Implementation of a diabetes in pregnancy clinical register in a complex setting: Findings from a process evaluation

Cherie Whitbread, Christine Connors, Richa Richa, Federica Barzi, Michelle Dowden, Jeremy J N Oats, Chrissie Inglis, Margaret Cotter, Harold D. McIntyre, Marie Kirkwood, Paula van Dokkum, Stacey Svenson, Paul Zimmet, Jonathan E. Shaw, Kerin O’Dea, Alex Brown, Louise J Maple-Brown, Northern Territory Diabetes in Pregnancy Partnership

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Rates of diabetes in pregnancy are disproportionately higher among Aboriginal than non-Aboriginal women in Australia. Additional challenges are posed by the context of Aboriginal health including remoteness and disadvantage. A clinical register was established in 2011 to improve care coordination, and as an epidemiological and quality assurance tool. This paper presents results from a process evaluation identifying what worked well, persisting challenges and opportunities for improvement. Methods: Clinical register data were compared to the Northern Territory Midwives Data Collection. A cross-sectional survey of 113 health professionals across the region was also conducted in 2016 to assess use and value of the register; and five focus groups (49 healthcare professionals) documented improvements to models of care. Results: From January 2012 to December 2015, 1,410 women were referred to the register, 48% of whom were Aboriginal. In 2014, women on the register represented 75% of those on the Midwives Data Collection for Aboriginal women with gestational diabetes and 100% for Aboriginal women with pre-existing diabetes. Since commencement of the register, an 80% increase in reported prevalence of gestational diabetes among Aboriginal women in the Midwives Data Collection occurred (2011–2013), prior to adoption of new diagnostic criteria (2014). As most women met both diagnostic criteria (81% in 2012 and 74% in 2015) it is unlikely that the changes in criteria contributed to this increase. Over half (57%) of survey respondents reported improvement in knowledge of the epidemiology of diabetes in pregnancy since establishment of the register. However, only 32% of survey respondents thought that the register improved care-coordination. The need for improved integration and awareness to increase use was also highlighted. Conclusion: Although the register has not been reported to improve care coordination, it has contributed to increased reported prevalence of gestational diabetes among high risk Aboriginal women, in a routinely collected jurisdiction-wide pregnancy dataset. It has therefore contributed to an improved understanding of epidemiology and disease burden and may in future contribute to improved management and outcomes. Regions with similar challenges in context and high risk populations for diabetes in pregnancy may benefit from this experience of implementing a register.

Original languageEnglish
Article numbere0179487
Number of pages15
JournalPLoS ONE
Volume12
Issue number8
DOIs
Publication statusPublished - 1 Aug 2017

Cite this

Whitbread, C., Connors, C., Richa, R., Barzi, F., Dowden, M., Oats, J. J. N., ... Northern Territory Diabetes in Pregnancy Partnership (2017). Implementation of a diabetes in pregnancy clinical register in a complex setting: Findings from a process evaluation. PLoS ONE, 12(8), [e0179487]. https://doi.org/10.1371/journal.pone.0179487
Whitbread, Cherie ; Connors, Christine ; Richa, Richa ; Barzi, Federica ; Dowden, Michelle ; Oats, Jeremy J N ; Inglis, Chrissie ; Cotter, Margaret ; McIntyre, Harold D. ; Kirkwood, Marie ; van Dokkum, Paula ; Svenson, Stacey ; Zimmet, Paul ; Shaw, Jonathan E. ; O’Dea, Kerin ; Brown, Alex ; Maple-Brown, Louise J ; Northern Territory Diabetes in Pregnancy Partnership. / Implementation of a diabetes in pregnancy clinical register in a complex setting : Findings from a process evaluation. In: PLoS ONE. 2017 ; Vol. 12, No. 8.
@article{ee5f905e176c4f99b5d41ccc6bd996ed,
title = "Implementation of a diabetes in pregnancy clinical register in a complex setting: Findings from a process evaluation",
abstract = "Background: Rates of diabetes in pregnancy are disproportionately higher among Aboriginal than non-Aboriginal women in Australia. Additional challenges are posed by the context of Aboriginal health including remoteness and disadvantage. A clinical register was established in 2011 to improve care coordination, and as an epidemiological and quality assurance tool. This paper presents results from a process evaluation identifying what worked well, persisting challenges and opportunities for improvement. Methods: Clinical register data were compared to the Northern Territory Midwives Data Collection. A cross-sectional survey of 113 health professionals across the region was also conducted in 2016 to assess use and value of the register; and five focus groups (49 healthcare professionals) documented improvements to models of care. Results: From January 2012 to December 2015, 1,410 women were referred to the register, 48{\%} of whom were Aboriginal. In 2014, women on the register represented 75{\%} of those on the Midwives Data Collection for Aboriginal women with gestational diabetes and 100{\%} for Aboriginal women with pre-existing diabetes. Since commencement of the register, an 80{\%} increase in reported prevalence of gestational diabetes among Aboriginal women in the Midwives Data Collection occurred (2011–2013), prior to adoption of new diagnostic criteria (2014). As most women met both diagnostic criteria (81{\%} in 2012 and 74{\%} in 2015) it is unlikely that the changes in criteria contributed to this increase. Over half (57{\%}) of survey respondents reported improvement in knowledge of the epidemiology of diabetes in pregnancy since establishment of the register. However, only 32{\%} of survey respondents thought that the register improved care-coordination. The need for improved integration and awareness to increase use was also highlighted. Conclusion: Although the register has not been reported to improve care coordination, it has contributed to increased reported prevalence of gestational diabetes among high risk Aboriginal women, in a routinely collected jurisdiction-wide pregnancy dataset. It has therefore contributed to an improved understanding of epidemiology and disease burden and may in future contribute to improved management and outcomes. Regions with similar challenges in context and high risk populations for diabetes in pregnancy may benefit from this experience of implementing a register.",
author = "Cherie Whitbread and Christine Connors and Richa Richa and Federica Barzi and Michelle Dowden and Oats, {Jeremy J N} and Chrissie Inglis and Margaret Cotter and McIntyre, {Harold D.} and Marie Kirkwood and {van Dokkum}, Paula and Stacey Svenson and Paul Zimmet and Shaw, {Jonathan E.} and Kerin O’Dea and Alex Brown and Maple-Brown, {Louise J} and {Northern Territory Diabetes in Pregnancy Partnership}",
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Whitbread, C, Connors, C, Richa, R, Barzi, F, Dowden, M, Oats, JJN, Inglis, C, Cotter, M, McIntyre, HD, Kirkwood, M, van Dokkum, P, Svenson, S, Zimmet, P, Shaw, JE, O’Dea, K, Brown, A, Maple-Brown, LJ & Northern Territory Diabetes in Pregnancy Partnership 2017, 'Implementation of a diabetes in pregnancy clinical register in a complex setting: Findings from a process evaluation' PLoS ONE, vol. 12, no. 8, e0179487. https://doi.org/10.1371/journal.pone.0179487

