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Trial registered on ANZCTR
Registration number
ACTRN12625000423415p
Ethics application status
Submitted, not yet approved
Date submitted
8/04/2025
Date registered
8/05/2025
Date last updated
8/05/2025
Date data sharing statement initially provided
8/05/2025
Type of registration
Prospectively registered
Titles & IDs
Public title
Does offering a combination of video health and face-to-face visits for antenatal care result in improved patient experience and is it as safe as standard (face-to-face) care? A co-designed non-inferiority randomised controlled trial.
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Scientific title
Does offering a combination of video health and face-to-face visits for antenatal care result in improved patient experience and is it as safe as standard (face-to-face) care? A co-designed non-inferiority randomised controlled trial.
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Secondary ID [1]
313151
0
NHMRC Application ID: 2032615
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Universal Trial Number (UTN)
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Trial acronym
TULIP
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Linked study record
ACTRN12622000915752 is the feasibility study conducted prior to this RCT.
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Health condition
Health condition(s) or problem(s) studied:
pregnancy
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antenatal care
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Condition category
Condition code
Reproductive Health and Childbirth
331983
331983
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0
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Antenatal care
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
This study will have two arms – the intervention: combined video-based telehealth and face-to-face pregnancy care; and the control: all face-to-face pregnancy care.
Women allocated to the intervention will have a combination of video-based telehealth and face-to-face visits (consumer led, a minimum of one up to a maximum of five telehealth visits and the remainder face-to-face), from 20 weeks gestation. The following is the expected schedule of visits for the intervention:
20-22 weeks gestation: Either midwife appointment telehealth OR midwife appointment face-to-face. If telehealth: Midwife reviews and discusses patients’ morphology ultrasound, if occurs prior to this appointment, organises further ultrasounds if required, assesses maternal and fetal health and concerns via discussion (e.g., fetal movement, presence/occurrence of pain/bleeding etc.), answers questions and provides education and screening appropriate to gestation, individual needs, and hospital guidelines. Midwife reviews recent tests if occurred prior to this appointment and organises further testing/management if required. Midwife organises gestational diabetes testing and any other testing appropriate to risk factors/indication prior to next appointment. Midwife records recent blood pressure (taken at home prior to appointment) and acts upon if required. Duration 20 minutes.
If midwife appointment face-to-face: Midwife reviews and discusses patients’ morphology ultrasound, if occurs prior to this appointment, organises further ultrasounds if required, assesses maternal and fetal health and concerns via discussion (e.g., fetal movement, presence/occurrence of pain/bleeding etc.), answers questions and provides education and screening appropriate to gestation, individual needs, and hospital guidelines. Midwife reviews recent tests if occurred prior to this appointment and organises further testing/management if required. Midwife organises gestational diabetes testing and any other testing appropriate to risk factors/indication prior to next appointment. Midwife measures blood pressure and acts upon any abnormal findings. Duration 20 minutes
26-28 weeks gestation: Either midwife appointment telehealth OR midwife appointment face-to-face. If telehealth*: Midwife reviews and discusses patients’ morphology ultrasound if occurred post last appointment, assesses maternal and fetal health and concerns via discussion (e.g., fetal movement, presence/occurrence of pain/bleeding etc.), answers questions and provides education and screening appropriate to gestation, individual needs, and hospital guidelines. Midwife reviews recent tests/ultrasounds if occurred prior to this appointment and organises further testing/management if required. Midwife records symphysis-pubis fundal height measurement that has been self-measured by the woman and acts upon if required. Midwife records recent blood pressure (taken at home prior to appointment) and acts upon if required. Duration 20 minutes
If midwife appointment face-to-face: Midwife reviews and discusses patients’ morphology ultrasound if occurred post last appointment, assesses maternal and fetal health and concerns via discussion (e.g., fetal movement, presence/occurrence of pain/bleeding etc.), answers questions and provides education and screening appropriate to gestation, individual needs, and hospital guidelines. Midwife reviews recent tests/ultrasounds if occurred prior to this appointment and organises further testing/management if required. Midwife carries out symphysis-pubis fundal height measurement, abdominal palpation for fetal position, fetal heart rate auscultation and measures blood pressure and acts upon any abnormal findings. If the woman is a negative blood group, Anti-D is administered. Duration 20 minutes.
30-31 weeks gestation: Either midwife appointment telehealth OR midwife appointment face-to-face. Midwife appointment telehealth: Midwife assesses maternal and fetal health and concerns via discussion (e.g., fetal movement, presence/occurrence of pain/bleeding etc.), answers questions and provides education and screening appropriate to gestation, individual needs, and hospital guidelines. Midwife reviews any recent tests/ultrasounds and organises further testing/management if required. Midwife records symphysis-pubis fundal height measurement that has been self-measured by the woman and acts upon if required. Midwife records recent blood pressure (taken at home prior to appointment) and acts upon if required. Duration 20 minutes.
Midwife appointment face-to-face: Midwife assesses maternal and fetal health and concerns via discussion (e.g., fetal movement, presence/occurrence of pain/bleeding etc.), answers questions and provides education and screening appropriate to gestation, individual needs, and hospital guidelines. Midwife reviews any recent tests/ultrasounds and organises further testing/management if required. Midwife carries out symphysis-pubis fundal height measurement, abdominal palpation for fetal position, fetal heart rate auscultation and measures blood pressure and acts upon any abnormal findings. Duration 20 minutes.
34 weeks gestation: Either midwife appointment telehealth OR midwife appointment face-to-face. Midwife appointment telehealth*: Midwife assesses maternal and fetal health and concerns via discussion (e.g., fetal movement, presence/occurrence of pain/bleeding etc.), answers questions and provides education and screening appropriate to gestation, individual needs, and hospital guidelines. Midwife reviews any recent tests/ultrasounds and organises further testing/management if required. Midwife records symphysis-pubis fundal height measurement that has been self-measured by the woman and acts upon if required. Midwife records recent blood pressure (taken at home prior to appointment) and acts upon if required. Duration 20 minutes.
Midwife appointment face-to-face: Midwife assesses maternal and fetal health and concerns via discussion (e.g., fetal movement, presence/occurrence of pain/bleeding etc.), answers questions and provides education and screening appropriate to gestation, individual needs, and hospital guidelines. Midwife reviews any recent tests/ultrasounds and organises further testing/management if required. Midwife carries out symphysis-pubis fundal height measurement, abdominal palpation for fetal position, fetal heart rate auscultation and measures blood pressure and acts upon any abnormal findings. If the woman is a negative blood group, Anti-D is administered. Duration 20 minutes.
36 weeks gestation: Midwife appointment face-to-face: Midwife assesses maternal and fetal health and concerns via discussion (e.g., fetal movement, presence/occurrence of pain/bleeding etc.), answers questions and provides education and screening appropriate to gestation, individual needs, and hospital guidelines. Midwife reviews recent tests/ultrasounds if occurred prior to this appointment and organises further testing/management if required. Midwife carries out symphysis-pubis fundal height measurement, abdominal palpation for fetal position, fetal heart rate auscultation and measures blood pressure and acts upon any abnormal findings. If woman consents, midwife organises Group B Streptococcus testing. Duration 20 minutes.
38 weeks gestation: Either midwife appointment telehealth OR midwife appointment face-to-face. Midwife appointment telehealth: Midwife assesses maternal and fetal health and concerns via discussion (e.g., fetal movement, presence/occurrence of pain/bleeding etc.), answers questions and provides education and screening appropriate to gestation, individual needs, and hospital guidelines. Midwife reviews any recent tests/ultrasounds and organises further testing/management if required. Midwife records symphysis-pubis fundal height measurement that has been self-measured by the woman and acts upon if required. Midwife records recent blood pressure (taken at home prior to appointment) and acts upon if required. Duration 20 minutes.
