A randomised controlled trial of a tailored multifaceted strategy to promote implementation of a clinical guideline on induced abortion care

被引:27
作者
Foy, R
Penney, GC
Grimshaw, JM
Ramsay, CR
Walker, AE
MacLennan, G
Stearns, SC
McKenzie, L
Glasier, A
机构
[1] Univ Edinburgh, Simpson Ctr Reprod Hlth, Edinburgh EH8 9YL, Midlothian, Scotland
[2] Ottawa Hlth Res Inst, Clin Epidemiol Programme, Ottawa, ON, Canada
[3] Univ Ottawa, Inst Populat Hlth, Ctr Best Practice, Ottawa, ON K1N 6N5, Canada
[4] Univ Aberdeen, Hlth Serv Res Unit, Aberdeen AB9 1FX, Scotland
[5] Univ N Carolina, Dept Hlth Policy & Adm, Chapel Hill, NC USA
[6] Univ Aberdeen, Hlth Econ Res Unit, Aberdeen AB9 1FX, Scotland
[7] Univ London London Sch Hyg & Trop Med, Dept Publ Hlth & Policy, London WC1E 7HT, England
关键词
D O I
10.1111/j.1471-0528.2004.00168.x
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
Objective To evaluate the effectiveness and efficiency of a tailored multifaceted strategy, delivered by a national clinical effectiveness programme, to implement a guideline on induced abortion. Design Cluster randomised controlled trial. Setting and participants All 26 hospital gynaecology units in Scotland providing induced abortion care. Intervention Following the identification of barriers to guideline implementation, intervention units received a package comprising audit and feedback, unit educational meetings, dissemination of structured case records and promotion of a patient information booklet. Control units received printed guideline summaries alone. Main outcome measures Compliance with five key guideline recommendations (primary outcomes) and compliance with other recommendations, patient satisfaction and costs of the implementation strategy (secondary outcomes). Results No effect was observed for any key recommendation: appointment with a gynaecologist within five days of referral (odds ratio 0.89; 95% confidence interval 0.50 to 1.58); ascertainment of cervical cytology history (0.93; 0.36 to 2.40); antibiotic prophylaxis or screening for lower genital tract infection (1.70; 0.71 to 5.99); use of misoprostol as an alternative to gemeprost (1.00; 0.27 to 1.77); and offer of contraceptive supplies at discharge (1.11; 0.48 to 2.53). Median pre-intervention compliance was near optimal for antibiotic prophylaxis and misoprostol use. No intervention benefit was observed for any secondary outcome. The intervention costs an average of pound2607 per gynaecology unit. Conclusions The tailored multifaceted strategy was ineffective. This was possibly attributable to high pre-intervention compliance and the limited impact of the strategy on factors outside the perceived control of clinical staff.
引用
收藏
页码:726 / 733
页数:8
相关论文
共 21 条
[1]  
[Anonymous], 2004, HLTH TECHNOL ASSESS
[2]   ROBUST TESTS FOR EQUALITY OF VARIANCES [J].
BROWN, MB ;
FORSYTHE, AB .
JOURNAL OF THE AMERICAN STATISTICAL ASSOCIATION, 1974, 69 (346) :364-367
[3]   THE RETURN TO OVULATION FOLLOWING EARLY ABORTION - A COMPARISON BETWEEN VACUUM ASPIRATION AND PROSTAGLANDIN [J].
CAMERON, IT ;
BAIRD, DT .
ACTA ENDOCRINOLOGICA, 1988, 118 (02) :161-167
[4]   Analysis of cluster randomized trials in primary care: a practical approach [J].
Campbell, MK ;
Mollison, J ;
Steen, N ;
Grimshaw, JM ;
Eccles, M .
FAMILY PRACTICE, 2000, 17 (02) :192-196
[5]  
CHEATER F, 2003, TAILORED INTERVENTIO
[6]  
Donaldson LJ, 1998, QUAL HEALTH CARE, V7, pS37
[7]   Improving the quality of health care in the United Kingdom and the United States: A framework for change [J].
Ferlie, EB ;
Shortell, SM .
MILBANK QUARTERLY, 2001, 79 (02) :281-+
[8]  
Goldstein H., 2010, Multilevel statistical models, V4th
[9]   EFFECT OF CLINICAL GUIDELINES ON MEDICAL-PRACTICE - A SYSTEMATIC REVIEW OF RIGOROUS EVALUATIONS [J].
GRIMSHAW, JM ;
RUSSELL, IT .
LANCET, 1993, 342 (8883) :1317-1322
[10]  
*INF STAT DIV NHS, 2000, AB STAT SCOTL 1968 1