Implementation of national antenatal hypertension guidelines: a multicentre multiple methods study

Abstract

ObjectiveTo evaluate the implementation of National Institute for Health and Care Excellence antenatal hypertension guidelines, to identify strategies to reduce incidences of severe hypertension and associated maternal and perinatal morbidity and mortality in pregnant women with chronic hypertension.MethodsWe used a multiple method multisite approach to establish implementation of guidelines and the associated barriers and facilitators. We used a national survey of healthcare professionals (n=97), case notes review (n=55) and structured observations (n=42) to assess implementation. The barriers and facilitators to implementation were identified from semistructured qualitative interviews with healthcare professionals (n=13) and pregnant women (n=18) using inductive thematic analysis. The findings were integrated and evaluated using the Consolidated Framework for Implementation Research.Setting and participantsPregnant women with chronic hypertension and their principal carers (obstetricians, midwives and physicians), at three National Health Service hospital trusts with different models of care.ResultsWe found severe hypertension to be prevalent (46% of case notes reviewed) and target blood pressure practices to be suboptimal (56% of women had an antenatal blood pressure target documented). Women were infrequently given information (52%) or offered choice (19%) regarding antihypertensives. Women (14/18) reported internal conflict in taking antihypertensives and non-adherence was prevalent (8/18). Women who were concordant with treatment recommendations described having mutual trust with professionals mediated through appropriate information, side effect management and involvement in decision making. Professionals reported needing updates and tools for target blood pressure setting and shared decision making underpinned by antihypertensive safety and effectiveness research.ConclusionsWomen’s non-adherence to antihypertensives is higher than anticipated. Suboptimal information provision around treatment, choice of antihypertensives and target setting practices by healthcare professionals may be contributory. Understanding the reasons for non-adherence will inform education and decision-making strategies needed to address both clinician and women’s behaviour. Further research into the effectiveness and long-term safety of common antihypertensives is also required.

Síntesis de evidencia y recomendaciones: guías de práctica clínica para el tratamiento farmacológico de la hipertensión arterial en el embarazo

“…En el cuadro 4 se presentan algunas barreras, facilitadores y estrategias de implementación que pueden ser consideradas por los países. [14][15][16][17][18][19][20][21][22][23][24] En el recuadro 1 se sugieren indicadores de proceso y resultado de la implementación de las guías, en base a la revisión contribuir a mejorar la calidad de la atención y la salud de la población de las mujeres gestantes en la Región de las Américas.…”

Using the Consolidated Framework for Implementation Research to design and implement a perinatal education program in a large maternity hospital

“…We chose CFIR because: i) CFIR has been tested in a range of health care settings with over 300 peer reviewed articles reporting its application including settings of a similar size and complexity to ours [43], had been effectively applied to other multifaceted, patient focused interventions [44], and does not rely on a specific role of the researcher within the framework [37]; ii) CFIR is a multifaceted framework designed to be applied pragmatically from inception to implementation evaluation [44,45]; and iii) CFIR has been successfully used with other theories, models, and frameworks [34,45,46] including perinatal interventions [47][48][49]. Additional research support is available from a worldwide community of researchers who have used CFIR and developed, tested and published additional tools and resources [43].…”

CNN-Based LCD Transcription of Blood Pressure From a Mobile Phone Camera

“…They are associated with placental abruption, preterm delivery, fetal growth restriction, stillbirth, maternal death secondary to stroke and preeclampsia, as well as future risk of hypertension, diabetes mellitus, and cardiovascular disease in the mother (ACOG, 2013). Moreover, blood pressure monitoring and management, has been shown to be beneficial during pregnancy (Scantlebury et al, 2013;Gillon et al, 2014;Magee et al, 2016;Podymow and August, 2017;Chawla et al, 2020;Whybrow et al, 2020). However, the majority of evidence is provided for populations in high-income settings.…”