Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2017

Open Access 01-12-2017 | Research article

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

Authors: R. Kirkham, J. A. Boyle, C. Whitbread, M. Dowden, C. Connors, S. Corpus, L. McCarthy, J. Oats, H. D. McIntyre, E. Moore, K. O’Dea, A. Brown, L. Maple-Brown, On behalf of the NT Diabetes in Pregnancy Partnership

Published in: BMC Health Services Research | Issue 1/2017

Login to get access

Abstract

Background

Australian 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.

Methods

Changes 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.

Results

Key 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.

Conclusions

The 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.
Literature
1.
Maple-Brown LJ. The combined burden of diabetes and cardiovascular disease in indigenous Australians. Curr Cardiovasc Risk Rep. 2011;5(3):215–22.CrossRef
2.
Dyck R, Osgood N, Lin TH, Gao A, Stang MR. Epidemiology of diabetes mellitus among first nations and non-first nations adults. Can Med Assoc J. 2010;182(3):249–56.CrossRef
3.
Wang Z, Hoy W. Hypertension, dyslipidemia, body mass index, diabetes and smoking status in aboriginal Australians in a remote community. Ethn Dis. 2003;13(3):324–30.PubMed
4.
O'Dea K. Westernization and non-insulin-dependent diabetes in Australian aborigines. Ethn Dis. 1991;1(2):171–87.PubMed
5.
Chen L, Magliano DJ, Zimmet PZ. The worldwide epidemiology of type 2 diabetes mellitus—present and future perspectives. Nat Rev Endocrinol. 2012;8(4):228–36.CrossRef
6.
7.
Lee AJ, Hiscock RJ, Wein P, Walker SP, Permezel M. Gestational diabetes mellitus: clinical predictors and long-term risk of developing type 2 diabetes a retrospective cohort study using survival analysis. Diabetes Care. 2007;30(4):878–83.CrossRefPubMed
8.
Pettitt DJ, Aleck KA, Baird HR, Carraher MJ, Bennett PH, Knowler WC. Congenital susceptibility to NIDDM: role of intrauterine environment. Diabetes. 1988;37(5):622–8.CrossRefPubMed
9.
Clausen TD, Mathiesen ER, Hansen T, Pedersen O, Jensen DM, Lauenborg J, Schmidt L, Damm P. Overweight and the metabolic syndrome in adult offspring of women with diet-treated gestational diabetes mellitus or type 1 diabetes. J Clin Endocrinol Metab. 2009;94(7):2464–70.CrossRefPubMed
10.
Franks PW, Looker HC, Kobes S, Touger L, Tataranni PA, Hanson RL, Knowler WC. Gestational glucose tolerance and risk of type 2 diabetes in young pima Indian offspring. Diabetes. 2006;55(2):460–5.CrossRefPubMed
11.
Hillier TA, Pedula KL, Schmidt MM, Mullen JA, Charles M-A, Pettitt DJ. Childhood obesity and metabolic imprinting the ongoing effects of maternal hyperglycemia. Diabetes Care. 2007;30(9):2287–92.CrossRefPubMed
12.
Bunt JC, Tataranni PA, Salbe AD. Intrauterine exposure to diabetes is a determinant of hemoglobin A1c and systolic blood pressure in pima Indian children. J Clin Endocrinol Metab. 2005;90(6):3225–9.CrossRefPubMedPubMedCentral
13.
Hall J, Case A, O’Neil L. Northern territory midwives’ collection, mothers and babies 2013. In. Darwin: Department of Health; 2015.
14.
Rumbold AR, Bailie RS, Si D, Dowden MC, Kennedy CM, Cox RJ, O’Donoghue L, Liddle HE, Kwedza RK, Thompson SC: Delivery of maternal health care in indigenous primary care services: baseline data for an ongoing quality improvement initiative. BMC pregnancy and childbirth 2011, 11(1):1–10.
15.
Banscott Health Consulting: Maternity services review in the Northern Territory. In. Northern Territory: Department of Health and Community Services; 2007.
16.
Commission on Social Determinants of Health: Closing the gap in a generation: health equity through action on the social determinants of health. Geneva: World Health Organisation; 2008.
17.
Australian Health Ministers' Advisory Council: Aboriginal and Torres Strait Islander Health Performance Framework 2014 Report In Edited by AHMAC Canberra; 2015.
18.
Buykx P, Humphreys JS, Tham R, Kinsman L, Wakerman J, Asaid A, Tuohey K. How do small rural primary health care services sustain themselves in a constantly changing health system environment? BMC Health Serv Res. 2012;12(1):1–7.CrossRef
19.
Maple-Brown LJ, Brown A, Lee I-L, Connors C, Oats J, McIntyre HD, Whitbread C, Moore E, Longmore D, Dent G. Pregnancy and neonatal diabetes outcomes in remote Australia (PANDORA) study. BMC Pregnancy and Childbirth. 2013;13(1):221.CrossRefPubMedPubMedCentral
20.
Central Australian Rural Practitioners Association Inc. CARPA standard treatment manual. 6th ed. Alice Springs: Centre for Remote Health; 2014.
21.
World Health Organization: Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy. In. Switzerland: Edited by Practice DRaC; 2013.
22.
Edwards L, Connors C, Whitbread C, Brown A, Oats J, Maple-Brown L. Improving health service delivery for women with diabetes in pregnancy in remote Australia: survey of care in the northern territory diabetes in pregnancy partnership. Aust N Z J Obstet Gynaecol. 2014;54(6):534–40.CrossRefPubMed
