A practice change intervention to improve antenatal care addressing alcohol consumption by women during pregnancy: research protocol for a randomised stepped-wedge cluster trial

Kingsland, Melanie; Doherty, Emma; Anderson, Anne H.; Crooks, Kristy; Tully, Belinda; Tremain, Danika; Tsang, Tracey W; Attia, John; Wolfenden, Luke; Dunlop, Adrian; Bennett, Nicole; Hunter, Mandy; Ward, Sarah; Reeves, Penny; Symonds, Ian; Rissel, Chris; Azzopardi, Carol; Searles, Andrew; Gillham, Karen; Elliott, Elizabeth J; Wiggers, John

doi:10.1186/s13012-018-0806-x

Cited by 30 publications

(46 citation statements)

References 54 publications

(48 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This protocol outlines the assessment of cost, e ciency and affordability of a multi-strategy practice change implementation-intervention compared to usual practice. The outcomes of this economic evaluation will provide insight into the cost, cost-consequence and cost-effectiveness of implementation strategies designed to improve antenatal care addressing the recognised risk of alcohol consumption to the health and wellbeing of both the mother and child (34), and inform future health care policy, investment allocation and research.…”

Section: Resultsmentioning

confidence: 99%

“…Second, there are bene ts to the research and broader community in greater understanding of economic evaluation, especially with respect to their conduct alongside implementation trials. There is a clear absence of research evidence of the effectiveness, cost, cost-effectiveness and budget impact of implementation strategies to improve antenatal care that addresses maternal alcohol consumption during pregnancy (34). The application of economic evaluation to health promoting, implementation interventions is limited (12) while the application of budget impact assessment at the local health service level is completely novel.…”

Section: Discussionmentioning

confidence: 99%

“…The multi-strategy practice change implementation trial will be a randomised, stepped-wedge controlled trial. The protocol has been previously published (3). In brief, the trial will be conducted in all public antenatal services within three sectors across two health districts in New South Wales, Australia.…”

Section: Methodsmentioning

confidence: 99%

“…Identi cation and measurement of outcomes It has been suggested that one of the ways to improve e ciency in conducting economic evaluations of implementation interventions is to con ne studies to measures of the care process or intermediate outcomes (11); for example, change in professional guidance adherence or compliance (3). This approach is based on the premise that the guideline recommendations are cost-effective in and of themselves.…”

Section: Trial-based Economic Evaluation and Budget Impact Assessmentmentioning

confidence: 99%

“…It is also recommended that follow up care is provided during subsequent antenatal visits. Despite these clear recommendations, the provision of routine antenatal care addressing maternal alcohol consumption during pregnancy is limited (3). For example, in Canada approximately 50% of health professionals have reported providing advice to pregnant women regarding the consumption of alcohol (4) and, in the United Kingdom two thirds of women reported receiving such advice from a midwife (5).…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Protocol for an economic evaluation and budget impact assessment of a randomised, stepped-wedge controlled trial for practice change support to increase routine provision of antenatal care for maternal alcohol consumption

Reeves

Szewczyk

Kingsland

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

Background Antenatal clinical practice guidelines recommend routine assessment of women’s alcohol consumption during pregnancy. The delivery of advice and referral when necessary are also recommended. However, evidence suggests there are barriers to the uptake of best-care guidelines. Effective, cost-effective and affordable implementation strategies are needed to ensure the intended benefit of guidelines are realized through addressing identified barriers. This paper describes the protocol for evaluating the efficiency and affordability of a practice change intervention compared to usual practice in an implementation trial. Methods The effectiveness of the intervention will be evaluated in a stepped-wedge randomised controlled implementation trial, conducted in an Australian setting. An economic evaluation will be conducted alongside the trial to assess intervention efficiency. Budget impact assessment will be conducted to assess affordability. The prospective trial-based economic evaluation will identify, measure and value key resource and outcome impacts arising from the multi-strategy practice change intervention compared with usual practice. The evaluation will comprise: (i) a cost-consequence analyses, where a score card approach will be used to show the costs and benefits given the multiple primary outcomes included in the trial; and (ii) a cost effectiveness analyses, where the primary outcome will be incremental cost per percent increase in participants reporting receipt of antenatal care for maternal alcohol consumption consistent with guideline recommendations. Intervention affordability will be evaluated using budget impact assessment and will estimate the financial implications of adoption and diffusion of this implementation strategy from the perspective of relevant fund-holders. Results will be extrapolated to estimate the cost and cost-effectiveness of rolling out the model of care. Discussion Uptake of clinical guidelines requires practice change support. It is hypothesized that the implementation strategy, if found to be effective, will also be cost-effective, affordable and scalable. This protocol describes the economic evaluation that will address these hypotheses.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Trial-based Economic Evaluation and Budget Impact Assessmentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations