改善产前筛查和酒精及其他药物使用的早期干预质量：系统改革的多阶段方法方案。
Improving the quality of antenatal screening and early intervention for alcohol and other drug use: protocol for a multi-stage approach to systems reform.
机构信息
School of Biomedicine, The University of Adelaide, Adelaide, South Australia, Australia.
Caring Futures Institute Flinders University, Bedford Park, South Australia, Australia.
出版信息
Addict Sci Clin Pract. 2024 Jan 5;19(1):2. doi: 10.1186/s13722-023-00434-6.
BACKGROUND
Alcohol, tobacco and illicit drug use during pregnancy can cause significant harm to women and their developing fetuses. Despite recommendations for abstinence during pregnancy, some women continue to use, making screening for substance use during antenatal clinic attendances an important strategy for reducing risk. This study aims to improve the rates of screening and intervention for substance use among pregnant women, including appropriate referral for those who may be substance-dependent. The protocol outlined here focuses on a multi-stage implementation study.
METHODS
This study will occur in four phases. Phase 1 will identify a baseline rate of screening and subsequent care at the antenatal clinics of two, South Australian hospital-based maternity services, through a retrospective case note audit. Rates of self-reported substance use identified in the case notes will also be compared against representative data from Adelaide Primary Health Network to establish rates of over or underreporting. Phase 2 will involve an online Training Needs Analysis of midwifery staff working at those services, to assess their knowledge, attitudes, beliefs, and commitment to the care of women who use substances during pregnancy. Phase 3 will involve a training package for all midwifery staff at those services, focused on routine screening for substance use, and how to provide appropriate care. Outcome measures from phase 2 will be reassessed during phase 3 and any changes since training will be evaluated. Phase 4 will then repeat phase 1 to compare the changes in rates of both screening and any associated intervention before and after training.
DISCUSSION
From a public health perspective, this project has the potential to make a significant impact on reducing risk of harm from substance use disorders among pregnant women, and contribute to better health outcomes for their children.
TRIAL REGISTRATION
This trial has been pre-registered under the Open Science Framework.
REGISTRATION
背景
孕妇在怀孕期间饮酒、吸烟和使用非法药物会对她们及其发育中的胎儿造成重大伤害。尽管建议孕妇在怀孕期间戒酒，但一些女性仍在继续使用，因此在产前诊所就诊时对物质使用进行筛查是降低风险的重要策略。本研究旨在提高孕妇物质使用的筛查和干预率，包括对可能有物质依赖的孕妇进行适当转介。本方案重点介绍了一个多阶段实施研究。
方法
本研究将分四个阶段进行。第一阶段将通过回顾性病历审核，确定两家南澳大利亚医院产科服务机构的产前诊所的筛查率和随后的护理情况。病历中确定的自我报告物质使用率也将与阿德莱德初级卫生网络的代表性数据进行比较，以确定报告过高或过低的情况。第二阶段将对在这些服务机构工作的助产士进行在线培训需求分析，以评估他们对孕妇物质使用护理的知识、态度、信念和承诺。第三阶段将为这些服务机构的所有助产士提供培训包，重点是对物质使用进行常规筛查以及如何提供适当的护理。第二阶段的结果指标将在第三阶段重新评估，并评估培训以来的任何变化。然后，第四阶段将重复第一阶段，比较培训前后筛查率和任何相关干预措施的变化。
讨论
从公共卫生的角度来看，该项目有可能显著降低孕妇物质使用障碍造成的伤害风险，并为其子女带来更好的健康结果。
试验注册
本试验已在开放科学框架下预先注册。
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