Midwife appointment face-to-face: Midwife assesses maternal and fetal health and concerns via discussion (e.g., fetal movement, presence/occurrence of pain/bleeding etc.), answers questions and provides education and screening appropriate to gestation, individual needs, and hospital guidelines. Midwife reviews any recent tests/ultrasounds and organises further testing/management if required. Midwife carries out symphysis-pubis fundal height measurement, abdominal palpation for fetal position, fetal heart rate auscultation and measures blood pressure and acts upon any abnormal findings. Duration 20 minutes.
40 weeks gestation: Midwife appointment face-to-face: Midwife assesses maternal and fetal health and concerns via discussion (e.g., fetal movement, presence/occurrence of pain/bleeding etc.), answers questions and provides education and screening appropriate to gestation, individual needs, and hospital guidelines. Midwife reviews recent tests/ultrasounds if occurred prior to this appointment and organises further testing/management if required. Midwife carries out symphysis-pubis fundal height measurement, abdominal palpation for fetal position, fetal heart rate auscultation and measures blood pressure and acts upon any abnormal findings. Duration 20 minutes.
41 weeks gestation: Midwife appointment face-to-face: Midwife assesses maternal and fetal health and concerns via discussion (e.g., fetal movement, presence/occurrence of pain/bleeding etc.), answers questions and provides education and screening appropriate to gestation, individual needs, and hospital guidelines. Midwife reviews recent tests/ultrasounds if occurred prior to this appointment and organises further testing/management if required. Midwife carries out symphysis-pubis fundal height measurement, abdominal palpation for fetal position, fetal heart rate auscultation and measures blood pressure and acts upon any abnormal findings. Midwife organises follow up for induction of labour planning as per hospital guidelines. Duration 20 minutes.
*Where the woman is a negative blood group, this appointment will be made face-to-face to accommodate anti-D administration.
The visits at 36, 40, and 41 weeks gestation will be face-to-face. As telehealth visits will be conducted via video, routine physically examinations such as fundal height (measurement to monitor growth of the fetus), abdominal palpation for fetal position, auscultation of the fetal heart and blood pressure measurement will not be able to be undertaken during the appointment. Each woman randomised to combined care will be shown how to self-measure their symphysis pubis fundal height and will be provided with written instructions and a video to support them with this. Women will be asked to measure their sysmphysis pubis funal height prior to each telehealth appointment. Each woman randomised to combined care will be provided with a blood pressure machine, shown how to use it by the research midwife, provided with written instructions, and asked to take her blood pressure before each telehealth appointment.
Women will not need to decide their whole schedule in advance. The Government funded Health Direct portal, a free national encrypted web-based virtual public health service will be used for video-health calls. As it is a portal, women do not need to download an app, which is likely to increase ease of use and acceptability.
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Intervention code [1]
329723
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Prevention
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Comparator / control treatment
Control: All face-to-face pregnancy care
20-22 weeks gestation: Midwife appointment face-to-face: Midwife reviews and discusses patients’ morphology ultrasound, if occurs prior to this appointment, organises further ultrasounds if required, assesses maternal and fetal health and concerns via discussion (e.g., fetal movement, presence/occurrence of pain/bleeding etc.), answers questions and provides education and screening appropriate to gestation, individual needs, and hospital guidelines. Midwife reviews recent tests if occurred prior to this appointment and organises further testing/management if required. Midwife organises gestational diabetes testing and any other testing appropriate to risk factors/indication prior to next appointment. Midwife measures blood pressure and acts upon any abnormal findings. Duration 20 minutes.
26-28 weeks gestation: Midwife appointment face-to-face: Midwife reviews and discusses patients’ morphology ultrasound if occurred post last appointment, assesses maternal and fetal health and concerns via discussion (e.g., fetal movement, presence/occurrence of pain/bleeding etc.), answers questions and provides education and screening appropriate to gestation, individual needs, and hospital guidelines. Midwife reviews recent tests/ultrasounds if occurred prior to this appointment and organises further testing/management if required. Midwife carries out symphysis-pubis fundal height measurement, abdominal palpation for fetal position, fetal heart rate auscultation and measures blood pressure and acts upon any abnormal findings. If the woman is a negative blood group, Anti-D is administered. Duration 20 minutes.