23.
24.
Gardner K, Dowden M, Togni S, Bailie R. Understanding uptake of continuous quality improvement in indigenous primary health care: lessons from a multi-site case study of the audit and best practice for chronic disease project. Implement Sci. 2010;5(1):21.CrossRefPubMedPubMedCentral
25.
Gibson-Helm M, Teede H, Rumbold A, Ranasinha S, Bailie R, Boyle J. Continuous quality improvement and metabolic screening during pregnancy at primary health centres attended by aboriginal and Torres Strait islander women. Med J Aust. 2015;203(9):369–70.CrossRefPubMed
26.
Patton MQ. Qualitative research & evaluation methods. Fourth ed. SAGE: United States of America; 2015.
27.
28.
Montenegro H, Levcovitz E, Holder R, Ruales J, Suarez J. Integrated health service delivery networks: concepts, policy options and road map for implementation in the Americas. 2011:90.
29.
Birks M, Mills J, Francis K, Coyle M, Davis J, Jones J. Models of health service delivery in remote or isolated areas of Queensland: a multiple case study. Aust J Adv Nurs. 2010;28:25–34.
30.
Smith JD, O’Dea K, McDermott R, Schmidt B, Connors C. Educating to improve population health outcomes in chronic disease: an innovative workforce initiative across remote, rural and indigenous communities in northern Australia: Australian Rural Health Education Network; 2006.
31.
Joshi R, Alim M, Kengne AP, Jan S, Maulik PK, Peiris D, Patel AA. Task shifting for non-communicable disease Management in low and Middle Income Countries - a systematic review. PLoS One. 2014;9(8):e103754.CrossRefPubMedPubMedCentral
32.
Lenthall S, Wakerman J, Opie T, Dollard M, Dunn S, Knight S, MacLeod M, Watson C. What stresses remote area nurses? Current knowledge and future action. Aust J Rural Health. 2009;17(4):208–13.CrossRefPubMed
33.
34.
Wilson G. What Do Aboriginal Women Think Is Good Antenatal Care? Consultation Report, Cooperative Research Centre for Aboriginal Health, Darwin. 2009.
35.
Tursan d’Espaignet E, Measey ML, Carnegie MA, Mackerras D. Monitoring the ‘strong women, strong babies, strong culture program’: the first eight years. J Paediatr Child Health. 2003;39(9):668–72.CrossRefPubMed
36.
Kildea S, Van Wagner V. birthing on Country maternity service delivery models: a rapid review. New South Wales: Sax Institute; 2012.
37.
Wallace A. Evaluation of the healthy for life program: final report. In. Woden: Office for Aboriginal and Torres Strait Islander Health; 2009.
38.
Herceg A. Improving health in aboriginal and Torres Strait islander mothers, babies and young children: a literature review. Canberra: Department of Health and Ageing Canberra; 2005.
39.
Curry N, Ham C. Clinical and service integration. In: The route to improve outcomes. London: The Kings Fund; 2010.
40.
Bailie R, Matthews V, Brands J, Schierhout G. A systems-based partnership learning model for strengthening primary healthcare. Implementation Science. 2013;8(1):143.CrossRefPubMedPubMedCentral
41.
Bailie M. Brands, Schierhout: a systems-based partnership learning model for strengthening primary healthcare. Implement Sci. 2013;8(1):1–12.CrossRef
42.
Cheung NW, Byth K. Population health significance of gestational diabetes. Diabetes Care. 2003;26(7):2005–9.CrossRefPubMed
Metadata
Title
Health service changes to address diabetes in pregnancy in a complex setting: perspectives of health professionals
Authors
R. Kirkham
J. A. Boyle
C. Whitbread
M. Dowden
C. Connors
S. Corpus
L. McCarthy
J. Oats
H. D. McIntyre
E. Moore
K. O’Dea
A. Brown
L. Maple-Brown
On behalf of the NT Diabetes in Pregnancy Partnership
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2017
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-017-2478-7

Other articles of this Issue 1/2017

BMC Health Services Research 1/2017 Go to the issue

Research article

Patient experiences of engagement with care plans and healthcare professionals’ perceptions of that engagement

Research article

Adaption, implementation and evaluation of collaborative service improvements in the testing and result communication process in primary care from patient and staff perspectives: a qualitative study

Research article

Doctors’ opinion on the contribution of coordination mechanisms to improving clinical coordination between primary and outpatient secondary care in the Catalan national health system

Research article

Differences in the prevalence of hospitalizations and utilization of emergency outpatient services for ambulatory care sensitive conditions between asylum-seeking children and children of the general population: a cross-sectional medical records study (2015)

Research article

Dignity in people with frontotemporal dementia and similar disorders — a qualitative study of the perspective of family caregivers

Research article

Cancer related fatigue: implementing guidelines for optimal management