Kirkham R

Boyle JA

Whitbread, Cherie

Dowden M

Connors, Christine

Corpus, Sumaria

McCarthy L

Oats J

McIntyre HD

Moore E

O'Dea K

Brown A

Maple-Brown, Louise

2017-08-03

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. 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. 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. 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.

Wellbeing and Preventable Chronic Disease, Menzies School of Health Research, Darwin, NT, 0811, Australia..

Wellbeing and Preventable Chronic Disease, Menzies School of Health Research, Darwin, NT, 0811, Australia.. Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia..

Wellbeing and Preventable Chronic Disease, Menzies School of Health Research, Darwin, NT, 0811, Australia.. Diabetes Education Unit, Royal Darwin Hospital, Darwin, Australia..

Health Services and Planning, Sunrise Health Service Aboriginal Corporation, Katherine, Australia..

Top End Health Services, Northern Territory Department of Health, Darwin, Australia..

Womens Health, Danila Dilba Butji Binnilutlum Health Service Aboriginal Corporation, Darwin, Australia..

Wellbeing and Preventable Chronic Disease, Menzies School of Health Research, Darwin, NT, 0811, Australia..

Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia..

Mater Medical Research Institute, University of Queensland, Brisbane, Australia..

Aboriginal Medical Services Alliance Northern Territory, Darwin, Australia..

Population Health Research, University of South Australia, Adelaide, Australia..

Population Health Research, University of South Australia, Adelaide, Australia.. South Australian Health and Medical Research Institute, Adelaide, Australia..

Wellbeing and Preventable Chronic Disease, Menzies School of Health Research, Darwin, NT, 0811, Australia. louise.maple-brown@menzies.edu.au.. Department of Endocrinology, Royal Darwin Hospital, Darwin, Australia. louise.maple-brown@menzies.edu.au..

BMC health services research 2017-08-03; 17(1): 524

0000-0002-4993-6585

https://pubmed.ncbi.nlm.nih.gov/28774291/?otool=iaurydwlib

https://hdl.handle.net/10137/5205

Diabetes in pregnancy

Health services

Healthcare delivery

Indigenous

Integration of care

Australia

Delivery of Health Care

Diabetes Mellitus, Type 2

Female

Focus Groups

Health Personnel

Humans

Pregnancy

Pregnancy in Diabetics

Health Services, Indigenous

Oceanic Ancestry Group

Quality Improvement

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

Journal Article

Publication