30-31 weeks gestation: Midwife appointment face-to-face: Midwife assesses maternal and fetal health and concerns via discussion (e.g., fetal movement, presence/occurrence of pain/bleeding etc.), answers questions and provides education and screening appropriate to gestation, individual needs, and hospital guidelines. Midwife reviews any recent tests/ultrasounds and organises further testing/management if required. Midwife carries out symphysis-pubis fundal height measurement, abdominal palpation for fetal position, fetal heart rate auscultation and measures blood pressure and acts upon any abnormal findings. Duration 20 minutes.
34 weeks gestation: Midwife appointment face-to-face: Midwife assesses maternal and fetal health and concerns via discussion (e.g., fetal movement, presence/occurrence of pain/bleeding etc.), answers questions and provides education and screening appropriate to gestation, individual needs, and hospital guidelines. Midwife reviews any recent tests/ultrasounds and organises further testing/management if required. Midwife carries out symphysis-pubis fundal height measurement, abdominal palpation for fetal position, fetal heart rate auscultation and measures blood pressure and acts upon any abnormal findings. If the woman is a negative blood group, Anti-D is administered. Duration 20 minutes.
36 weeks gestation: Midwife appointment face-to-face: Midwife assesses maternal and fetal health and concerns via discussion (e.g., fetal movement, presence/occurrence of pain/bleeding etc.), answers questions and provides education and screening appropriate to gestation, individual needs, and hospital guidelines. Midwife reviews recent tests/ultrasounds if occurred prior to this appointment and organises further testing/management if required. Midwife carries out symphysis-pubis fundal height measurement, abdominal palpation for fetal position, fetal heart rate auscultation and measures blood pressure and acts upon any abnormal findings. If woman consents, midwife organises Group B Streptococcus testing. Duration 20 minutes.
38 weeks gestation: Midwife appointment face-to-face: Midwife assesses maternal and fetal health and concerns via discussion (e.g., fetal movement, presence/occurrence of pain/bleeding etc.), answers questions and provides education and screening appropriate to gestation, individual needs, and hospital guidelines. Midwife reviews any recent tests/ultrasounds and organises further testing/management if required. Midwife carries out symphysis-pubis fundal height measurement, abdominal palpation for fetal position, fetal heart rate auscultation and measures blood pressure and acts upon any abnormal findings. Duration 20 minutes.
40 weeks gestation: Midwife appointment face-to-face: Midwife assesses maternal and fetal health and concerns via discussion (e.g., fetal movement, presence/occurrence of pain/bleeding etc.), answers questions and provides education and screening appropriate to gestation, individual needs, and hospital guidelines. Midwife reviews any recent tests/ultrasounds and organises further testing/management if required. Midwife carries out symphysis-pubis fundal height measurement, abdominal palpation for fetal position, fetal heart rate auscultation and measures blood pressure and acts upon any abnormal findings. Duration 20 minutes.
41 weeks gestation: Midwife appointment face-to-face: Midwife assesses maternal and fetal health and concerns via discussion (e.g., fetal movement, presence/occurrence of pain/bleeding etc.), answers questions and provides education and screening appropriate to gestation, individual needs, and hospital guidelines. Midwife reviews recent tests/ultrasounds if occurred prior to this appointment and organises further testing/management if required. Midwife carries out symphysis-pubis fundal height measurement, abdominal palpation for fetal position, fetal heart rate auscultation and measures blood pressure and acts upon any abnormal findings. Midwife organises follow up for induction of labour planning as per hospital guidelines. Duration 20 minutes.
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Control group
Active
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Outcomes
Primary outcome [1]
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Composite outcome – proportion of participants who experience of any one (or more) of the adverse neonatal or maternal outcomes: • neonatal – preterm birth, small for gestational age at greater than or equal to 40 weeks, fetal growth restriction at greater than or equal to 40 weeks, macrosomia at greater than or equal to 4500g), term admission to Special Care Nursery/Neonatal Intensive Care, fetal death in utero, stillbirth, APGAR score less than 7 at five minutes post birth; • maternal– eclampsia, pre-eclampsia with severe features (e.g., HELLP syndrome), Intensive Care Unit/High Dependency Unit admission, death.
