Promoting effective reproductive health care

This thesis is concerned with approaches used by the Scottish Programme for Clinical Effectiveness in Reproductive Health (SPCERH) to improve quality of care. The work embraces two main themes: understanding factors that influence clinical practice; and evaluating strategies to improve practiceMany factors influence practice, such as the nature of targeted behaviours, professionals and organisations (Chapter 1). An observational study, of practice related to 42 audit recommendations in 16 gynaecology units, found that attributes of recommendations independently modified the effects of a national audit and feedback project (Chapter 2). Four evaluations of dissemination and implementation strategies were conducted. The first, a telephone survey of 201 obstetricians and midwives, highlighted gaps in awareness of national recommendations on the prevention of maternal mortality (Chapter 3). The second, a before-and-after postal survey of 92 obstetricians, found mixed changes in self-reported practice following the dissemination of four national obstetric guidelines (Chapter 4). The third, an interrupted time series analysis, evaluated trends in the care of 1263 women in four maternity units related to of these guidelines, on mild, non-proteinuric hypertension in pregnancy (Chapter 5). No improvements in the appropriateness of initial investigations and subsequent clinical management were found. The fourth study, a cluster randomised trial involving all 26 gynaecology units in Scotland, evaluated a strategy to promote a guideline on induced abortion care. The strategy, delivered under the auspices of SPCERH, comprised audit and feedback, educational meetings, dissemination of a structured case record, and promotion of patient information. The strategy was refined in the light of barriers identified following a pre-intervention case record review, interviews with gynaecologists and a theoretically-derived survey of 151 clinical staff (Chapter 6). Post-intervention compliance with guideline recommendations was assessed by a review of 1474 case records and a survey of 1028 patients. No intervention effect was observed, possibly related to high preintervention compliance with selected recommendations and the appropriateness of the implementation strategy (Chapter 7).The choices of study design were determined by SPCERHs' objectives, available time and resources. More rigorous designs were judged to be less susceptible to bias (Chapter 8). All studies were of moderate to high generalisability to secondary care professionals targeted by SPCERH activities. Recommendations are made for future evaluations of implementation activities (Chapter 9)

System-wide approaches to antimicrobial therapy and antimicrobial resistance in the UK: the AMR-X framework

Antimicrobial resistance (AMR) threatens human, animal, and environmental health. Acknowledging the urgency of addressing AMR, an opportunity exists to extend AMR action-focused research beyond the confines of an isolated biomedical paradigm. An AMR learning system, AMR-X, envisions a national network of health systems creating and applying optimal use of antimicrobials on the basis of their data collected from the delivery of routine clinical care. AMR-X integrates traditional AMR discovery, experimental research, and applied research with continuous analysis of pathogens, antimicrobial uses, and clinical outcomes that are routinely disseminated to practitioners, policy makers, patients, and the public to drive changes in practice and outcomes. AMR-X uses connected data-to-action systems to underpin an evaluation framework embedded in routine care, continuously driving implementation of improvements in patient and population health, targeting investment, and incentivising innovation. All stakeholders co-create AMR-X, protecting the public from AMR by adapting to continuously evolving AMR threats and generating the information needed for precision patient and population care

System-wide approaches to antimicrobial therapy and antimicrobial resistance in the UK: the AMR-X framework

Antimicrobial resistance (AMR) threatens human, animal, and environmental health. Acknowledging the urgency of addressing AMR, an opportunity exists to extend AMR action-focused research beyond the confines of an isolated biomedical paradigm. An AMR learning system, AMR-X, envisions a national network of health systems creating and applying optimal use of antimicrobials on the basis of their data collected from the delivery of routine clinical care. AMR-X integrates traditional AMR discovery, experimental research, and applied research with continuous analysis of pathogens, antimicrobial uses, and clinical outcomes that are routinely disseminated to practitioners, policy makers, patients, and the public to drive changes in practice and outcomes. AMR-X uses connected data-to-action systems to underpin an evaluation framework embedded in routine care, continuously driving implementation of improvements in patient and population health, targeting investment, and incentivising innovation. All stakeholders co-create AMR-X, protecting the public from AMR by adapting to continuously evolving AMR threats and generating the information needed for precision patient and population care.</p

System-wide approaches to antimicrobial therapy and antimicrobial resistance in the UK: the AMR-X framework

Antimicrobial resistance (AMR) threatens human, animal, and environmental health. Acknowledging the urgency of addressing AMR, an opportunity exists to extend AMR action-focused research beyond the confines of an isolated biomedical paradigm. An AMR learning system, AMR-X, envisions a national network of health systems creating and applying optimal use of antimicrobials on the basis of their data collected from the delivery of routine clinical care. AMR-X integrates traditional AMR discovery, experimental research, and applied research with continuous analysis of pathogens, antimicrobial uses, and clinical outcomes that are routinely disseminated to practitioners, policy makers, patients, and the public to drive changes in practice and outcomes. AMR-X uses connected data-to-action systems to underpin an evaluation framework embedded in routine care, continuously driving implementation of improvements in patient and population health, targeting investment, and incentivising innovation. All stakeholders co-create AMR-X, protecting the public from AMR by adapting to continuously evolving AMR threats and generating the information needed for precision patient and population care.</p