesarean sections appear to be the most effective. Other strategies include review of decisions by an external organization, such as an insurance company evaluating reimbursement, informing the public of cesarean rates for different doctors and hospitals, and revising payment systems for physicians and hospitals. More research on the feasibility and effectiveness of these approaches is needed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Management, Surgery, Childbirth, Delivery (Childbirth), Surgery, Unnecessary, Unnecessary surgery, Obstetrical surgery

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Promotion and prescribing of hormone therapy after report of harm by the women's health initiative

Article Abstract:

A study is conducted to examine the pharmaceutical industry response to the WHI E+P results by analyzing promotional expenditures for hormone therapy before and after July 2002. The reporting of the evidence of harm from the report by WHI E+P showed that there was a substantial decline in promotional spending for hormone therapy, particularly for the agents most directly implicated in the trial.

United States, Science & research, Research, Hormone therapy, Medical care, Cost of, Health care costs, Women's health

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