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Uniject, Training and Reminders to Increase the Use of Prophylactic Oxytocin for the Management of the Third Stage of Labor in Latin America. Institute for Clinical Effectiveness and Health Policy (IECS) , Buenos Aires, Argentina. Fernando Althabe.

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Fernando althabe l.jpg

Uniject, Training and Reminders to Increase the Use of Prophylactic Oxytocin for the Management of the Third Stage of Labor in Latin America

Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina

Fernando Althabe

Tackling the biggest maternal killer: Progress and

challenges in preventing postpartum hemorrhage

Woodrow Wilson International Center for Scholars

Washington, DC

Friday, November 20, 2009


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A behavioral intervention to improve adoption of evidence-based clinical care: the Global Network Guidelines Trial

Fernando Althabe

José M Belizán

Pierre Buekens

Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina

School of Public Health and Tropical Medicine, Tulane University

Global Network for Women’s and Children’s Health Research


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Objective evidence-based clinical care: the Global Network Guidelines Trial

  • To design an evaluate a multifaceted behavioral intervention to facilitate the adoption of evidence-based practices in Latin American maternity hospitals


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The evidence-based clinical care: the Global Network Guidelines Trial

Intervention

The Intervention

  • Implementation &

  • maintenance

  • Training

  • Reminders

  • Audit & feedback

  • Selection of opinion leaders

  • Peer nomination

  • 3 - 6 per hospital

  • Guideline dissemination

  • Academic detailing

  • Computer and bibliography

  • Guidelines workshop

  • Development

  • Training on academic detailing

Formativeresearch


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Trial Design and Timeline evidence-based clinical care: the Global Network Guidelines Trial


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Follow-up at one year evidence-based clinical care: the Global Network Guidelines Trial Active management


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Follow-up at one year evidence-based clinical care: the Global Network Guidelines Trial Episiotomy


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Following questions evidence-based clinical care: the Global Network Guidelines Trial

  • Is this intervention feasible in other settings?

  • Can the effects be replicated?

    • CAMBIO project

  • Can we simplify the intervention an still show effect?

    • Uniject study


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Uniject, Training and Reminders evidence-based clinical care: the Global Network Guidelines Trial Intervention


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Oxytocin Unijects evidence-based clinical care: the Global Network Guidelines Trial

BIOL, Argentina


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Training evidence-based clinical care: the Global Network Guidelines Trial

  • Evidence on prophylactic oxytocin

  • How to administer

    • Vials & syringes

    • Unijects

  • Training using JHPIEGO model

  • 2-3 hs


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Use of Reminders evidence-based clinical care: the Global Network Guidelines Trial


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Methods- Study Design evidence-based clinical care: the Global Network Guidelines Trial

Use of Prophylactic Oxytocin

Baseline Intervention

80%

60%

40%

10%

Presentationseminar

0

1

3

5

6

7

8

4

9

2

10

11

12

Month of data collection


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Setting evidence-based clinical care: the Global Network Guidelines Trial

  • 5 1st-2nd level maternity hospitals

  • Province of Corrientes


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Outcome Measures evidence-based clinical care: the Global Network Guidelines Trial

Primary outcome:

Rate of use of prophylactic oxytocin

Secondary outcomes:

Use of controlled cord traction

Use of uterine massage

Rate of use of oxytocin through Uniject

Maternal admissions to ICU, blood transfusions, and post-partum interventions

Birth attendants’ views of AMTSL and acceptability of Uniject


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Maternal and Childbirth Characteristics evidence-based clinical care: the Global Network Guidelines Trial

* Mean and S.D of the women.

** Median of the rates of the five hospitals [Minimum - Maximum]


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Results evidence-based clinical care: the Global Network Guidelines Trial

* Median of the rates of the 5 hospitals

** The median of the differences is calculated based on the difference between the intervention rate and the baseline rate for each hospital.





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Preliminary Conclusions hospital

  • The 3-component intervention is feasible in the context of small maternity hospitals.

  • It is probably effective to increase the use of prophylactic oxytocin, CCT and uterine massage.

  • Uniject was well accepted and used by birth atendants


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Thank you! hospital

falthabe@iecs.org.ar