title: Intravenous iron: barriers and facilitators to its use at nine maternity hospitals in New South Wales, Australia.
abstract: BACKGROUND
  Anaemia in pregnancy is mostly due to iron deficiency, and the use of intravenous (IV) iron is gaining acceptance as a treatment option. Recently released obstetric transfusion guidelines recommend IV iron for obstetric patients in certain situations, including when oral formulations are poorly tolerated, unlikely to be well absorbed, or when rapid restoration of iron stores is required.
  
  
  OBJECTIVE
  To identify barriers and facilitators to the use of IV iron in pregnancy among nine maternity hospitals in New South Wales, Australia.
  
  
  METHODS
  A qualitative research study was undertaken using semi-structured interviews. Nine maternity units were chosen to cover a range of clinical settings and obstetric blood transfusion rates. Interviews were conducted with haematologists, obstetricians and midwives, and included questions about the use of IV iron in each institution. Interviews were transcribed and coded, and NVivo software was used to develop themes.
  
  
  RESULTS
  A total of 125 interviews were conducted: 61 with doctors. The use of IV iron differed between hospitals and individual doctors. There were hospital/pharmaceutical, clinician and patient factors which acted as either barriers or facilitators to the use of IV iron. Where perceived barriers outweighed facilitators in a particular hospital, doctors were less likely to use IV iron.
  
  
  CONCLUSIONS
  The use of IV iron, as perceived by doctors, differed across hospitals. There are some potentially modifiable barriers to the use of IV iron that may need to be addressed for IV iron to be available to obstetric patients not tolerating oral formulations or requiring rapid restoration of iron stores.
authors.affiliation: Clinical and Population Perinatal Health Research Unit, Kolling Institute of Medical Research (University of Sydney) at Royal North Shore Hospital, Sydney, New South Wales, Australia.|Department of Haematology and Bone Marrow Transplant, St Vincent's Hospital, Sydney, New South Wales, Australia.
authors.forename: Eleni
authors.identifier: http://orcid.org/0000-0003-3376-2071
authors.initials: E
authors.lastname: Mayson
authors.affiliation: Clinical and Population Perinatal Health Research Unit, Kolling Institute of Medical Research (University of Sydney) at Royal North Shore Hospital, Sydney, New South Wales, Australia.
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Ampt
authors.affiliation: Clinical and Population Perinatal Health Research Unit, Kolling Institute of Medical Research (University of Sydney) at Royal North Shore Hospital, Sydney, New South Wales, Australia.|Department of Obstetrics and Maternal Fetal Medicine, Royal Hospital for Women, Sydney, New South Wales, Australia.
authors.forename: Antonia W
authors.initials: AW
authors.lastname: Shand
authors.affiliation: Clinical and Population Perinatal Health Research Unit, Kolling Institute of Medical Research (University of Sydney) at Royal North Shore Hospital, Sydney, New South Wales, Australia.
authors.forename: Jane B
authors.initials: JB
authors.lastname: Ford
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D018798:Anemia, Iron-Deficiency / Q000188:drug therapy* / Q000628:therapy; D002983:Clinical Competence; D005260:Female; D006405:Hematology; D006771:Hospitals, Maternity; D006801:Humans; D007407:Interviews as Topic; D007501:Iron / Q000008:administration & dosage* / Q000009:adverse effects; D008880:Midwifery; D009517:New South Wales; D009774:Obstetrics; D057240:Patient Preference; D010607:Pharmacy Service, Hospital / Q000600:supply & distribution; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D036301:Qualitative Research; D065227:Transfusion Reaction
chemical_list: D007501:Iron
keywords: anaemia; blood transfusion; iron; pregnancy; qualitative