Please use this identifier to cite or link to this item: https://hdl.handle.net/10137/7025
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dc.contributor.authorRalph APen
dc.contributor.authorde Dassel JLen
dc.contributor.authorKirby Aen
dc.contributor.authorRead Cen
dc.contributor.authorMitchell AGen
dc.contributor.authorMaguire GPen
dc.contributor.authorCurrie BJen
dc.contributor.authorBailie RSen
dc.contributor.authorJohnston Ven
dc.contributor.authorCarapetis JRen
dc.date2018en
dc.date.accessioned2018-08-10T06:41:58Zen
dc.date.available2018-08-10T06:41:58Zen
dc.date.issued2018-07-17en
dc.identifier.citationJournal of the American Heart Association 2018-07-17; 7(14)en
dc.identifier.urihttps://hdl.handle.net/10137/7025en
dc.description.abstractHealth system strengthening is needed to improve delivery of secondary prophylaxis against rheumatic heart disease. 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 fever recurrence related to late penicillin and acute rheumatic fever recurrence rates. Overall, 304 patients requiring prophylaxis were eligible. The proportion receiving ≥80% of scheduled injections during baseline was 141 of 304 (46%)-higher than anticipated. No effect attributable to the study was evident: in the intensive phase, 126 of 304 (41%) received ≥80% of scheduled injections (odds ratio compared with baseline: 0.78; 95% confidence interval, 0.54-1.11). There was modest improvement in the maintenance phase among high-adhering patients (43% received ≥90% of injections versus 30% [baseline] and 28% [intensive], P<0.001). Also, the proportion of days at risk in the whole cohort decreased in the maintenance phase (0.28 versus 0.32 [baseline] and 0.34 [intensive], P=0.001). Acute rheumatic fever recurrence rates did not differ between study sites during the intensive phase and the whole jurisdiction (3.0 versus 3.5 recurrences per 100 patient-years, P=0.65). This strategy did not improve adherence to rheumatic heart disease secondary prophylaxis within the study time frame. Longer term primary care strengthening strategies are needed. URL: www.anzctr.org.au. Unique identifier: ACTRN12613000223730.en
dc.language.isoengen
dc.subjectacute rheumatic feveren
dc.subjectadherenceen
dc.subjectcluster randomized trialen
dc.subjectquality improvementen
dc.subjectrheumatic heart diseaseen
dc.subjectsystems of careen
dc.titleImproving Delivery of Secondary Prophylaxis for Rheumatic Heart Disease in a High-Burden Setting: Outcome of a Stepped-Wedge, Community, Randomized Trial.en
dc.typeJournal Articleen
dc.identifier.journaltitleJournal of the American Heart Associationen
dc.identifier.doi10.1161/JAHA.118.009308en
dc.identifier.pubmedidhttps://www.ezpdhcs.nt.gov.au/login?url=https://www.ncbi.nlm.nih.gov/pubmed//30018165en
dc.identifier.affiliationMenzies School of Health Research, Darwin, Northern Territory, Australia anna.ralph@menzies.edu.au.. Charles Darwin University, Darwin, Northern Territory, Australia.. Royal Darwin Hospital, Darwin, Northern Territory, Australia..en
dc.identifier.affiliationCharles Darwin University, Darwin, Northern Territory, Australia..en
dc.identifier.affiliationNational Health and Medical Research Council Clinical Trials Centre, University of Sydney, New South Wales, Australia..en
dc.identifier.affiliationTelethon Kids Institute University of Western Australia, Perth, Western Australia, Australia.. Princess Margaret Hospital for Children, Perth, Western Australia, Australia..en
dc.identifier.affiliationMenzies School of Health Research, Darwin, Northern Territory, Australia..en
dc.identifier.affiliationBaker Heart and Diabetes Institute, Melbourne, Victoria, Australia..en
dc.identifier.affiliationMenzies School of Health Research, Darwin, Northern Territory, Australia.. Charles Darwin University, Darwin, Northern Territory, Australia.. Royal Darwin Hospital, Darwin, Northern Territory, Australia..en
dc.identifier.affiliationUniversity of Sydney University Centre for Rural Health, Lismore, New South Wales, Australia..en
dc.identifier.affiliationMenzies School of Health Research, Darwin, Northern Territory, Australia.. Medical School, Australian National University, Australian Capital Territory, Canberra, Australia..en
dc.identifier.affiliationTelethon Kids Institute University of Western Australia, Perth, Western Australia, Australia.. Princess Margaret Hospital for Children, Perth, Western Australia, Australia.. Perth Children's Hospital, Perth, Western Australia, Australia..en
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