Health service changes to address diabetes in pregnancy in a complex setting: perspectives of health professionals

Abstract

BackgroundAustralian Aboriginal and Torres Strait Islander women have high rates of gestational and pre-existing type 2 diabetes in pregnancy. The Northern Territory (NT) Diabetes in Pregnancy Partnership was established to enhance systems and services to improve health outcomes. It has three arms: a clinical register, developing models of care and a longitudinal birth cohort. This study used a process evaluation to report on health professional’s perceptions of models of care and related quality improvement activities since the implementation of the Partnership.MethodsChanges to models of care were documented according to goals and aims of the Partnership and reviewed annually by the Partnership Steering group. A ‘systems assessment tool’ was used to guide six focus groups (49 healthcare professionals). Transcripts were coded and analysed according to pre-identified themes of orientation and guidelines, education, communication, logistics and access, and information technology.ResultsKey improvements since implementation of the Partnership include: health professional relationships, communication and education; and integration of quality improvement activities. Focus groups with 49 health professionals provided in depth information about how these activities have impacted their practice and models of care for diabetes in pregnancy. Co-ordination of care was reported to have improved, however it was also identified as an opportunity for further development. Recommendations included a central care coordinator, better integration of information technology systems and ongoing comprehensive quality improvement processes.ConclusionsThe Partnership has facilitated quality improvement through supporting the development of improved systems that enhance models of care. Persisting challenges exist for delivering care to a high risk population however improvements in formal processes and structures, as demonstrated in this work thus far, play an important role in work towards improving health outcomes.

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

“…This intervention aims to translate the knowledge of barriers and opportunities identified in our formative findings into tangible health service improvements. Previous work of the Partnership in the NT includes improving systems of care during pregnancy and implementing the NT DIP Clinical Register [26,27]. These endeavours have resulted in the development of strong relationships between clinicians, policymakers and researchers.…”

“…The impact of such intervention components is yet to be demonstrated in the regional and remote Australian context, where there are multiple barriers to implementing guideline-based recommendations for the care of women with hyperglycaemia in pregnancy. These barriers include a disproportionate burden of socioeconomic disadvantage, population mobility, geographic remoteness, high turnover of clinical staff, and fragmentation between service providers [26].…”

“…The Partnership expanded in 2016 to include the region of Far North Queensland, and more recently to consider the intergenerational impact of diabetes, and thus is now the "Diabetes Across the Lifecourse: Northern Australia Partnership" ("the Partnership"). Previous work of the Partnership has included improvements in antenatal service delivery for women with hyperglycaemia in pregnancy in the Northern Territory [26] and the establishment of the DIP Clinical Register [27].…”

Real‐world experience of metformin use in pregnancy: Observational data from the Northern Territory Diabetes in Pregnancy Clinical Register

“…Thus, data from the Clinical Register provide valuable quality improvement data that have been and will continue to be used to inform the design of models of care interventions in order to improve outcomes for women with hyperglycemia in pregnancy and their babies. As we have recently reported, it is important that a clinical register is developed alongside other efforts to improve health systems, rather than in isolation, in order to optimize benefits for patients, clinicians and health services.…”

Pregnancy outcomes for women with pre‐pregnancy diabetes mellitus in Australian populations, rural and metropolitan: A review

“…Some plausible constraints on rural‐based care for women with PPDM might be overcome by technology‐enhanced pre‐pregnancy education, networking and enhancing primary care . Alongside listening to individual rural women's experiences, audit and feedback for health services of all sizes are necessary to achieve excellence everywhere for women with PPDM and their infants …”