A survey study examining the de‐implementation of routine Rh testing and Rh D immune globulin administration in early pregnancy among complex family planning specialists

Abstract Introduction New guidelines recommend foregoing routine Rh testing and Rh immunoglobulin (RhIg) administration for abortion or miscarriage before 12 weeks. Objective To examine whether US complex family planning (CFP) specialists practice according to the new guideline, and to describe the de‐implementation process for routine Rh testing and RhIg administration. Methods Using the CFP e‐mail listserv, we invited US physicians to complete an anonymous online survey hosted on Qualtrics. To examine factors associated with following new guidelines, we conducted a relative risk regression using a modified Poisson approach with robust error variances, including covariates with p less than 0.1 on bivariate analysis. We used Stata SE 16.1 for analyses, setting the level of significance at 5%. Results Of 575 listserv members, 241 (41.9%) responded to the survey. Of these, 152 (63.1%) initiated Rh testing and 179 (74.3%) administered RhIg only after 12 weeks. Physicians in the Midwest and West were more likely than those in the Northeast to follow new guidelines (Relative risk [RR], 1.81 [1.23–2.66] and RR, 2.25 [1.62–3.13], respectively). Those practicing at Planned Parenthood or independent clinics were more likely to follow new guidelines than those at academic medical centers (RR, 1.39 [1.11–1.74]). Most respondents reported a deliberate effort to change practice at their facility (161/203, 79.3%). Some (78/203, 38.4%) reported disagreements among clinicians difficult to resolve due to conflicting guidelines. Some expressed concerns about the “shared decision‐making” approach recommended to address this complex problem, but most said patients rarely (134/203, 66.0%) or never (35/203, 17.2%) disagreed with foregoing RhIg prior to 12 weeks gestation. Conclusion De‐implementation of routine Rh testing and RhIg administration in early pregnancy is well underway among US CFP specialists, but this is not universal across regions and even within institutions. Concerted efforts are needed to educate clinicians more broadly and guide patient counseling for this complex problem.