Redesigning antenatal care: Prospective use of an implementation framework to establish a population-based multidisciplinary first-trimester screening, assessment and prevention service.
implementation science
prenatal care
prenatal diagnosis
pre‐eclampsia
Journal
The Australian & New Zealand journal of obstetrics & gynaecology
ISSN: 1479-828X
Titre abrégé: Aust N Z J Obstet Gynaecol
Pays: Australia
ID NLM: 0001027
Informations de publication
Date de publication:
23 May 2024
23 May 2024
Historique:
received:
03
12
2023
accepted:
30
04
2024
medline:
23
5
2024
pubmed:
23
5
2024
entrez:
23
5
2024
Statut:
aheadofprint
Résumé
Australian rates of adverse obstetric outcomes have improved little despite guidelines recommending history-based screening and intervention. The first trimester provides a unique opportunity to predict and prevent complications, yet population-based screening has failed to be translated into broad clinical practice. This study aimed to redesign antenatal care within an Australian public healthcare centre to align with evidence-based maternity care, including population-based first-trimester screening with early initiation of preventative strategies in high-risk pregnancies. A five-phase action-process model, sharing key elements with implementation science theory, was used to explore barriers to change in antenatal care, co-design a novel service with consumers and establish a population-based antenatal pathway commencing with a multidisciplinary first-trimester screening, assessment and planning visit. The case for change and associated barriers were defined from the perspective of antenatal care stakeholders. Key needs of each group were established, and solutions were created using co-design methodology, allowing the team to create a novel approach to antenatal care which directly addressed identified barriers. Implementation of the service was associated with a fall in the median gestation at first specialist maternity care provider visit from 20 to 13 weeks. This study confirms the feasibility of establishing a comprehensive first-trimester screening program within a public Australian healthcare setting and highlights a co-design process which places individualised assessment at the forefront of antenatal care. This framework may be applicable to most public maternity settings in Australia, with expansion aimed at providing equity of care, including in rural and remote settings.
Sections du résumé
BACKGROUND
BACKGROUND
Australian rates of adverse obstetric outcomes have improved little despite guidelines recommending history-based screening and intervention. The first trimester provides a unique opportunity to predict and prevent complications, yet population-based screening has failed to be translated into broad clinical practice.
AIMS
OBJECTIVE
This study aimed to redesign antenatal care within an Australian public healthcare centre to align with evidence-based maternity care, including population-based first-trimester screening with early initiation of preventative strategies in high-risk pregnancies.
METHODS
METHODS
A five-phase action-process model, sharing key elements with implementation science theory, was used to explore barriers to change in antenatal care, co-design a novel service with consumers and establish a population-based antenatal pathway commencing with a multidisciplinary first-trimester screening, assessment and planning visit.
RESULTS
RESULTS
The case for change and associated barriers were defined from the perspective of antenatal care stakeholders. Key needs of each group were established, and solutions were created using co-design methodology, allowing the team to create a novel approach to antenatal care which directly addressed identified barriers. Implementation of the service was associated with a fall in the median gestation at first specialist maternity care provider visit from 20 to 13 weeks.
CONCLUSIONS
CONCLUSIONS
This study confirms the feasibility of establishing a comprehensive first-trimester screening program within a public Australian healthcare setting and highlights a co-design process which places individualised assessment at the forefront of antenatal care. This framework may be applicable to most public maternity settings in Australia, with expansion aimed at providing equity of care, including in rural and remote settings.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Hunter New England Local Health District
Informations de copyright
© 2024 The Authors. Australian and New Zealand Journal of Obstetrics and Gynaecology published by John Wiley & Sons Australia, Ltd on behalf of Royal Australian and New Zealand College of Obstetricians and Gynaecologists.
Références
Centre for Epidemiology and Evidence. New South Wales Mothers and Babies 2002‐2021. Sydney: NSW Ministry of Health, 2004‐2023.
D'Silva A, Fyfe R, Hyett J. First trimester prediction and prevention of adverse pregnancy outcomes related to poor placentation. Curr Opin Obstet Gynecol 2017; 29: 367–374.
Spencer K, Spencer CE, Power M et al. Screening for chromosomal abnormalities in the first trimester using ultrasound and maternal serum biochemistry in a one‐stop clinic: a review of three years prospective experience. BJOG 2003; 110: 281–286.
Poon LC, McIntyre HD, Hyett JA et al. The first‐trimester of pregnancy–a window of opportunity for prediction and prevention of pregnancy complications and future life. Diabetes Res Clin Pract 2018; 145: 20–30.
Rolnik DL, Wright D, Poon LC et al. Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia. N Engl J Med 2017; 377: 613–622.
Foster AB, Park F, Hyett J. Do first‐trimester screening algorithms for preeclampsia aligned to use of preventative therapies reduce the prevalence of pre‐term preeclampsia: a systematic review and meta‐analysis. Prenat Diagn 2023; 43: 950–958.
Tan MY, Syngelaki A, Poon LC et al. Screening for pre‐eclampsia by maternal factors and biomarkers at 11–13 weeks' gestation. Ultrasound Obstet Gynecol 2018; 52(2): 186–195.
Tan M, Poon L, Rolnik D et al. Prediction and prevention of small‐for‐gestational‐age neonates: Evidence from SPREE and ASPRE. Ultrasound Obstet Gynecol 2018; 52(1): 52–59.
