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

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

doi:10.3389/fpubh.2019.00192

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

Front Public Health. 2019 Jul 19:7:192. doi: 10.3389/fpubh.2019.00192. eCollection 2019.

Authors

Anna McLean^{1

2}, Renae Kirkham², Sandra Campbell³, Cherie Whitbread^{2

4}, Jennifer Barrett⁵, Christine Connors⁶, Jacqueline Boyle^{2

7}, Alex Brown^{8

9}, Jacqueline Mein¹⁰, Mark Wenitong⁵, H David McIntyre¹¹, Federica Barzi², Jeremy Oats¹², Ashim Sinha¹, Louise Maple-Brown^{2

4}

Affiliations

¹ Cairns Hospital, North Cairns, QLD, Australia.
² Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, University Drive North, Casuarina, NT, Australia.
³ Department of Health, Central Queensland University, Cairns, QLD, Australia.
⁴ Royal Darwin Hospital, Tiwi, NT, Australia.
⁵ Apunipima Cape York Health Council, Bungalow, QLD, Australia.
⁶ Top End Health Service, Northern Territory Department of Health, Darwin City, NT, Australia.
⁷ Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia.
⁸ Population Health Research, University of South Australia, Adelaide, SA, Australia.
⁹ South Australian Health and Medical Research Institute, Adelaide, SA, Australia.
¹⁰ Wuchopperen Health Service, Cairns, QLD, Australia.
¹¹ Mater Medical Research Institute, University of Queensland, South Brisbane, QLD, Australia.
¹² Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia.

Abstract

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.

Keywords: access to health care; care coordination; diabetes in pregnancy; diabetes management; gestational diabetes–mellitus; model of care; screening practices.