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Assessment method [1]
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This will be measured by assessing routinely collected clinical data from electronic/medical record
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Timepoint [1]
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At three months post birth of last baby in study
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Primary outcome [2]
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Primary consumer experience outcome - proportion of women rating overall care in pregnancy as '6' or '7' on a Likert-type scale where ‘1’ is ‘Very poor’ and ‘7’ is ‘Very good’.
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Assessment method [2]
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A 7-point likert-type scale used extensively by the team previously with a global question “Overall, how would you describe your care during pregnancy” where ‘1’ is ‘Very poor’ and ‘7’ is ‘Very good’
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Timepoint [2]
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This will be assessed at 4 months postpartum.
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Secondary outcome [1]
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Rate of attendance for routine pregnancy care
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Assessment method [1]
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Examining attendance within the medical record.
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Timepoint [1]
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Post birth.
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Secondary outcome [2]
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Depression symptoms
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Assessment method [2]
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Using the Edinburgh Postnatal Depression Scale (EPDS)
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Timepoint [2]
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Measured at 36 weeks gestation and four months post birth
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Secondary outcome [3]
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Breastfeeding intention
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Assessment method [3]
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Participants will be asked: "Are you planning to breastfeed your baby?" and "How long do you plan to breastfeed your baby?"
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Timepoint [3]
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Baseline at recruitment and at 36 weeks gestation.
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Secondary outcome [4]
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Anxiety symptoms
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Assessment method [4]
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DASS-21 (anxiety scale)
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Timepoint [4]
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Measured at 36 weeks gestation and four months post birth
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Secondary outcome [5]
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Breastfeeding initiation
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Assessment method [5]
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Initiation data from medical record after birth
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Timepoint [5]
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Data collected up to discharge from hospital care.
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Secondary outcome [6]
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Maintenance of breastfeeding
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Assessment method [6]
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Asking at four month survey post birth if any breast milk feeding using questions extensively used by the team previously. It is not a validated scale but they are questions that the team have developed, used and published on extensively. It is complex to measure breastfeeding so we need to use this method. Here are two papers published using these questions: McLardie-Hore FE,Forster DA, McLachlan HL, Shafiei T, Amir L, Davey M-A, Grimes H, Gold L. (2023) Is proactive telephone-based breastfeeding peer support a cost-effective intervention? A within-trial cost-effectiveness analysis of the ‘Ringing Up about Breastfeeding earlY’ (RUBY) randomised controlled trial. BMJ Open. 13:e067049 doi:10.1136/ bmjopen-2022-067049 and Forster, D., McLachlan, H., Lumley, J. et al. ABFAB. Attachment to the breast and family attitudes to breastfeeding. The effect of breastfeeding education in the middle of pregnancy on the initiation and duration of breastfeeding: a randomised controlled trial [ISRCTN21556494]. BMC Pregnancy Childbirth 3, 5 (2003). https://doi.org/10.1186/1471-2393-3-5
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Timepoint [6]
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Four months post birth.
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Secondary outcome [7]
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Baby born before arrival at hospital.
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Assessment method [7]
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Obtained from data in the medical record.
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Timepoint [7]
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Post birth.
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Secondary outcome [8]
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Body mass index (BMI)
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Assessment method [8]
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Self-report using questions used by the team in other studies. They are questions the team has used and published previously extensively that we want to use again to be able to make comparisons with our previous work. BMI is calculated from self-reported height and weight. Citation for study that has used this question: Emily J Callander, Hannah Jackson, Helen L McLachlan, Mary-Ann Davey, Della A Forster - Continuity of care by a primary midwife (caseload midwifery): a cost analysis using results from the COSMOS randomised controlled trial: Gynecology and Obstetrics Clinical Medicine 2024;4:e000008.
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Timepoint [8]
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Baseline at recruitment, at 36 weeks gestation and at four months post birth.
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Secondary outcome [9]
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Stress symptoms
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Assessment method [9]
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DASS-21
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Timepoint [9]
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Measured at 36 weeks and at four months post birth.
