Liggins Institute, University of Auckland, Auckland, Aotearoa New Zealand.
Taonga Tuku Iho Principal Investigator Group, Auckland, Aotearoa New Zealand.
BMC Pregnancy Childbirth. 2024 Apr 3;24(1):234. doi: 10.1186/s12884-024-06415-0.
Preterm birth is a leading cause of perinatal morbidity and mortality and a defining event for pregnant people, infants, and whānau (extended families). Recommendations have been made for a national preterm birth prevention initiative focusing on equity in Aotearoa New Zealand, including the development of a national best practice guide. An understanding of the number and quality of guidelines, and consideration of their suitability and impact on equity is required.
Guidelines were identified through a systematic literature search, search of professional bodies websites, and invitation to regional health services in Aotearoa New Zealand. Obstetric and midwifery clinical directors were invited to report on guideline use. Identified guidelines were appraised by a 23-member trans-disciplinary Review Panel; quantitatively using the AGREE-II instrument and qualitatively using modified ADAPTE questions. The quality of guidelines available but not in use was compared against those in current use, and by health services by level of maternity and neonatal care. Major themes affecting implementation and impact on equity were identified using Braun and Clarke methodology.
A total of 235 guidelines were included for appraisal. Guidelines available but not in use by regional health services scored higher in quality than guidelines in current use (median domain score Rigour and Development 47.5 versus 18.8, p < 0.001, median domain score Overall Assessment 62.5 versus 44.4, p < 0.001). Guidelines in use by regional health services with tertiary maternity and neonatal services had higher median AGREE II scores in several domains, than those with secondary level services (median domain score Overall Assessment 50.0 versus 37.5, p < 0.001). Groups identified by the Review Panel as experiencing the greatest constraints and limitations to guideline implementation were rural, provincial, low socioeconomic, Māori, and Pacific populations. Identified themes to improve equity included a targeted approach to groups experiencing the least advantage; a culturally considered approach; nationally consistent guidance; and improved funding to support implementation of guideline recommendations.
We have systematically identified and assessed guidelines on preterm birth. High-quality guidelines will inform a national best practice guide for use in Taonga Tuku Iho, a knowledge translation project for equity in preterm birth care and outcomes in Aotearoa.
早产是围产期发病率和死亡率的主要原因，也是孕妇、婴儿和家庭（扩展家庭）的一个决定性事件。新西兰建议开展一项国家早产预防计划，重点关注公平问题，包括制定国家最佳实践指南。需要了解指南的数量和质量，并考虑其适用性和对公平的影响。
通过系统的文献搜索、专业机构网站搜索以及邀请新西兰地区卫生服务机构，确定了指南。产科和助产临床主任被邀请报告指南的使用情况。确定的指南由一个由 23 名跨学科评审小组进行评估；使用 AGREE-II 工具进行定量评估，并使用修改后的 ADAPTE 问题进行定性评估。对当前使用的指南与未使用的指南进行了质量比较，并按产妇和新生儿护理水平对卫生服务机构进行了比较。使用 Braun 和 Clarke 方法确定了影响实施和公平的主要主题。
共有 235 项指南被纳入评估。未被地区卫生服务机构使用但可获得的指南在质量方面得分高于当前使用的指南（严格性和发展领域的中位数评分为 47.5 与 18.8，p<0.001，整体评估领域的中位数评分为 62.5 与 44.4，p<0.001）。拥有三级产妇和新生儿服务的地区卫生服务机构使用的指南在几个领域的 AGREE II 得分中位数较高，高于拥有二级服务的机构（整体评估领域的中位数评分为 50.0 与 37.5，p<0.001）。评审小组确定的在实施指南方面面临最大限制和困难的群体包括农村、省级、低社会经济、毛利人和太平洋地区人群。为改善公平而确定的主题包括针对受益最少的群体采取有针对性的方法；考虑文化因素的方法；全国一致的指导；以及增加资金以支持实施指南建议。
我们系统地确定并评估了关于早产的指南。高质量的指南将为“宝藏之屋”提供国家最佳实践指南，这是一个知识转化项目，旨在提高新西兰在早产护理和结果方面的公平性。
