Improving systems of care during and after a pregnancy complicated by hyperglycaemia: A protocol for a complex health systems intervention.

Autor: MacKay D; Menzies School of Health Research, Charles Darwin University, Darwin, Australia.; Royal Darwin Hospital, Darwin, Australia., Kirkham R; Menzies School of Health Research, Charles Darwin University, Darwin, Australia., Freeman N; Menzies School of Health Research, Charles Darwin University, Darwin, Australia., Murtha K; Menzies School of Health Research, Charles Darwin University, Darwin, Australia., Van Dokkum P; Baker Heart & Diabetes Institute Central Australia, Alice Springs, Australia., Boyle J; Menzies School of Health Research, Charles Darwin University, Darwin, Australia.; Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia., Campbell S; College of Nursing and Midwifery, Charles Darwin University, Cairns, Australia., Barzi F; Menzies School of Health Research, Charles Darwin University, Darwin, Australia., Connors C; Top End Health Service, Northern Territory Department of Health, Darwin, Australia., O'Dea K; Population School of Health Research, University of South Australia, Adelaide, Australia.; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia., Oats J; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia., Zimmet P; Department of Diabetes, Central Clinical School, Monash University, Melbourne, Australia., Wenitong M; Apunipima Cape York Health Council, Bungalow, Australia., Sinha A; Cairns and Hinterland Hospital and Health Service, Cairns, Australia., Hanley AJ; Department of Nutritional Sciences, Faculty of Medicine and the Dalla Lana School of Public Health, The University of Toronto, Toronto, Canada., Moore E; Aboriginal Medical Services Alliance Northern Territory, Darwin, Australia., Peiris D; The George Institute for Global Health, Sydney, Australia., McLean A; Menzies School of Health Research, Charles Darwin University, Darwin, Australia.; Cairns and Hinterland Hospital and Health Service, Cairns, Australia., Davis B; Cairns and Hinterland Hospital and Health Service, Cairns, Australia., Whitbread C; Menzies School of Health Research, Charles Darwin University, Darwin, Australia.; Royal Darwin Hospital, Darwin, Australia., McIntyre HD; Mater Medical Research Institute, University of Queensland, Brisbane, Australia., Mein J; Wuchopperen Health Service, Cairns, Australia., McDermott R; Centre for Chronic Disease Prevention, Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Australia., Corpus S; Danila Dilba Health Service, Darwin, Australia., Canuto K; South Australian Health and Medical Research Institute, Adelaide, Australia., Shaw JE; Aboriginal Health Domain, Baker IDI Heart and Diabetes Institute, Melbourne, Australia., Brown A; South Australian Health and Medical Research Institute, Adelaide, Australia.; Faculty of Health and Medical Science, University of Adelaide, Adelaide, Australia., Maple-Brown L; Menzies School of Health Research, Charles Darwin University, Darwin, Australia. louise.maple-brown@menzies.edu.au.; Royal Darwin Hospital, Darwin, Australia. louise.maple-brown@menzies.edu.au.
Jazyk: angličtina
Zdroj: BMC health services research [BMC Health Serv Res] 2020 Sep 01; Vol. 20 (1), pp. 814. Date of Electronic Publication: 2020 Sep 01.
DOI: 10.1186/s12913-020-05680-x
Abstrakt: Background: Many women with hyperglycaemia in pregnancy do not receive care during and after pregnancy according to standards recommended in international guidelines. The burden of hyperglycaemia in pregnancy falls disproportionately upon Indigenous peoples worldwide, including Aboriginal and Torres Strait Islander women in Australia. The remote and regional Australian context poses additional barriers to delivering healthcare, including high staff turnover and a socially disadvantaged population with a high prevalence of diabetes.
Methods: A complex health systems intervention to improve care for women during and after a pregnancy complicated by hyperglycaemia will be implemented in remote and regional Australia (the Northern Territory and Far North Queensland). The Theoretical Domains Framework was used during formative work with stakeholders to identify intervention components: (1) increasing workforce capacity, skills and knowledge and improving health literacy of health professionals and women; (2) improving access to healthcare through culturally and clinically appropriate pathways; (3) improving information management and communication; (4) enhancing policies and guidelines; (5) embedding use of a clinical register as a quality improvement tool. The intervention will be evaluated utilising the RE-AIM framework at two timepoints: firstly, a qualitative interim evaluation involving interviews with stakeholders (health professionals, champions and project implementers); and subsequently a mixed-methods final evaluation of outcomes and processes: interviews with stakeholders; survey of health professionals; an audit of electronic health records and clinical register; and a review of operational documents. Outcome measures include changes between pre- and post-intervention in: proportion of high risk women receiving recommended glucose screening in early pregnancy; diabetes-related birth outcomes; proportion of women receiving recommended postpartum care including glucose testing; health practitioner confidence in providing care, knowledge and use of relevant guidelines and referral pathways, and perception of care coordination and communication systems; changes to health systems including referral pathways and clinical guidelines.
Discussion: This study will provide insights into the impact of health systems changes in improving care for women with hyperglycaemia during and after pregnancy in a challenging setting. It will also provide detailed information on process measures in the implementation of such health system changes.
Databáze: MEDLINE
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