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Secondary outcome [10]
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Economics - health service use since birth and cost effectiveness
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Assessment method [10]
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Self-reported health service use using questions used by the team in previous studies. The incremental cost per quality adjusted life year gained for antenatal telehealth relative to standard care will be assessed. A one-year post-birth time horizon will be utilised, with a health service funder perspective taken. Costs will include all antenatal, birth and postnatal health service use in hospitals and the community, identified from hospital administrative data and from the 4-month data collection tool , collected with consent from participating women. Costs will be disaggregated into costs to public hospital funders and out of pocket costs. Outcomes will be measured in quality adjusted life years, captured through the AQoL-4D. Costs and quality adjusted life years will be extrapolated from 4 months postpartum to 12 months postpartum.
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Timepoint [10]
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Four months post birth
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Secondary outcome [11]
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Parenting self-efficacy and readiness
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Assessment method [11]
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Using the Karitane Parenting Confidence Scale
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Timepoint [11]
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Measured at four months postpartum.
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Secondary outcome [12]
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Quality of life
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Assessment method [12]
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AQol-4D
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Timepoint [12]
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Assessed at 36 weeks gestation and four months post birth.
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Secondary outcome [13]
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Mode of birth
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Assessment method [13]
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Obtained from medical record data.
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Timepoint [13]
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Post birth.
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Secondary outcome [14]
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Disclosure of family violence in pregnancy via self report and then compared with medical record data.
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Assessment method [14]
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Using the same family violence screening questions as used at the study site and we will also ask women "Were you asked about family violence during this pregnancy by a midwife or doctor?” We will examine medical record data to compare with self-report.
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Timepoint [14]
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36 weeks gestation. Compare with medical record data after birth.
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Secondary outcome [15]
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Alcohol consumption
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Assessment method [15]
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Self-report using questions used by the team in other studies. They are questions the team has used and published previously extensively that we want to use again to be able to make comparisons with our previous work. Citation for study that has used this question: Shafiei T, McLachlan HL, Dennis C, et al. Preventing postnatal depression in new mothers using telephone peer support: protocol for the DAISY (Depression and AnxIety peer Support studY) multi-centre randomised controlled trial BMJ Open 2024;14:e087477. doi: 10.1136/bmjopen-2024-087477
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Timepoint [15]
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Baseline at recruitment, at 36 weeks gestation and at four months post birth.
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Secondary outcome [16]
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Fear of childbirth
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Assessment method [16]
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Fear of Birth Scale (FOBS) and the Fear of Childbirth Questionnaire (FCQ). It is two questions exploring the same outcome - not a composite. We will compare outcomes between the more simple FOBS scale and the more complex FCQ.
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Timepoint [16]
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36 weeks gestation.
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Secondary outcome [17]
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Smoking
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Assessment method [17]
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Self-report using questions used by the team in other studies. They are questions the team has used and published previously extensively that we want to use again to be able to make comparisons with our previous work. One of the studies that used this question was: McLachlan HL, Forster DA, Davey M-A, Farrell T, Flood M, Shafiei T, Waldenstro¨m U. The effect of primary midwife-led care on women’s experience of childbirth: results from the COSMOS randomised controlled trial. BJOG 2016;123:465–474
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Timepoint [17]
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Baseline at recruitment, at 36 weeks gestation and at four months post birth.
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Secondary outcome [18]
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Vaping
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Assessment method [18]
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Self-report using questions used by the team in other studies. This question we are we are using this in a current trial we are running also (GEM trial - group antenatal care), but we have taken the vaping question from: Bowker, K., Lewis, S., Ussher, M., Naughton, F., Phillips, L., Coleman, T., Orton, S., McRobbie, H., Bauld, L., & Cooper, S. (2021). Smoking and vaping patterns during pregnancy and the postpartum: A longitudinal UK cohort survey. Addictive behaviors, 123, 107050. https://doi.org/10.1016/j.addbeh.2021.107050
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Timepoint [18]
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Baseline at recruitment, at 36 weeks gestation and at four months post birth.
