Practice change intervention to improve antenatal care addressing alcohol consumption during pregnancy: a randomised stepped-wedge controlled trial

BMC Pregnancy and Childbirth

Ian Symonds¹  Chris Rissel²  Tracey W. Tsang³  Elizabeth J. Elliott³  Sarah Ward⁴  Penny Reeves⁵  Carol Azzopardi⁶  Mandy Hunter⁶  Belinda Tully⁷  Karen Gillham⁷  Luke Wolfenden⁷  Melanie Kingsland⁷  John Wiggers⁷  Emma Doherty⁷  Adrian Dunlop⁸  John Attia⁸ 

[1] Adelaide Medical School, The University of Adelaide;College of Medicine and Public Health, Flinders University;Faculty of Medicine and Health and Discipline of Child and Adolescent Health, The University of Sydney;Foundation for Alcohol Research and Education;Hunter Medical Research Institute;Maternity and Gynaecology John Hunter Hospital;Population Health, Hunter New England Local Health District;School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle;

关键词: Antenatal care;    Alcohol;    Pregnancy;    Clinical practice change;    Implementation;    Stepped-wedge trial;   

DOI  :  10.1186/s12884-022-04646-7

来源: DOAJ

【 摘 要 】

Abstract Background Clinical guideline recommendations for addressing alcohol consumption during pregnancy are sub-optimally implemented and limited evidence exists to inform practice improvements. The aim of this study was to estimate the effectiveness of a practice change intervention in improving the provision of antenatal care addressing alcohol consumption during pregnancy in public maternity services. Methods A randomised stepped-wedge controlled trial was undertaken with all public maternity services in three sectors (one urban, two regional/rural) of a single local health district in New South Wales, Australia. All antenatal care providers were subject to a seven-month multi-strategy intervention to support the introduction of a recommended model of care. For 35 months (July 2017 – May 2020) outcome data were collected from randomly selected women post an initial, 27–28 weeks and 35–36 weeks gestation antenatal visit. Logistic regression models assessed intervention effectiveness. Results Five thousand six hundred ninety-four interviews/online questionnaires were completed by pregnant women. The intervention was effective in increasing women’s reported receipt of: assessment of alcohol consumption (OR: 2.63; 95% CI: 2.26–3.05; p < 0.001), advice not to consume alcohol during pregnancy and of potential risks (OR: 2.07; 95% CI: 1.78–2.41; p < 0.001), complete care relevant to alcohol risk level (advice and referral) (OR: 2.10; 95% CI: 1.80–2.44; p < 0.001) and all guideline elements relevant to alcohol risk level (assessment, advice and referral) (OR: 2.32; 95% CI: 1.94–2.76; p < 0.001). Greater intervention effects were found at the 27–28 and 35–36 weeks gestation visits compared with the initial antenatal visit. No differences by sector were found. Almost all women (98.8%) reported that the model of care was acceptable. Conclusions The practice change intervention improved the provision of antenatal care addressing alcohol consumption during pregnancy in public maternity services. Future research could explore the characteristics of pregnant women and maternity services associated with intervention effectiveness as well as the sustainment of care practices over time to inform the need for, and development of, further tailored practice change support. Trial registration Australian and New Zealand Clinical Trials Registry (Registration number: ACTRN12617000882325; Registration date: 16/06/2017) https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372985&isReview=true

【 授权许可】

Unknown