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2018 JCR, Web of Science Group 2019

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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Public Health | doi: 10.3389/fpubh.2019.00192

Improving models of care for diabetes in pregnancy: Experience of current practice in Far North Queensland, Australia

 Anna McLean1,  Renae Kirkham1, Sandra Campbell2, Cherie Whitbread3, Jennifer Barrett1, Christine Connors4,  Jacqueline Boyle1, 5,  Alex Brown6, 7, Jacqueline Mein8,  Mark Wenitong9, David McIntyre10, Federica Barzi1,  Jeremy Oats11, Ashim Sinha12 and Louise Maple-Brown1, 3*
  • 1Menzies School of Health Research, Charles Darwin University, Australia
  • 2Central Queensland University, Australia
  • 3Royal Darwin Hospital, Australia
  • 4Northern Territory Health Services, Australia
  • 5Monash Health, Australia
  • 6University of South Australia, Australia
  • 7South Australian Health and Medical Research Institute (SAHMRI), Australia
  • 8Wuchopperen Health Service Ltd, Australia
  • 9Apunipima Cape York Health Council, Australia
  • 10University of Queensland, Australia
  • 11The University of Melbourne, Australia
  • 12Cairns Hospital, Australia

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 75g 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.
Conclusion: 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: Gestational diabetes – mellitus, Diabetes in pregnancy, Model of care, screening practices, diabetes management, care coordination, access to health care

Received: 09 Jul 2018; Accepted: 26 Jun 2019.

Edited by:

Wei Bao, The University of Iowa, United States

Reviewed by:

Harshal Deshmukh, University of Hull, United Kingdom
Evelyn A. Huhn, Department of Obstetrics and Gynecology, University Hospital Basel, Switzerland  

Copyright: © 2019 McLean, Kirkham, Campbell, Whitbread, Barrett, Connors, Boyle, Brown, Mein, Wenitong, McIntyre, Barzi, Oats, Sinha and Maple-Brown. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Louise Maple-Brown, Menzies School of Health Research, Charles Darwin University, Darwin, Australia, Louise.Maple-Brown@menzies.edu.au