TY - JOUR

T1 - Improving systems of prenatal and postpartum care for hyperglycemia in pregnancy

T2 - A process evaluation

AU - MacKay, Diana

AU - Freeman, Natasha

AU - Boyle, Jacqueline A.

AU - Campbell, Sandra

AU - McLean, Anna

AU - Peiris, David

AU - Corpus, Sumaria

AU - Connors, Christine

AU - Moore, Elizabeth

AU - Wenitong, Mark

AU - Silver, Bronwyn

AU - McIntyre, H. David

AU - Shaw, Jonathan E.

AU - Brown, Alex

AU - Kirkham, Renae

AU - Maple-Brown, Louise

AU - Chitturi, S.

AU - Eades, S.

AU - Inglis, C.

AU - Dempsey, K.

AU - Lynch, M.

AU - Skinner, T.

AU - Wright, R.

AU - O’Dea, K.

AU - Oats, J.

AU - Zimmett, P.

AU - Sinha, A.

AU - Hanley, A. J.

AU - Whitbread, C.

AU - Barzi, F.

AU - Davis, B.

AU - Mein, J.

AU - McDermott, R.

AU - Canuto, K.

AU - the Diabetes Across the Lifecourse: Northern Australia Partnership

N1 - Funding Information: This study was funded by the Australian National Health and Medical Research Council (NHMRC) Global Alliance for Chronic Diseases Grant 1092968 and was independently peer-reviewed by this funding body. DM is supported by NHMRC Postgraduate Scholarship GNT1168668; JB was supported by NHMRC Career Development Fellowship; DP is supported by an NHMRC Career Development Fellowship 1143904 and a Heart Foundation Future Leader Fellowship; AB was supported by a Sylvia and Charles Viertel Senior Medical Research Fellowship and NHMRC Research Fellowship 1137563; LMB is supported by NHMRC Fellowship 1078477. The views expressed in this publication are those of the authors and do not reflect the views of the NHMRC or Global Alliance for Chronic Diseases. The funders had no role in the study design, decision to publish, or preparation of the manuscript. The Diabetes Across the Lifecourse: Northern Australia Partnership is a collaboration between researchers, policy makers, and health organizations committed to using a lifecourse approach to improve care for people across Northern Australia with diabetes, focusing on hyperglycemia in pregnancy and youth diabetes. We gratefully acknowledge all Diabetes Across the Lifecourse: Northern Australia Partnership staff and participants, including Vanya Webster, Sian Graham, Kirby Murtha, Paula Van Dokkum, Dianne Bell, Katarina Keeler, Chenoa Wapau, Martil Zachariah, Jennifer Barrett, Tara Dias, Kristina Vine, Bronwyn Davis, Bonnie White; Partnership investigators; the Partnership Indigenous Reference Group, Northern Territory clinical reference group, and FNQ working group; and health professionals across the Northern Territory and FNQ from hospitals, primary health care and Aboriginal community-controlled health organizations who have contributed to the Partnership activities. Investigators of the Diabetes Across the Lifecourse: Northern Australia Partnership in addition to those named authors are: 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. Further information about the Diabetes Across the Lifecourse: Northern Australia Partnership can be obtained by contacting ntdippartnership@menzies.edu.au or dippinq@menzies.edu.au. Funding Information: This study was funded by the Australian National Health and Medical Research Council (NHMRC) Global Alliance for Chronic Diseases Grant 1092968 and was independently peer‐reviewed by this funding body. DM is supported by NHMRC Postgraduate Scholarship GNT1168668; JB was supported by NHMRC Career Development Fellowship; DP is supported by an NHMRC Career Development Fellowship 1143904 and a Heart Foundation Future Leader Fellowship; AB was supported by a Sylvia and Charles Viertel Senior Medical Research Fellowship and NHMRC Research Fellowship 1137563; LMB is supported by NHMRC Fellowship 1078477. The views expressed in this publication are those of the authors and do not reflect the views of the NHMRC or Global Alliance for Chronic Diseases. The funders had no role in the study design, decision to publish, or preparation of the manuscript. The Diabetes Across the Lifecourse: Northern Australia Partnership is a collaboration between researchers, policy makers, and health organizations committed to using a lifecourse approach to improve care for people across Northern Australia with diabetes, focusing on hyperglycemia in pregnancy and youth diabetes. We gratefully acknowledge all Diabetes Across the Lifecourse: Northern Australia Partnership staff and participants, including Vanya Webster, Sian Graham, Kirby Murtha, Paula Van Dokkum, Dianne Bell, Katarina Keeler, Chenoa Wapau, Martil Zachariah, Jennifer Barrett, Tara Dias, Kristina Vine, Bronwyn Davis, Bonnie White; Partnership investigators; the Partnership Indigenous Reference Group, Northern Territory clinical reference group, and FNQ working group; and health professionals across the Northern Territory and FNQ from hospitals, primary health care and Aboriginal community‐controlled health organizations who have contributed to the Partnership activities. Investigators of the Diabetes Across the Lifecourse: Northern Australia Partnership in addition to those named authors are: 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. Further information about the Diabetes Across the Lifecourse: Northern Australia Partnership can be obtained by contacting ntdippartnership@menzies.edu.au or dippinq@menzies.edu.au . Publisher Copyright: © 2021 International Federation of Gynecology and Obstetrics.

PY - 2021/11

Y1 - 2021/11

N2 - 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.

AB - 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.

KW - diabetes in pregnancy

KW - gestational diabetes

KW - health systems

KW - hyperglycemia in pregnancy

KW - indigenous health

KW - process evaluation

KW - quality improvement

U2 - 10.1002/ijgo.13850

DO - 10.1002/ijgo.13850

M3 - Journal article

C2 - 34331708

AN - SCOPUS:85114318915

VL - 155

SP - 179

EP - 194

JO - International Journal of Gynecology & Obstetrics

JF - International Journal of Gynecology & Obstetrics

SN - 0020-7292

IS - 2

ER -