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

• Main Authors: Anna McLean, Renae Kirkham, Sandra Campbell, Cherie Whitbread, Jennifer Barrett, Christine Connors, Jacqueline Boyle, Alex Brown, Jacqueline Mein, Mark Wenitong, H. David McIntyre, Federica Barzi, Jeremy Oats, Ashim Sinha, Louise Maple-Brown
• Format: Article
• Language: English
• Published: Frontiers Media S.A. 2019-07-01
• Series: Frontiers in Public Health
• Subjects: gestational diabetes–mellitus; diabetes in pregnancy; model of care; screening practices; diabetes management; care coordination
• Online Access: https://www.frontiersin.org/article/10.3389/fpubh.2019.00192/full

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.