PDF(Pubmed)
Abstract：
BACKGROUND: Preterm birth is a leading cause of perinatal morbidity and mortality and a defining event for pregnant people, infants, and whānau (extended families). Recommendations have been made for a national preterm birth prevention initiative focusing on equity in Aotearoa New Zealand, including the development of a national best practice guide. An understanding of the number and quality of guidelines, and consideration of their suitability and impact on equity is required.
METHODS: Guidelines were identified through a systematic literature search, search of professional bodies websites, and invitation to regional health services in Aotearoa New Zealand. Obstetric and midwifery clinical directors were invited to report on guideline use. Identified guidelines were appraised by a 23-member trans-disciplinary Review Panel; quantitatively using the AGREE-II instrument and qualitatively using modified ADAPTE questions. The quality of guidelines available but not in use was compared against those in current use, and by health services by level of maternity and neonatal care. Major themes affecting implementation and impact on equity were identified using Braun and Clarke methodology.
RESULTS: A total of 235 guidelines were included for appraisal. Guidelines available but not in use by regional health services scored higher in quality than guidelines in current use (median domain score Rigour and Development 47.5 versus 18.8, p < 0.001, median domain score Overall Assessment 62.5 versus 44.4, p < 0.001). Guidelines in use by regional health services with tertiary maternity and neonatal services had higher median AGREE II scores in several domains, than those with secondary level services (median domain score Overall Assessment 50.0 versus 37.5, p < 0.001). Groups identified by the Review Panel as experiencing the greatest constraints and limitations to guideline implementation were rural, provincial, low socioeconomic, Māori, and Pacific populations. Identified themes to improve equity included a targeted approach to groups experiencing the least advantage; a culturally considered approach; nationally consistent guidance; and improved funding to support implementation of guideline recommendations.
CONCLUSIONS: We have systematically identified and assessed guidelines on preterm birth. High-quality guidelines will inform a national best practice guide for use in Taonga Tuku Iho, a knowledge translation project for equity in preterm birth care and outcomes in Aotearoa.
METHODS: Guidelines were identified through a systematic literature search, search of professional bodies websites, and invitation to regional health services in Aotearoa New Zealand. Obstetric and midwifery clinical directors were invited to report on guideline use. Identified guidelines were appraised by a 23-member trans-disciplinary Review Panel; quantitatively using the AGREE-II instrument and qualitatively using modified ADAPTE questions. The quality of guidelines available but not in use was compared against those in current use, and by health services by level of maternity and neonatal care. Major themes affecting implementation and impact on equity were identified using Braun and Clarke methodology.
RESULTS: A total of 235 guidelines were included for appraisal. Guidelines available but not in use by regional health services scored higher in quality than guidelines in current use (median domain score Rigour and Development 47.5 versus 18.8, p < 0.001, median domain score Overall Assessment 62.5 versus 44.4, p < 0.001). Guidelines in use by regional health services with tertiary maternity and neonatal services had higher median AGREE II scores in several domains, than those with secondary level services (median domain score Overall Assessment 50.0 versus 37.5, p < 0.001). Groups identified by the Review Panel as experiencing the greatest constraints and limitations to guideline implementation were rural, provincial, low socioeconomic, Māori, and Pacific populations. Identified themes to improve equity included a targeted approach to groups experiencing the least advantage; a culturally considered approach; nationally consistent guidance; and improved funding to support implementation of guideline recommendations.
CONCLUSIONS: We have systematically identified and assessed guidelines on preterm birth. High-quality guidelines will inform a national best practice guide for use in Taonga Tuku Iho, a knowledge translation project for equity in preterm birth care and outcomes in Aotearoa.
摘要：
背景：早产是围产期发病率和死亡率的主要原因，也是孕妇的决定性事件，婴儿,和whānau（大家庭）。已就新西兰奥特罗阿的国家早产预防倡议提出了建议，该倡议侧重于公平，包括制定国家最佳做法指南。了解准则的数量和质量，并考虑其适宜性和对权益的影响。
方法：通过系统的文献检索确定了指南，搜索专业机构网站，并邀请新西兰奥特罗阿的区域卫生服务。产科和助产临床主任被邀请报告指南使用情况。由23名成员组成的跨学科审查小组对确定的指南进行了评估；定量使用AGREE-II工具，定性使用修改后的ADAPTE问题。将现有但未使用的指南的质量与当前使用的指南进行了比较，以及按产妇和新生儿保健水平分列的保健服务。使用Braun和Clarke方法确定了影响实施和对公平的影响的主要主题。
结果：共纳入235个指南进行评估。区域卫生服务机构可用但未使用的指南的质量得分高于当前使用的指南（中位数领域评分RigourandDevelopment47.5vs18.8，p<0.001，中位数领域评分总体评估62.5vs44.4，p<0.001）。区域卫生服务机构使用的具有三级产妇和新生儿服务的指南在几个领域的AGREEII得分中位数较高，比那些有二级服务的人(中位领域评分总体评估50.0对37.5，p<0.001)。审查小组确定的在执行准则方面遇到最大制约和限制的群体是农村，省,低社会经济，毛利人,太平洋人口。确定的改善公平的主题包括对优势最小的群体采取有针对性的方法；一种文化上考虑的方法；国家一致的指导；以及改善资金以支持实施准则建议。
结论：我们已经系统地确定并评估了早产指南。高质量的指南将为在TaongaTukuIho使用的国家最佳实践指南提供信息，Aotearoa的早产护理和结局公平性知识翻译项目。
方法：通过系统的文献检索确定了指南，搜索专业机构网站，并邀请新西兰奥特罗阿的区域卫生服务。产科和助产临床主任被邀请报告指南使用情况。由23名成员组成的跨学科审查小组对确定的指南进行了评估；定量使用AGREE-II工具，定性使用修改后的ADAPTE问题。将现有但未使用的指南的质量与当前使用的指南进行了比较，以及按产妇和新生儿保健水平分列的保健服务。使用Braun和Clarke方法确定了影响实施和对公平的影响的主要主题。
结果：共纳入235个指南进行评估。区域卫生服务机构可用但未使用的指南的质量得分高于当前使用的指南（中位数领域评分RigourandDevelopment47.5vs18.8，p<0.001，中位数领域评分总体评估62.5vs44.4，p<0.001）。区域卫生服务机构使用的具有三级产妇和新生儿服务的指南在几个领域的AGREEII得分中位数较高，比那些有二级服务的人(中位领域评分总体评估50.0对37.5，p<0.001)。审查小组确定的在执行准则方面遇到最大制约和限制的群体是农村，省,低社会经济，毛利人,太平洋人口。确定的改善公平的主题包括对优势最小的群体采取有针对性的方法；一种文化上考虑的方法；国家一致的指导；以及改善资金以支持实施准则建议。
结论：我们已经系统地确定并评估了早产指南。高质量的指南将为在TaongaTukuIho使用的国家最佳实践指南提供信息，Aotearoa的早产护理和结局公平性知识翻译项目。
