International Journal for Quality in Health Care Advance Access published online on December 23, 2007
International Journal for Quality in Health Care, doi:10.1093/intqhc/mzm070
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The decision to perform Caesarean section in Russia
1 Open Health Institute, Moscow, Russian Federation
2 European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London, UK
3 London School of Economics and Political Science, London, UK
4 Higher School of Economics, Moscow, Russian Federation
Background. Clinical practice in Russia is set out in a series of centralized guidelines. However, many of these guidelines are not supported by evidence and, despite their existence, there is considerable unexplained variation in practice. This study examines the decision to recommend a Caesarean section, an intervention for which there is a solid evidence base, but whose use varies considerably among facilities in Russia.
Aim. To identify the factors that Russian obstetricians take into account when recommending a Caesarean section.
Methods. Conjoint analysis. Ninety-two obstetricians from three regions were asked to state whether they would recommend a Caesarean section in each of 30 vignettes (including three for validation) combining 10 medical, social and organizational factors previously identified as contributing to the decision to intervene, including some absolute indications to intervene or not to, on the basis of international evidence.
Results. Checks for consistency within ratings by individuals gave no cause for concern. However, there was a wide variation in the probability of intervening among obstetricians, with six recommending intervention in only one scenario and one in 27 scenarios. Some factors were consistent with evidence but others were not, such as myopia or previous abortions. Intervention was more likely at 11 p.m. than at noon. Male obstetricians were more likely to intervene than females.
Conclusion. This study highlights the importance of understanding clinical decision-making in Russia as a prelude to changing it.
Keywords: Caesarean section, decision-making, obstetrics, Russia
Address reprint requests to: Martin Mckee, European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London, UK. Tel: +44 20 7927 2229; Fax: +44 20 7580 8183. E-mail: martin.mckee{at}lshtm.ac.uk
Accepted for publication November 15, 2007.