Improving systems of prenatal and postpartum care for hyperglycemia in pregnancy: A process evaluation

Diana MacKay; Natasha Freeman; Jacqueline A Boyle; Sandra Campbell; Anna McLean; David Peiris; Sumaria Corpus; Christine Connors; Elizabeth Moore; Mark Wenitong; Bronwyn Silver; H David McIntyre; Jonathan E Shaw; Alex Brown; Renae Kirkham; Louise Maple-Brown; Diabetes Across the Lifecourse: Northern Australia Partnership

doi:10.1002/ijgo.13850

Improving systems of prenatal and postpartum care for hyperglycemia in pregnancy: A process evaluation

Int J Gynaecol Obstet. 2021 Nov;155(2):179-194. doi: 10.1002/ijgo.13850. Epub 2021 Sep 4.

Authors

Diana MacKay^{1

2}, Natasha Freeman¹, Jacqueline A Boyle³, Sandra Campbell⁴, Anna McLean^{1

5}, David Peiris⁶, Sumaria Corpus⁷, Christine Connors⁸, Elizabeth Moore⁹, Mark Wenitong¹⁰, Bronwyn Silver¹¹, H David McIntyre¹², Jonathan E Shaw¹³, Alex Brown^{14

15}, Renae Kirkham¹, Louise Maple-Brown^{1

2}; Diabetes Across the Lifecourse: Northern Australia Partnership

Collaborators

Diabetes Across the Lifecourse: Northern Australia Partnership:
S Chitturi, S Eades, C Inglis, K Dempsey, M Lynch, T Skinner, R Wright, K O'Dea, J Oats, P Zimmett, A Sinha, A J Hanley, C Whitbread, F Barzi, B Davis, J Mein, R McDermott, K Canuto

Affiliations

¹ Division of Wellbeing and Preventable Chronic Disease, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
² Department of Endocrinology, Royal Darwin Hospital, Darwin, Northern Territory, Australia.
³ Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
⁴ College of Nursing and Midwifery, Charles Darwin University, Cairns, Queensland, Australia.
⁵ Department of Diabetes and Endocrinology, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia.
⁶ Centre for Health Systems Science, The George Institute for Global Health, Sydney, New South Wales, Australia.
⁷ Danila Dilba Health Service, Darwin, Northern Territory, Australia.
⁸ Population & Primary Health Care, Top End Health Service, Northern Territory Department of Health, Darwin, Northern Territory, Australia.
⁹ Aboriginal Medical Services Alliance Northern Territory, Darwin, Northern Territory, Australia.
¹⁰ School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia.
¹¹ Central Australian Aboriginal Congress, Alice Springs, Northern Territory, Australia.
¹² Clinical Unit, Mater Research, The University of Queensland, Brisbane, Queensland, Australia.
¹³ Aboriginal Health Domain, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.
¹⁴ South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.
¹⁵ Faculty of Health and Medical Science, University of Adelaide, Adelaide, South Australia, Australia.

PMID: 34331708
DOI: 10.1002/ijgo.13850

Abstract

Objective: To identify successes to date and opportunities for improvement in the implementation of a complex health systems intervention aiming to improve prenatal and postpartum care and health outcomes for women with hyperglycemia in pregnancy in regional and remote Australia.

Methods: A qualitative evaluation, underpinned by the RE-AIM framework (reach, effectiveness, adoption, implementation, maintenance), was conducted mid-intervention. Semi-structured interviews were conducted with the participants, who included clinicians, regional policymakers and managers, and study implementation staff.

Results: Interviewees (n = 45) reported that the early phase of the intervention had resulted in the establishment of a clinician network, increased clinician awareness of hyperglycemia in pregnancy, and improvements in management, including earlier referral for specialist care and a focus on improving communication with women. Enablers of implementation included existing relationships with stakeholders and alignment of the intervention with health service priorities. Challenges included engaging remote clinicians and the labor-intensive nature of maintaining a clinical register of women with hyperglycemia in pregnancy.

Conclusion: The early phase of this health systems intervention has had a positive perceived impact on systems of care for women with hyperglycemia in pregnancy. Findings have informed modifications to the intervention, including the development of a communication and engagement strategy.

Keywords: diabetes in pregnancy; gestational diabetes; health systems; hyperglycemia in pregnancy; indigenous health; process evaluation; quality improvement.

MeSH terms

Australia
Female
Humans
Hyperglycemia* / therapy
Postnatal Care*
Pregnancy
Prenatal Care
Referral and Consultation

Abstract

MeSH terms

Grants and funding