The impact of guidelines on mild hypertension in pregnancy: time series analysis

R. Foy, Craig R Ramsay, Gillian Penney, Luke David Vale, Anne Patricia Thomson, I. Greer

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Objective To determine the impact of a national strategy to promote implementation of a guideline on the management of mild, non-proteinuric hypertension in pregnancy.

Design Simple, interrupted time series analysis.

Setting Four maternity units in Scotland.

Population Women delivering a live or stillborn baby.

Methods Dissemination of the guideline under the auspices of a national clinical effectiveness programme, supported by a national launch meeting and feedback from a survey of obstetricians highlighting aspects of care that could be improved.

Main outcome measures Appropriateness of initial investigation and subsequent clinical management, and costs of guideline development and implementation activities.

Data collection Twenty-four months pre-intervention and 12 months post-intervention data were abstracted from a random sample of case notes.

Results Initial investigation was consistent with recommendations for 59.9% out of 1263 women and subsequent clinical management for 67.6% out of 1081 in whom a diagnosis could be made from available data. There were no significant changes in the appropriateness of initial investigation (10.6%; 95% confidence interval [CI] -0.1% to 19.3%; decreasing by 1.2% per month post-implementation, 95% CI -2.5% to 0.1%) or clinical management (-0.3%; 95% CI -8.7% to 11.2%). Guideline development and implementation cost an estimated pound2784 per maternity unit in Scotland.

Conclusions Clinical care of mild hypertension in pregnancy remains highly inconsistent. The lack of the intervention effect may be related to the complexity of the guideline recommendations and the nature of the implementation strategy.

Original languageEnglish
Pages (from-to)765-770
Number of pages5
JournalBJOG-An International Journal of Obstetrics and Gynaecology
Volume111
Issue number8
DOIs
Publication statusPublished - 2004

Cite this

The impact of guidelines on mild hypertension in pregnancy: time series analysis. / Foy, R.; Ramsay, Craig R; Penney, Gillian; Vale, Luke David; Thomson, Anne Patricia; Greer, I.

In: BJOG-An International Journal of Obstetrics and Gynaecology, Vol. 111, No. 8, 2004, p. 765-770.

Research output: Contribution to journalArticle

Foy, R. ; Ramsay, Craig R ; Penney, Gillian ; Vale, Luke David ; Thomson, Anne Patricia ; Greer, I. / The impact of guidelines on mild hypertension in pregnancy: time series analysis. In: BJOG-An International Journal of Obstetrics and Gynaecology. 2004 ; Vol. 111, No. 8. pp. 765-770.
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abstract = "Objective To determine the impact of a national strategy to promote implementation of a guideline on the management of mild, non-proteinuric hypertension in pregnancy.Design Simple, interrupted time series analysis.Setting Four maternity units in Scotland.Population Women delivering a live or stillborn baby.Methods Dissemination of the guideline under the auspices of a national clinical effectiveness programme, supported by a national launch meeting and feedback from a survey of obstetricians highlighting aspects of care that could be improved.Main outcome measures Appropriateness of initial investigation and subsequent clinical management, and costs of guideline development and implementation activities.Data collection Twenty-four months pre-intervention and 12 months post-intervention data were abstracted from a random sample of case notes.Results Initial investigation was consistent with recommendations for 59.9{\%} out of 1263 women and subsequent clinical management for 67.6{\%} out of 1081 in whom a diagnosis could be made from available data. There were no significant changes in the appropriateness of initial investigation (10.6{\%}; 95{\%} confidence interval [CI] -0.1{\%} to 19.3{\%}; decreasing by 1.2{\%} per month post-implementation, 95{\%} CI -2.5{\%} to 0.1{\%}) or clinical management (-0.3{\%}; 95{\%} CI -8.7{\%} to 11.2{\%}). Guideline development and implementation cost an estimated pound2784 per maternity unit in Scotland.Conclusions Clinical care of mild hypertension in pregnancy remains highly inconsistent. The lack of the intervention effect may be related to the complexity of the guideline recommendations and the nature of the implementation strategy.",
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N2 - Objective To determine the impact of a national strategy to promote implementation of a guideline on the management of mild, non-proteinuric hypertension in pregnancy.Design Simple, interrupted time series analysis.Setting Four maternity units in Scotland.Population Women delivering a live or stillborn baby.Methods Dissemination of the guideline under the auspices of a national clinical effectiveness programme, supported by a national launch meeting and feedback from a survey of obstetricians highlighting aspects of care that could be improved.Main outcome measures Appropriateness of initial investigation and subsequent clinical management, and costs of guideline development and implementation activities.Data collection Twenty-four months pre-intervention and 12 months post-intervention data were abstracted from a random sample of case notes.Results Initial investigation was consistent with recommendations for 59.9% out of 1263 women and subsequent clinical management for 67.6% out of 1081 in whom a diagnosis could be made from available data. There were no significant changes in the appropriateness of initial investigation (10.6%; 95% confidence interval [CI] -0.1% to 19.3%; decreasing by 1.2% per month post-implementation, 95% CI -2.5% to 0.1%) or clinical management (-0.3%; 95% CI -8.7% to 11.2%). Guideline development and implementation cost an estimated pound2784 per maternity unit in Scotland.Conclusions Clinical care of mild hypertension in pregnancy remains highly inconsistent. The lack of the intervention effect may be related to the complexity of the guideline recommendations and the nature of the implementation strategy.

AB - Objective To determine the impact of a national strategy to promote implementation of a guideline on the management of mild, non-proteinuric hypertension in pregnancy.Design Simple, interrupted time series analysis.Setting Four maternity units in Scotland.Population Women delivering a live or stillborn baby.Methods Dissemination of the guideline under the auspices of a national clinical effectiveness programme, supported by a national launch meeting and feedback from a survey of obstetricians highlighting aspects of care that could be improved.Main outcome measures Appropriateness of initial investigation and subsequent clinical management, and costs of guideline development and implementation activities.Data collection Twenty-four months pre-intervention and 12 months post-intervention data were abstracted from a random sample of case notes.Results Initial investigation was consistent with recommendations for 59.9% out of 1263 women and subsequent clinical management for 67.6% out of 1081 in whom a diagnosis could be made from available data. There were no significant changes in the appropriateness of initial investigation (10.6%; 95% confidence interval [CI] -0.1% to 19.3%; decreasing by 1.2% per month post-implementation, 95% CI -2.5% to 0.1%) or clinical management (-0.3%; 95% CI -8.7% to 11.2%). Guideline development and implementation cost an estimated pound2784 per maternity unit in Scotland.Conclusions Clinical care of mild hypertension in pregnancy remains highly inconsistent. The lack of the intervention effect may be related to the complexity of the guideline recommendations and the nature of the implementation strategy.

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