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Eligibility
Key inclusion criteria
Women with a singleton pregnancy attending the study site as a public patient , assessed as low or moderate obstetric risk, aged 16 years or over, less than 24 weeks gestation and able to speak and understand English.
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Minimum age
16
Years
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Maximum age
No limit
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Sex
Females
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Can healthy volunteers participate?
No
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Key exclusion criteria
At initial pregnancy booking visit women who are considered high risk needing close obstetric monitoring, maternal body mass index >40, drug and alcohol issues requiring specialist care, known major fetal anomaly or compromise requiring significant medical input (e.g. aneuploidy, heart defects), women unable to provide informed consent, women who do not have access to a computer, tablet or smart phone with a reliable internet connection for video-based telehealth appointments and women who choose shared care with an external provider.
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Study design
Purpose of the study
Prevention
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
A secure, password-protected, computerised randomisation schedule will be designed and administered by an independent service, accessed online by recruiting staff.
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Women will be randomly allocated to the intervention (Combined Care) or the control group (Usual Care), with stratification by a) parity (first baby or not), and b) obstetric risk status (low or moderate risk). The randomisation ratio will be 1:1 combined care to usual care, with permuted blocks of variable length
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people assessing the outcomes
The people analysing the results/data
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Intervention assignment
Parallel
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Other design features
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Phase
Not Applicable
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
Sample size: To estimate the baseline prevalence of women and infants with the composite outcome, we used data from 56,193 births from 2012 to 2019 (pre implementation of routine telehealth in pregnancy) from the Women’s, excluding women with multiple pregnancies, those with Type 1 and Type 2 diabetes and women with a BMI >40, and found 22% had the composite outcome (i.e., one or more of the factors in the list making up the composite). We believe that the risk of the composite outcome will be the same in the two groups, but the sample size calculations assumed that the true underlying proportion is 0.01 higher in the telehealth group (i.e., 0.22 vs 0.23) to be conservative. Based on clinically important differences, the non-inferiority margin was defined as an absolute increase in the composite outcome of 0.05 in the telehealth (‘intervention’) group. With a 2-sided 95% confidence interval, and 80% power, a sample size of 3426 (1713 per group) is required. We expect near complete ascertainment of the primary outcome based on our previous work43, 44 and given the outcome will be collected electronically, so allowing 2% loss to follow up we will need 3496 women in total, 1748 per group.
Planned analyses: Data will be collected to meet CONSORT guidelines. We will check the baseline comparability of the groups, then the intervention group will be compared with the control group for all trial hypotheses using intention-to-treat analysis. For the primary clinical outcome, the proportion of women (with their infants) having the composite outcome will be compared. Risk differences and 95% confidence intervals will be estimated using binomial regression with identity link, adjusting for all stratification variables, and for any differences in the key demographic characteristics at baseline. The adjusted risk difference and 95% confidence intervals will be presented graphically along with the non-inferiority margin.38 Combined care will be considered to be non-inferior if the upper limit of the 95% confidence interval for the risk difference (combined care minus usual care) is within the non-inferiority margin. For other outcomes standard superiority tests will be undertaken.38 Binary variables will be compared using relative risks with 95% confidence intervals, categorial variables compared using chi-squared, comparison of means will be undertaken using t-tests where data are normally distributed, or medians compared using Mann-Whitney U tests otherwise. The primary consumer experience outcome will be compared by dichotomising the 1-7 scale and comparing the percentage of women in each trial arm who rate their overall care in pregnancy as ‘6’ or ‘7’. For views and experiences of telehealth (applicable only to participants receiving telehealth), descriptive statistics will be used, with most items summarised using frequency and percentage, or analysed using standard superiority tests in any subgroup analyses. The incremental cost per quality adjusted life year gained for antenatal telehealth relative to standard care will be assessed. A one-year post-birth time horizon will be utilised, with a health service funder perspective taken. Costs will include all antenatal, birth and postnatal health service use in hospitals and the community, identified from hospital administrative data collected with consent from participating women.
