Associate Professor, Nursing Department, Faculty of Nursing, University of Murcia, Murcia, Spain.
Midwife, Hospital Rafael Méndez, III Healthcare Area, Murcia Health Service, Murcia, Spain.
J Nurs Scholarsh. 2021 May;53(3):358-368. doi: 10.1111/jnu.12636. Epub 2021 Feb 8.
Current literature provides poor information about the implementation of health-promoting clinical practice guidelines (CPGs) and their longitudinal monitoring.
The aim of this study was to evaluate the longitudinal impact of a CPG implementation program that promotes breastfeeding, its associated quantitative and qualitative indicators, and direct costs.
A mixed-methods design with a longitudinal approach was utilized, with an interrupted time series design and the analysis of reports from the implementation program as the qualitative approach.
The study setting was maternity and pediatric units of a health area in the Spanish health system. The implementation of a CPG for the promotion of breastfeeding was evaluated, which included a pre-implementation year (2011), 3 years of implementation (2012-2014), and 2 years of post-implementation (2015-2016). The sample was composed of mother-infant dyads. A segmented logistic regression analysis was utilized to evaluate the changes in the most important breastfeeding indicators. A deductive thematic content analysis was performed starting with quality indicators and a descriptive economic analysis.
In the 6 years of monitoring, 7,842 mother-infant dyads were recorded. The results of the quantitative indicators showed the presence of four stages: baseline, gain, adjustment, and sustainability or saturation. The breast milk at the first feeding had an increasing slope in the gain stage (24% per quarter; odds ratio [OR] = 1.24, 95% confidence interval [CI] 1.12-1.37). The exclusive breastfeeding at hospital discharge showed significant changes in the period of gain (OR = 2.45, 95% CI 1.95-3.08), which was maintained in the adjustment period, with an increase of 18% in the slope of the gain stage (OR = 1.18, 95% CI 1.06-1.32). The longitudinal distribution of the qualitative indicators showed a greater concentration of indicators towards the first half of each phase. The total cost was 209,575€ ($248,670.17).
The implementation of the breastfeeding CPG showed early, positive, and sustained results in the exclusive breastfeeding rates. The implementation implied the application of a complex intervention, with its qualitative indicators showing a wave-shaped dynamic.
Our findings contribute to the understanding and evolution of the main indicators of the implementation of a breastfeeding CPG, providing details on the magnitude of the effect, the process of change, and the associated costs.
目前的文献资料对于促进健康的临床实践指南（CPG）的实施及其纵向监测提供的信息甚少。
本研究旨在评估促进母乳喂养的 CPG 实施计划的纵向影响，以及其相关的定量和定性指标和直接成本。
本研究采用混合方法设计，采用纵向方法，以中断时间序列设计和实施计划报告的分析作为定性方法。
研究地点为西班牙卫生系统中一个卫生区域的产科和儿科病房。评估了促进母乳喂养的 CPG 的实施情况，其中包括实施前一年（2011 年）、实施的 3 年（2012-2014 年）和实施后的 2 年（2015-2016 年）。样本由母婴对组成。采用分段逻辑回归分析评估最重要的母乳喂养指标的变化。从质量指标开始进行演绎主题内容分析，并进行描述性经济分析。
在 6 年的监测中，记录了 7842 对母婴对。定量指标的结果显示存在四个阶段：基线、增长、调整和可持续性或饱和。首次喂养时的母乳有增长阶段的斜率增加（每季度增加 24%；优势比 [OR] = 1.24，95%置信区间 [CI] 1.12-1.37）。出院时的纯母乳喂养在增长期有显著变化（OR = 2.45，95%CI 1.95-3.08），在调整期得到维持，增长阶段斜率增加 18%（OR = 1.18，95%CI 1.06-1.32）。纵向分布的定性指标显示，指标更集中在每个阶段的前半部分。总成本为 209575 欧元（248670.17 美元）。
母乳喂养 CPG 的实施在纯母乳喂养率方面显示出早期、积极和持续的结果。实施意味着应用复杂的干预措施，其定性指标呈现出波浪形动态。
我们的研究结果有助于理解和发展母乳喂养 CPG 实施的主要指标，提供有关影响程度、变化过程和相关成本的详细信息。
