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

Journal of the American Heart Association
Anna P RalphJonathan Rhys Carapetis

Abstract

Health 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 impro...Continue Reading

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Citations

Jul 19, 2018·Journal of the American Heart Association·Clancy ReadAnna P Ralph
Apr 18, 2019·Australian and New Zealand Journal of Public Health·Joshua R FrancisKate Hardie
Nov 30, 2019·The Australian & New Zealand Journal of Obstetrics & Gynaecology·Chris O OngzalimaJudith M Katzenellenbogen
May 16, 2019·Current Cardiology Reviews·John A Woods, Judith M Katzenellenbogen
Dec 19, 2018·Journal of the American Heart Association·Jessica Langloh de DasselAnna P Ralph
Oct 20, 2020·Circulation·Raman Krishna KumarUNKNOWN American Heart Association Council on Lifelong Congenital Heart Disease and Heart Health in the Young; Council on Cardiovasc
Dec 20, 2020·Journal of Paediatrics and Child Health·Priya M KevatAlan R Ruben
Dec 18, 2020·Autoimmunity Reviews·Leanne M DooleyMichael Kotiw
Mar 12, 2021·The Lancet Child & Adolescent Health·Rosemary WyberJonathan Carapetis
May 25, 2021·Australian and New Zealand Journal of Public Health·Rosemary WyberUNKNOWN END RHD Communities Investigator and Advisory Group
Oct 3, 2021·Current Cardiology Reports·Joselyn RwebemberaBruno R Nascimento

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