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 - Diabetes Across the Lifecourse: Northern Australia Partnership
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.
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
UR - http://www.scopus.com/inward/record.url?scp=85114318915&partnerID=8YFLogxK
UR - http://purl.org/au-research/grants/NHMRC/1092968
UR - http://purl.org/au-research/grants/NHMRC/1137563
UR - http://purl.org/au-research/grants/NHMRC/1078477
U2 - 10.1002/ijgo.13850
DO - 10.1002/ijgo.13850
M3 - Article
C2 - 34331708
AN - SCOPUS:85114318915
SN - 0020-7292
VL - 155
SP - 179
EP - 194
JO - International Journal of Gynecology and Obstetrics
JF - International Journal of Gynecology and Obstetrics
IS - 2
ER -
