Transferring research knowledge into practice for improving survival and good health for babies at risk of being born preterm

Abstract

Background Antenatal corticosteroids (ACS) improve survival and health of babies born preterm. High quality clinical practice guidelines (CPGs) can improve health outcomes but only if implemented effectively. Investigating underlying determinants to practice change will aid effective implementation. Objectives To synthesise the evidence supporting ACS use. To investigate how best to identify key determinants likely to impact implementation of a new bi-national ACS CPG. To investigate the quality of existing ACS CPGs. Synthesis of evidence for ACS administration Methods: An overview of Cochrane systematic reviews. Results: Six systematic reviews were included. High quality evidence supports administration of a single course and a repeat course(s) of ACS. The quality of evidence for the administration of ACS prior to caesarean section (CS) at term and the optimum ACS regimen is low. Identifying key determinants to CPG implementation Methods: A randomised trial of semi-structured interviews versus on-line questionnaires for health professionals and consumers. Two qualitative studies nested within the randomised trial identified key barriers and enablers. Results: One assessment method was not identified as superior. The qualitative study of 73 health professionals identified 11 enablers and 13 barriers to ACS CPG implementation. The qualitative study of 24 consumers identified 10 barriers and 14 enablers to the receipt of ACS and use of CPGs. Quality of existing ACS CPGs. Methods: A survey of hospitals’ across Australia and New Zealand assessing ACS CPG content and the processes for production, implementation and renewal of CPGs. Quality was assessed using the AGREE II tool. Results: Recommendations were made for a single course of ACS in 89% of CPGs, a repeat course(s) in 37%, and prior to CS at term in 41%. A CPG development group existed in 85% of hospitals. The overall quality of 43 CPGs/protocols assessed was moderate to low. Conclusions The Overview provides clarity on the quality of evidence, treatment effects and remaining research questions for ACS administration. Quality and recommendations provided by existing CPGs vary; this could be addressed by the adoption of the new bi-national ACS CPG. This thesis provides valuable information to inform any implementation strategy to ensure effective uptake of the CPG.