(P283) Using implementation science to develop an adaptable clinical systems implementation package to embed routine syphilis screening in later pregnancy into clinical practice.

Project

Implementation of routine syphilis screening in later pregnancy at antenatal services across Victoria, Australia.



Issue

Syphilis is increasing among women globally, leading to an increase in congenital syphilis in many countries. Screening for syphilis in later pregnancy could help prevent congenital syphilis but is generally only advised for women identified as being at high risk for infection. However, there are barriers to the identification of risk. This project adopted an implementation science approach to embed syphilis screening into the routine 28-week antenatal clinic visit undertaken by pregnant women across several antenatal services in Victoria with differing health service systems.

Results

Data analysis from seven metropolitan and rural antenatal services informed the development of a low-cost implementation package to support practice change, with routine syphilis screening at the 28-week visit. The package comprises four core elements: (1) clinical guidelines recommending routine inclusion of syphilis serology with other blood tests taken for the 28-week visit; (2) automation of pathology ordering that includes syphilis testing with other tests; (3) clinician reminders within clinical records; and (4) training and resources for midwives and obstetricians including an educational video on screening and management for syphilis (Table 1). Use of a hybrid implementation framework identified contextual and behavioural barriers and facilitators that guided the development and integration of these elements to fit within existing clinical workflows and systems, including different systems for pathology ordering and electronic records. The Consolidated Framework for Implementation Research facilitated a deep contextual analysis of the intervention settings, informing tailored implementation strategies. The COM-B model for behaviour change assessed motivation, capability, and opportunity for change, which informed the development of training and resources.





Lessons learned:

Applying a change in process across varied health service settings required a deep contextual analysis of existing systems, local practices and resources within each setting. Meaningful engagement with clinical staff underpinned by implementation frameworks enabled identification of key elements for implementation that can be tailored according to local conditions. The resulting implementation package could be useful across a variety of healthcare settings to address the preventable epidemic of congenital syphilis.