Romero Infante XC, Uriel M, Porras Ramirez A, Rincon FS. Comparison of preeclampsia and fetal growth restriction screenings at first trimester in a high‐risk population. J Obstet Gynaecol Res 2021; 47(2): 765–773.
Minopoli M, Noël L, Meroni A et al. Adverse pregnancy outcomes in women at increased risk of preterm pre‐eclampsia on first‐trimester combined screening. BJOG 2023; 131: 81–87.
Liu B, Nadeem U, Frick A et al. Reducing health inequality in black, Asian and other minority ethnic pregnant women: impact of first trimester combined screening for placental dysfunction on perinatal mortality. BJOG 2022; 129: 1750–1756.
Guy G, Leslie K, Diaz Gomez D et al. Effect of routine first‐trimester combined screening for pre‐eclampsia on small‐for‐gestational‐age birth: secondary interrupted time series analysis. Ultrasound Obstet Gynecol 2022; 59(1): 55–60.
Poon LC, Shennan A, Hyett JA et al. The International Federation of Gynecology and Obstetrics (FIGO) initiative on preeclampsia (PE): a pragmatic guide for first trimester screening and prevention. Int J Gynaecol Obstet 2019; 145(Suppl 1): 1–33.
Magee LA, Smith GN, Bloch C et al. 426: Hypertensive disorders of pregnancy: diagnosis, prediction, prevention, and management. J Obstet Gynaecol Can 2022; 44: 547–571. e1.
Brown MA, Magee LA, Kenny LC et al. Hypertensive disorders of pregnancy: ISSHP classification, diagnosis, and management recommendations for international practice. Hypertension 2018; 72(1): 24–43.
Bilardo C, Chaoui R, Hyett J et al. ISUOG practice guidelines (updated): performance of 11–14‐week ultrasound scan. Ultrasound Obstet Gynecol 2023; 61(1): 127–143.
Department of Health. Clinical Practice Guidelines: Pregnancy Care. Canberra, NSW: Australian Government Department of Health, 2020.
Australian Preterm Birth Alliance. Clinical guidelines for the safe reduction in preterm birth. 2020. Available from URL: https://www.pretermalliance.com.au/Our‐Research/Clinical‐Guidelines. [Accessed 28th November 2023].
Centre of Research Excellence Stillbirth. Safer Baby Bundle Handbook and Resource Guide: Working Together to Reduce Stillbirth. Centre of Research Excellence Stillbirth, Australia,2019.
Helou A, Walker S, Stewart K, George J. Management of pregnancies complicated by hypertensive disorders of pregnancy: could we do better? Aust N Z J Obstet Gynaecol 2017; 57: 253–259.
Newnham JP, White SW, Lee H‐S et al. The elements of success in a comprehensive state‐wide program to safely reduce the rate of preterm birth. PLoS One 2020; 15: e0234033.
Leite D, Cecatti J. Fetal growth restriction prediction: how to move beyond. ScientificWorld Journal 2019; 2019: 1519048.
Meher S, Duley L, Hunter K, Askie L. Antiplatelet therapy before or after 16 weeks' gestation for preventing preeclampsia: an individual participant data meta‐analysis. Am J Obstet Gynecol 2017; 216(2): 121–128. e. 2.
Bujold E, Roberge S, Nicolaides KH. Low‐dose aspirin for prevention of adverse outcomes related to abnormal placentation. Prenat Diagn 2014; 34: 642–648.
Johnson J, Walsh JD, Okun NB et al. The implementation of preeclampsia screening and prevention (IMPRESS) study. Am J Obstet Gynecol 2023; 5(2): 100815.
Nilsen P. Making sense of implementation theories, models, and frameworks. Implement Sci 2020; 10: 53–79.
Dadich A, Piper A, Coates D. Implementation science in maternity care: a scoping review. Implement Sci 2021; 16: 1–20.
Park F, Deeming S, Bennett N, Hyett J. Cost‐effectiveness analysis of a model of first‐trimester prediction and prevention of preterm pre‐eclampsia compared with usual care. Ultrasound Obstet Gynecol 2021; 58: 688–697.
NSW Agency for Clinical Innovation (ACI). Understanding the Process to Develop a Model of Care. 2013 An ACI Framework. Available from URL: https://aci.health.nsw.gov.au/__data/assets/pdf_file/0009/181935/HS13‐034_Framework‐DevelopMoC_D7.pdf. [Accessed 17th November 2023].
Atkins LFJ, Islam R, O'Connor D et al. A guide to using the theoretical domains framework of behaviour change to investigate implementation problems. Implement Sci 2017; 12(1): 77.
NSW Agency for Clinical Innovation (ACI). A Guide to Build Co‐Design Capability Consumers and staff coming together to improve healthcare. 2019. Available from URL: https://aci.health.nsw.gov.au/data/assets/pdf_file/0013/502240/Guide‐Build‐Codesign‐Capability.pdf. [Accessed 1st December 2023].
NSW Department of Health. NSW Health/Families NSW Supporting Families Early Package – SAFE START Guidelines: Improving Mental Health Outcomes for Parents and Infants, NSW Department of Health. 2009.
Moore TG, Arefadib N, Deery A et al. The First Thousand Days: An Evidence Paper – Summary. 2017. Parkville, VIC: Centre for Community Child Health, Murdoch Children's Research Institute.
Carroli G, Villar J, Piaggio G et al. WHO systematic review of randomised controlled trials of routine antenatal care. Lancet 2001; 357: 1565–1570.