Identifying evidence-practice gaps and strategies for improvement in Aboriginal and Torres Strait Islander maternal health care

Abstract

IntroductionAdverse pregnancy outcomes are more common among Aboriginal and Torres Strait Islander populations than non-Indigenous populations in Australia. Later in life, most of the difference in life expectancy between Aboriginal and Torres Strait Islander women and non-Indigenous women is due to non-communicable diseases (NCDs). Most Aboriginal and Torres Strait Islander women attend health services regularly during pregnancy. Providing high-quality care within these appointments has an important role to play in improving the current and future health of women and babies.AimThis study engaged stakeholders in a theory-informed process to use aggregated continuous quality improvement (CQI) data to identify 1) priority evidence-practice gaps in Aboriginal and Torres Strait Islander maternal health care, 2) barriers and enablers to high-quality care, and 3) strategies to address identified priorities.MethodsThree phases of reporting and feedback were implemented using de-identified CQI data from 91 health services between 2007 and 2014 (4,402 client records). Stakeholders (n = 172) from a range of professions and organisations participated.ResultsStakeholders identified four priority areas relating to NCDs: smoking, alcohol, psychosocial wellbeing and nutrition. Barriers or enablers to high-quality care included workforce support, professional development, teamwork, woman-centred care, decision support, equipment and community engagement. Strategies to address the priorities included upskilling staff to provide best practice care in priority areas, advocating for availability of healthy food, housing and local referral options, partnering with communities on health promotion projects, systems to facilitate continuity of care and clear referral pathways.ConclusionsThis novel use of large-scale aggregate CQI data facilitated stakeholder input on priority evidence-practice gaps in maternal health care in Australia. Evidence-practice gaps relating to NCD risk factors and social determinants of health were prioritised, and stakeholders suggested both healthcare-focussed initiatives and approaches involving the community and the wider health sector. The findings can inform health service planning, advocacy, inter-agency strategies, and future research.

Improving developmental care in primary practice for disadvantaged children

“…However, unlike the UK, we did not have digitised primary care records in place at the time of implementation of our study. Recent data from our new digitised clinics indicate that uptake, audit and feedback are more rapid and impactful using electronic record systems 11. This may also be the case in the UK and the USA but careful evaluation is needed.…”

Population attributable fractions of perinatal outcomes for nulliparous women associated with overweight and obesity, 1990–2014

“…Women attending PHCs that had participated in continuous quality improvement activities were more likely to receive recommended pregnancy care related to screening and brief interventions for modifiable lifestyle‐related risk factors, such as obesity 4 , 5 . These findings support the incorporation of continuous quality improvement activities into the delivery of maternal care.…”

Aboriginal and Torres Strait Islander family access to continuity of health care services in the first 1000 days of life: a systematic review of the literature

“…Compared to non-Indigenous Australians, Aboriginal Australians experience a significant level of disadvantage in health, life expectancy, education, employment and living standards [1][2][3][4][5][6][7][8]. These disparities are evident when considering maternal and infant health outcomes, with higher rates of gestational diabetes and smoking during pregnancy among Aboriginal women, rates of preterm birth and low birth weight nearly double among Aboriginal babies, perinatal mortality rates of Aboriginal infants 50% higher than those of non-Aboriginal infants, and maternal mortality rates of Aboriginal women nearly three times higher compared to their non-Aboriginal counterparts [1,[5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]. Maternal and infant health outcomes worsen with increasing remoteness, due to challenges in health service provision and delivery [6].…”

“…Maternal and infant health outcomes worsen with increasing remoteness, due to challenges in health service provision and delivery [6]. This disproportionately affects Aboriginal women and their infants, as 26% of Aboriginal births occur in areas classified as remote or very remote, compared to only 2% of non-Aboriginal births [1,10,12,13]. The factors contributing to the observed disparities are complex and include poor access to culturally appropriate health services, sustained institutional racism, lower educational attainment, poverty, and the continuing effects of colonisation [7,10,13,21,22].…”