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https://hdl.handle.net/10137/5235
Title: | Preconception care for women with type 2 diabetes mellitus: A mixed-methods study of provider knowledge and practice. |
Authors: | Klein J Boyle JA Kirkham R Connors C Whitbread C Oats J Barzi F McIntyre D Lee I Luey M Shaw J Brown ADH Maple-Brown LJ |
Citation: | Diabetes research and clinical practice 2017-07; 129: 105-115 |
Abstract: | Preconception care may decrease adverse pregnancy outcomes associated with pre-existing diabetes mellitus. Aboriginal Australians are at high risk of type 2 diabetes mellitus (T2DM), with earlier onset. We explored practitioner views on preconception care delivery for women with T2DM in the Northern Territory, where 31% of births are to Aboriginal women. Mixed-methods study including cross-sectional survey of 156 health practitioners and 11 semi-structured interviews. Practitioners reported low attendance for preconception care however, 51% provided counselling on an opportunistic basis. Rural/remote practitioners were most likely to find counselling feasible. The majority (69%) utilised appropriate guidelines and addressed lifestyle modifications including smoking (81%), weight management (79%), and change medications appropriately such as ceasing ACE inhibitors (69%). Fewer (40%) prescribed the recommended dose of folate (5mg) or felt comfortable recommending delaying pregnancy to achieve optimal preconception glucose control (42%). Themes identified as barriers to care included the complexity of care setting and infrequent preconception consultations. There was a focus on motivation of women to make informed choices about conception, including birth spacing, timing and contraception. Preconception care enablers included cross-cultural communication, a multi-disciplinary care team and strong client-based relationships. Health practitioners are keen to provide preconception counselling and reported knowledge of evidence-based guidelines. Improvements are needed in recommending high dose folate and optimising glucose control. Cross-cultural communication and team-based care were reported as fundamental to successful preconception care in women with T2DM. Continued education and policy changes are required to support practitioners in opportunities to enhance pregnancy planning. |
Click to open PubMed article: | https://www.ezpdhcs.nt.gov.au/login?url=https://www.ncbi.nlm.nih.gov/pubmed//28521194 |
Journal title: | Diabetes research and clinical practice |
Publication Date: | 2017-07 |
Type: | Journal Article |
URI: | https://hdl.handle.net/10137/5235 |
DOI: | 10.1016/j.diabres.2017.03.035 |
Appears in Collections: | (a) NT Health Research Collection |
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