Improving Models of Care for Diabetes in Pregnancy: Experience of Current Practice in Far North Queensland, Australia

Abstract

Aims: To map health practitioners' experiences and describe knowledge regarding screening and management of Diabetes in Pregnancy (DIP) in Far North Queensland, Australia. Methods: Mixed methods including a cross-sectional survey (101 respondents) and 8 focus groups with 61 health practitioners. All participants provided clinical care for women with DIP. Results: A wide range of healthcare professionals participated; 96% worked with Indigenous women, and 63% were from regional or remote work settings. Universal screening for gestational diabetes at 24–28 weeks gestation was reported as routine with 87% using a 75 g Oral Glucose Tolerance Test. Early screening for DIP was reported by 61% although there was large variation in screening methods and who should be screened <24 weeks. Health practitioners were confident providing lifestyle advice (88%), dietary, and blood glucose monitoring education (67%, 81%) but only 50% were confident giving insulin education. Electronic medical records were used by 80% but 55% also used paper records. Dissatisfaction with information from hospitals was reported by 40%. In the focus groups improving communication and information technology systems were identified as key areas. Other barriers described were difficulties in care coordination and access for remote women. Conclusions: Communication, information technology systems, coordination of care, and education for health professionals are key areas that will be addressed by a complex health systems intervention being undertaken by the DIP Partnership in North Queensland.

Primary Health Care for Aboriginal Australian Women in Remote Communities after a Pregnancy with Hyperglycaemia

“…The Diabetes across the Lifecourse Northern Australia Partnership aims to improve health outcomes for women with hyperglycaemia in pregnancy and their children [12]. This review, coupled with formative work [21,55], will inform the development of a complex health systems intervention in the NT and Far North Queensland which includes improving information management and communication, access to culturally appropriate care and increasing workforce capacity and health literacy of health professionals. In 2017, specific Diabetes in Pregnancy Care Plans were introduced with recalls scheduled in the electronic medical records for postpartum OGTT testing.…”

Improving systems of care during and after a pregnancy complicated by hyperglycaemia: A protocol for a complex health systems intervention

“…Quantitative Analyses Survey data will be compared with baseline data collected through a prior health professional survey across the study regions, conducted during formative work for this health systems intervention [31,37]. Descriptive statistics will be reported.…”

“…Detailed barriers and enablers identified by this formative work have been previously reported [31,37]. In brief, multiple factors impacting on health service delivery were identified, including fragmentation of care, gaps in communication and a lack of clarity regarding healthcare provider responsibilities for components of care such as screening and post-partum follow-up [37].…”

“…Response rates will be estimated by region and profession by comparing with number of professionals per region registered with relevant professional associations, where these numbers are available. Baseline survey data for comparison was previously collected during formative work [31,37].…”

“…Clinical registers have been widely utilised, including in regional and remote Australia, to improve systems of care, clinical follow-up and health outcomes for chronic conditions [28,29]. The Partnership has undertaken formative research with health professionals and stakeholders to identify gaps in care, which contributed to further refining our intervention design [26,30,31].…”