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Recruitment
Recruitment status
Not yet recruiting
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Date of first participant enrolment
Anticipated
1/07/2025
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Actual
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Date of last participant enrolment
Anticipated
29/12/2028
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Actual
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Date of last data collection
Anticipated
1/10/2029
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Actual
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Sample size
Target
3496
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
VIC
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Recruitment hospital [1]
27430
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The Royal Women's Hospital - Parkville
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Recruitment postcode(s) [1]
43542
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3052 - Parkville
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Funding & Sponsors
Funding source category [1]
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Government body
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Name [1]
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National Health and Medical Research Council
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Address [1]
317594
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Country [1]
317594
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Australia
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Primary sponsor type
University
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Name
La Trobe University
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Address
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Country
Australia
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Secondary sponsor category [1]
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None
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Name [1]
319902
0
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Address [1]
319902
0
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Country [1]
319902
0
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Ethics approval
Ethics application status
Submitted, not yet approved
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Ethics committee name [1]
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The Royal Melbourne Hospital Human Research Ethics Committee
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Ethics committee address [1]
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https://www.thermh.org.au/research/researchers/ethics
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Ethics committee country [1]
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Australia
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Date submitted for ethics approval [1]
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27/11/2024
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Approval date [1]
316299
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Ethics approval number [1]
316299
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Summary
Brief summary
Telehealth has become part of routine pregnancy care largely due to circumstance – the onset of the COVID-19 pandemic, and the associated public health advice,1 led most maternity providers in Victoria and elsewhere to commence providing some pregnancy care as telephone and/or video health. Emerging evidence of safety is conflicting regarding clinical outcomes, and there is a lack of prospectively collected evidence of the benefit or potential harms associated with telehealth for routine pregnancy care. This study aims to carefully evaluate the use of telehealth for routine pregnancy care in a randomised controlled trial (RCT) and test the safety and efficacy, the cost implications, and explore women’s experiences. This RCT will test whether the practice of offering a minimum of one up to a maximum of five routine pregnancy care visits via video-based telehealth is no less safe (i.e., the outcomes are not worse) than the pre-pandemic ‘usual’ pregnancy care, which was all face-to-face, and to find out if having access to some telehealth in pregnancy improves women’s experiences and access to care.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Prof Della Forster
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Address
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Judith Lumley Centre Level 3, George Singer Building Kingsbury Drive (no number) La Trobe University Bundoora 3086 Victoria
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Country
137442
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Australia
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Phone
137442
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+61 3 9479 8783
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Fax
137442
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Email
137442
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[email protected]
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Contact person for public queries
Name
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Charlie Benzie
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Address
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Judith Lumley Centre Level 3, George Singer Building Kingsbury Drive (no number) La Trobe University Bundoora 3086 Victoria
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Country
137443
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Australia
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Phone
137443
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+61 9479 5081
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Fax
137443
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Email
137443
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[email protected]
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Contact person for scientific queries
Name
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Della Forster
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Address
137444
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Judith Lumley Centre Level 3, George Singer Building Kingsbury Drive (no number) La Trobe University Bundoora 3086 Victoria
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Country
137444
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Australia
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Phone
137444
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+61 3 9479 8783
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Fax
137444
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Email
137444
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[email protected]
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Data sharing statement
Will the study consider sharing individual participant data?
Yes
Will there be any conditions when requesting access to individual participant data?
Persons/groups eligible to request access:
•
Researchers
Conditions for requesting access:
•
Yes, conditions apply:
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Requires review on a case-by-case basis by the trial custodian, sponsor or data sharing committee
•
Requires a scientifically sound proposal or protocol
•
Requires approval by an ethics committee
•
Requires a data sharing agreement between data requester and trial custodian or sponsor
What individual participant data might be shared?
•
De-identified individual participant data:
•
All outcomes data
What types of analyses could be done with individual participant data?
•
To be discussed with Professor Della Forster when request is made.
When can requests for individual participant data be made (start and end dates)?
From:
Post completion of trial. No end date planned.
To:
-
Where can requests to access individual participant data be made, or data be obtained directly?
•
By request of Principle investigator Professor Della Forster (email:
[email protected]
).
Are there extra considerations when requesting access to individual participant data?
No
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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