Antiplatelets in Pregnancy Collaboration

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SEA-ORCHID Project
South East Asia - Optimising Reproductive Child
Health Outcomes in Developing Countries
Centre for Perinatal Health Services Research,
University of Sydney Khon Kaen University,
Thailand Australasian Cochrane Centre, Monash
University University of Philippines,
Manila Womens Childrens Hospital, University
of Adelaide Royal College of Medicine Perak,
Ipoh, Malaysia Gajdah Mada University,
Jogjakarta, Indonesia
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(No Transcript)
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Broad scientific question

• Can the health of mothers and babies in Thailand,
  Indonesia, the Philippines and Malaysia be
• improved by
• increasing the capacity for research synthesis
• improving the implementation of effective
  interventions and
• identifying gaps in knowledge needing further
  research?

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Aims

• Designed to answer the following questions
• What is the current teaching and practice related
  to pregnancy and childbirth in SE Asia?
• What are the local barriers to the use of
  research in SE Asia and how can they be overcome?
• Will a targeted intervention to build capacity
  for the generation, evaluation and implementation
  of relevant evidence lead to improved research
  output, research implementation and health
  outcomes?

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Rationale

• access to reliable health information for workers
  in developing countries is potentially the single
  most cost effective and achievable strategy for
  sustainable improvement in health care
• changing behaviour of health workers is a complex
  process requiring a multi-dimensional approach
  that is flexible, participatory and relevant
• builds on the Collaborations experience and
  existing networks

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Methods

• Pre-intervention phase (2004-05)
• establishment of SE Asian nodes
• baseline data collection
• Intervention phase (2005-07)
• educating practitioners in evidence-based
  practice
• supporting the preparation of systematic reviews
  and the development of guidelines
• promoting effective dissemination and identifying
  research priorities
• academic exchange through fellowships and
  AUS-based Educator study tours
• Outcome reporting phase (2007-08)
• reassessment of the practice and outcomes
  measured in phase one
• ongoing dissemination of results

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Methodology

• Interrupted time series
• Multi-dimensional educational intervention
• Quantitative and qualitative evaluation
• Action research

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Project design
Pre-intervention phase (2004-05) Baseline
collection of primary secondary outcomes
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Primary outcomes

• 20 areas of current practice
• 10 health outcomes of mothers babies
• at least 1000 women admitted over 9-month period
  at each site (9000 women)
• To help answer
• were best practice recommendations applied?
• what are the impact of these practices on the
  health of mothers and babies?

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Primary outcomes - recommended practices being
measured

• magnesium sulphate for eclampsia and
  pre-eclampsia
• use of corticosteroids prior to pre-term birth
• continuous support for women in labour
• selective use of episiotomy
• active management for the third stage of labour
• vacuum rather than forceps for operative delivery
  
• intra-operative antibiotics at time of caesarean
  section

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Secondary outcomes - evidence-based practice
policy

• number and quality of guidelines in clinical
  practice
• level of research activity
• EBM in curriculum
• knowledge of evidence-based practice
• level of involvement in Cochrane activities
• Qualitative data collection
• analysis of barriers to practice change,
  including identification of locally specific
  barriers to use of clinical practices
• focus groups to identify knowledge, beliefs and
  attitudes about EBP

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Progress to date primary outcomes

• nine tertiary, regional and provincial hospitals
  selected
• web-based baseline data collection began March
  2005
• 8,500 births recorded
• (completion of baseline data by end November)

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Secondary outcomes and project milestones

• developed tools to measure secondary outcomes
• recruitment of three Australian-based clinical
  educators
• survey of practitioners knowledge of EBP
• recruitment of SEA-based educators and Australian
  study tour (Oct/Nov 2005)
• planning of the educational intervention
• program logical framework link

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Project design
Pre-intervention phase measuring primary
secondary outcomes

• Intervention phase (2005-07)
• training practitioners in evidence-based
  practice
• supporting the preparation of systematic reviews
  and guidelines
• promoting effective dissemination
• identifying research priorities

Post-intervention phase measuring primary
secondary outcomes
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Planned training activities

• Generators of evidence evidence-based
  materials systematic reviewers guideline
  developers
• Critical appraisal of evidence, systematic
  reviewing, guideline development
• Users of evidence clinicians policymakers
• Use of Cochrane Library Reproductive Health
  Library
• Implementation use of guidelines
• Accessing interpreting evidence
• Educators about evidence teachers trainers
• Provide material training on principals of
  evidence-based practice

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Educational interventions

• communicate aims, objectives, methods and
  evaluation
• actively involve learners in planning, delivery
  and evaluation of the program
• be experiential and problem-based
• be perceived by learners as directly relevant to
  their professional roles
• explicitly recognise and tackle barriers to
  learning
• involve cycles of action and reflection
• build mutual trust, respect and collaborative
  relationships
• consider a range of qualitative and quantitative
  outcomes

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Evaluation of interventions

• knowledge and skill development measured through
  clinical and educative practice changes
• learning processes assessed through reflective
  diary summaries and focus groups

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Expected outcomes

• positive impact on health of mothers babies
• establishment of network of researchers
  clinicians
• ongoing development of evidence-based practice
  policy
• capacity building

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Capacity building

• train clinicians to find, interpret and implement
  evidence
• ensure locally relevant evidence available
  accessible
• identify important questions for future local
  research
• base policy decisions on research findings
• develop and implement local clinical practice
  guidelines

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• We know what want to achieve and we know the sort
  of activities that will help get us there
• But at a practical level, with one fte educator,
  what are we actually going to do?
• Our biggest challenge

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www.seaorchid.org