Adelaide Nursing School and Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia.
Department of Cardiology at the Northern Adelaide Local Health Network (NAHLN) and the University of Adelaide, Adelaide, South Australia.
PLoS One. 2020 Mar 17;15(3):e0230459. doi: 10.1371/journal.pone.0230459. eCollection 2020.
For pregnant women with a known cardiac condition or those who develop cardiac disease during pregnancy, there is an increased risk of complications during pregnancy, to both mother and foetus. To reduce this risk, best practice guidelines have been developed and available in South Australia for several years. Measuring clinical practice against the guideline recommendations verifies real-life practice and an essential part of any clinical practice quality improvement project by identifying gaps. This study is the first report on adherence to statewide perinatal guidelines for these women in South Australia.
To evaluate adherence to evidence-based clinical practice perinatal guidelinesTo identify predictors of adherence.Make comparisons across three practice settings examined.
A retrospective cross-sectional observational design that analysed data from medical records.
Three SA Health public metropolitan, university-affiliated teaching hospitals with an obstetric service within a ten-year timeframe (2003-2013).
271 admissions of women who were categorised as 'pre-existent' or 'newly acquired' cardiac condition during their pregnancy.
Adherence to guidelines was measured using a purposefully designed scoring system across the three sites. The researcher chose a minimum acceptable score of 17 applicable to the 'newly acquired' group and 35 for the 'pre-existent' group.
Overall adherence to the perinatal guidelines for the combined groups (n = 271) reported a mean score of 16.3, SD ± 6.7, with a median score of 17. Women in the 'newly acquired' group scored less compared to women in the 'pre-existent' group (Estimate -2.3, CI -3.9,-0.7). Variance in adherence was observed across the three hospitals (P value <0.0001). The most significant predictor of adherence to guidelines was pre-pregnancy cardiac consultation which increased the likelihood of preconception care by Odds ratio 18.5 (95%, CI 2, 168). Similarly, compliance with mental health screening was associated with improved adherence to antenatal assessments (OR: 11.3(95% CI 4.7, 27.3).
There was overall suboptimal adherence to the statewide guidelines for women with cardiac conditions in pregnancy. The variance in the level of adherence across the three hospitals correlated with the exposure to higher acuity cases, and that appropriate up- referral to a higher acuity hospital was intrinsically linked to better adherence. Recommendations include preconception counselling, and to ensure that all health practitioners have the skills, sufficient training and time to complete a comprehensive initial antenatal assessment.
ACTRN12617000417381.
对于患有已知心脏疾病或在怀孕期间出现心脏疾病的孕妇，母婴都面临着孕期并发症风险增加的问题。为了降低这种风险，南澳大利亚州已经制定了最佳实践指南，并已实施多年。将临床实践与指南建议进行对比，可以验证实际实践，并通过确定差距成为任何临床实践质量改进项目的重要组成部分。这项研究是首次报告南澳大利亚州全州围产期指南对这些女性的依从性。
评估对围产期循证临床实践指南的依从性。
识别依从性的预测因素。
对三个检查的实践环境进行比较。
回顾性的横截面观察性设计，分析了病历中的数据。
三家南澳大利亚州卫生署的大都市、大学附属教学医院，在十年内（2003-2013 年）提供产科服务。
271 名孕妇，其在怀孕期间被归类为“预先存在”或“新获得”的心脏疾病。
使用专门设计的评分系统在三个地点测量对指南的依从性。研究人员选择了一个最小可接受的分数 17 适用于“新获得”组，35 分适用于“预先存在”组。
综合组（n = 271）对围产期指南的总体依从性报告平均得分为 16.3，标准差 ± 6.7，中位数为 17。与“预先存在”组相比，“新获得”组的得分较低（估计值-2.3，CI-3.9，-0.7）。三个医院之间存在依从性的差异（P 值<0.0001）。依从性的最显著预测因素是孕前心脏咨询，这增加了受孕前护理的可能性，优势比为 18.5（95%CI 2，168）。同样，遵守精神健康筛查与更好的产前评估依从性相关（OR：11.3（95%CI 4.7，27.3））。
全州范围内，孕妇心脏疾病的围产期指南的总体依从性不理想。三个医院之间依从性水平的差异与接触更高急症病例相关，适当向上转诊至更高急症医院与更好的依从性密切相关。建议包括受孕前咨询，并确保所有卫生保健从业者都具备技能、足够的培训和时间来完成全面的初始产前评估。
ACTRN12617000417381。
