Implementation of national antenatal hypertension guidelines: a multicentre multiple methods study
Objective To 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 hypertensio...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2020-10-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/10/e035762.full |
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| author | Hannah Wilson Heather Brown Jane Sandall Joanna Girling Lucy Chappell Rebecca Whybrow Louise Webster |
| author_facet | Hannah Wilson Heather Brown Jane Sandall Joanna Girling Lucy Chappell Rebecca Whybrow Louise Webster |
| author_sort | Hannah Wilson |
| collection | DOAJ |
| description | Objective To 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.Methods We 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 participants Pregnant women with chronic hypertension and their principal carers (obstetricians, midwives and physicians), at three National Health Service hospital trusts with different models of care.Results We 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.Conclusions Women’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. |
| format | Article |
| id | doaj-art-d319fc42e1e64905b5de637dbd14619c |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-10-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-d319fc42e1e64905b5de637dbd14619c2025-08-20T02:26:10ZengBMJ Publishing GroupBMJ Open2044-60552020-10-01101010.1136/bmjopen-2019-035762Implementation of national antenatal hypertension guidelines: a multicentre multiple methods studyHannah Wilson0Heather Brown1Jane Sandall2Joanna Girling3Lucy Chappell4Rebecca Whybrow5Louise Webster6Methodologies Department, King’s College London, London, UKRoyal Sussex County Hospital, Brighton, UKWomen and Children`s Health, King`s College London, London, UKWomen`s Health Service, Chelsea and Westminster Hospital NHS Foundation Trust, London, UKMethodologies Department, King’s College London, London, UKWomen and Children`s Health, King`s College London, London, UKWomen and Children`s Health, King`s College London, London, UKObjective To 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.Methods We 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 participants Pregnant women with chronic hypertension and their principal carers (obstetricians, midwives and physicians), at three National Health Service hospital trusts with different models of care.Results We 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.Conclusions Women’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.https://bmjopen.bmj.com/content/10/10/e035762.full |
| spellingShingle | Hannah Wilson Heather Brown Jane Sandall Joanna Girling Lucy Chappell Rebecca Whybrow Louise Webster Implementation of national antenatal hypertension guidelines: a multicentre multiple methods study BMJ Open |
| title | Implementation of national antenatal hypertension guidelines: a multicentre multiple methods study |
| title_full | Implementation of national antenatal hypertension guidelines: a multicentre multiple methods study |
| title_fullStr | Implementation of national antenatal hypertension guidelines: a multicentre multiple methods study |
| title_full_unstemmed | Implementation of national antenatal hypertension guidelines: a multicentre multiple methods study |
| title_short | Implementation of national antenatal hypertension guidelines: a multicentre multiple methods study |
| title_sort | implementation of national antenatal hypertension guidelines a multicentre multiple methods study |
| url | https://bmjopen.bmj.com/content/10/10/e035762.full |
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