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    Health service changes to address diabetes in pregnancy in a complex setting: perspectives of health professionals.

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    Author
    Kirkham, R; Boyle, JA; Whitbread, C; Dowden, M; Connors, C; Corpus, S; McCarthy, L; Oats, J; McIntyre, HD; Moore, E; ...
    Date
    2017-08-03
    Source Title
    BMC Health Services Research
    Publisher
    Springer Science and Business Media LLC
    University of Melbourne Author/s
    Oats, Jeremy
    Affiliation
    Melbourne School of Population and Global Health
    Metadata
    Show full item record
    Document Type
    Journal Article
    Citations
    Kirkham, R., Boyle, J. A., Whitbread, C., Dowden, M., Connors, C., Corpus, S., McCarthy, L., Oats, J., McIntyre, H. D., Moore, E., O'Dea, K., Brown, A., Maple-Brown, L. & NT Diabetes in Pregnancy Partnership (2017). Health service changes to address diabetes in pregnancy in a complex setting: perspectives of health professionals.. BMC Health Serv Res, 17 (1), pp.524-. https://doi.org/10.1186/s12913-017-2478-7.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/256870
    DOI
    10.1186/s12913-017-2478-7
    Open Access at PMC
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5543438
    Abstract
    BACKGROUND: Australian Aboriginal and Torres Strait Islander women have high rates of gestational and pre-existing type 2 diabetes in pregnancy. The Northern Territory (NT) Diabetes in Pregnancy Partnership was established to enhance systems and services to improve health outcomes. It has three arms: a clinical register, developing models of care and a longitudinal birth cohort. This study used a process evaluation to report on health professional's perceptions of models of care and related quality improvement activities since the implementation of the Partnership. METHODS: Changes to models of care were documented according to goals and aims of the Partnership and reviewed annually by the Partnership Steering group. A 'systems assessment tool' was used to guide six focus groups (49 healthcare professionals). Transcripts were coded and analysed according to pre-identified themes of orientation and guidelines, education, communication, logistics and access, and information technology. RESULTS: Key improvements since implementation of the Partnership include: health professional relationships, communication and education; and integration of quality improvement activities. Focus groups with 49 health professionals provided in depth information about how these activities have impacted their practice and models of care for diabetes in pregnancy. Co-ordination of care was reported to have improved, however it was also identified as an opportunity for further development. Recommendations included a central care coordinator, better integration of information technology systems and ongoing comprehensive quality improvement processes. CONCLUSIONS: The Partnership has facilitated quality improvement through supporting the development of improved systems that enhance models of care. Persisting challenges exist for delivering care to a high risk population however improvements in formal processes and structures, as demonstrated in this work thus far, play an important role in work towards improving health outcomes.

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