Practice change intervention to improve antenatal care for alcohol consumption: a randomised stepped wedge controlled trial

Abstract

Introduction and Aims:Clinical guideline recommendations for addressing alcohol consumption in pregnancy are sub-optimally implemented by maternity services. The aim of this study was to determine the effectiveness of a practice change intervention in improving the provision of antenatal care addressing alcohol con-sumption during pregnancy. Design and Methods: A randomised stepped-wedge controlled trial was undertaken with maternity services in three health sectors of the Hunter New England Local Health District. All antenatal care pro-viders were subject to a seven-month multi-strategy intervention to support the introduction of a recommended model of care for addressing alcohol use in pregnancy. For 35 months (July 2017–May2020) outcome data were collected from randomly selected women following attendance at an initial, 27-28 weeks gestation and35-36 weeks gestation antenatal visit. Logistic regression models assessed intervention effectiveness. Results: A total of 5694 telephone/online surveys were completed with pregnant women. The intervention was effective in increasing receipt of assessment (odds ratio [OR] 2.63; 95% confidence interval[CI] 2.26-3.05;P<0.001), advice (OR 2.07; 95% CI 1.78-2.41;P<0.001), complete care (advice and referral) (OR 2.10; 95% CI1.80-2.44;P<0.001) and all guideline elements (OR 2.32; 95% CI1.94-2.76;P<0.001). Greater intervention effects were found at the27-28 and 35-36 weeks gestation visits compared to the initial ante-natal visit. No differences by health sector were found. Almost all women (98.8%) found the model of care acceptable. Discussions and Conclusions: The practice change intervention improved the provision of antenatal care addressing alcohol consumption in pregnancy. Future research is warranted to target elements of care that did not achieve optimal levels and to sustain improvements. Implications for Practice or Policy: The practice change approach utilised in this study could be adopted by maternity services to improve antenatal care addressing alcohol consumption in pregnancy. Disclosure of Interest Statement: This study was funded by a National Health and Medical Research Council Partnership Project grant (APP1113032)