Improving Delivery of Secondary Prophylaxis for Rheumatic Heart Disease in a High-Burden Setting: Outcome of a Stepped-Wedge, Community, Randomized Trial.

ABSTRACT:

Background

Health system strengthening is needed to improve delivery of secondary prophylaxis against rheumatic heart disease.

Methods and results

We undertook a stepped-wedge, randomized trial in northern Australia. Five pairs of Indigenous community clinics entered the study at 3-month steps. Study phases comprised a 12 month baseline phase, 3 month transition phase, 12 month intensive phase and a 3- to 12-month maintenance phase. Clinics received a multicomponent intervention supporting activities to improve penicillin delivery, aligned with the chronic care model, with continuous quality-improvement feedback on adherence. The primary outcome was the proportion receiving ≥80% of scheduled penicillin injections. Secondary outcomes included "days at risk" of acute rheumatic

SUBMITTER: Ralph AP 

PROVIDER: S-EPMC6064833 | biostudies-literature | 2018 Jul

REPOSITORIES: biostudies-literature