Implementation of a diabetes in pregnancy clinical register in a complex setting : Findings from a process evaluation. / Whitbread, Cherie; Connors, Christine; Richa, Richa; Barzi, Federica; Dowden, Michelle; Oats, Jeremy J N; Inglis, Chrissie; Cotter, Margaret; McIntyre, Harold D.; Kirkwood, Marie; van Dokkum, Paula; Svenson, Stacey; Zimmet, Paul; Shaw, Jonathan E.; O’Dea, Kerin; Brown, Alex; Maple-Brown, Louise J; Northern Territory Diabetes in Pregnancy Partnership.

In: PLoS ONE, Vol. 12, No. 8, e0179487, 01.08.2017.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Implementation of a diabetes in pregnancy clinical register in a complex setting

T2 - Findings from a process evaluation

AU - Whitbread, Cherie

AU - Connors, Christine

AU - Richa, Richa

AU - Barzi, Federica

AU - Dowden, Michelle

AU - Oats, Jeremy J N

AU - Inglis, Chrissie

AU - Cotter, Margaret

AU - McIntyre, Harold D.

AU - Kirkwood, Marie

AU - van Dokkum, Paula

AU - Svenson, Stacey

AU - Zimmet, Paul

AU - Shaw, Jonathan E.

AU - O’Dea, Kerin

AU - Brown, Alex

AU - Maple-Brown, Louise J

AU - Northern Territory Diabetes in Pregnancy Partnership

PY - 2017/8/1

Y1 - 2017/8/1

N2 - Background: Rates of diabetes in pregnancy are disproportionately higher among Aboriginal than non-Aboriginal women in Australia. Additional challenges are posed by the context of Aboriginal health including remoteness and disadvantage. A clinical register was established in 2011 to improve care coordination, and as an epidemiological and quality assurance tool. This paper presents results from a process evaluation identifying what worked well, persisting challenges and opportunities for improvement. Methods: Clinical register data were compared to the Northern Territory Midwives Data Collection. A cross-sectional survey of 113 health professionals across the region was also conducted in 2016 to assess use and value of the register; and five focus groups (49 healthcare professionals) documented improvements to models of care. Results: From January 2012 to December 2015, 1,410 women were referred to the register, 48% of whom were Aboriginal. In 2014, women on the register represented 75% of those on the Midwives Data Collection for Aboriginal women with gestational diabetes and 100% for Aboriginal women with pre-existing diabetes. Since commencement of the register, an 80% increase in reported prevalence of gestational diabetes among Aboriginal women in the Midwives Data Collection occurred (2011–2013), prior to adoption of new diagnostic criteria (2014). As most women met both diagnostic criteria (81% in 2012 and 74% in 2015) it is unlikely that the changes in criteria contributed to this increase. Over half (57%) of survey respondents reported improvement in knowledge of the epidemiology of diabetes in pregnancy since establishment of the register. However, only 32% of survey respondents thought that the register improved care-coordination. The need for improved integration and awareness to increase use was also highlighted. Conclusion: Although the register has not been reported to improve care coordination, it has contributed to increased reported prevalence of gestational diabetes among high risk Aboriginal women, in a routinely collected jurisdiction-wide pregnancy dataset. It has therefore contributed to an improved understanding of epidemiology and disease burden and may in future contribute to improved management and outcomes. Regions with similar challenges in context and high risk populations for diabetes in pregnancy may benefit from this experience of implementing a register.

AB - Background: Rates of diabetes in pregnancy are disproportionately higher among Aboriginal than non-Aboriginal women in Australia. Additional challenges are posed by the context of Aboriginal health including remoteness and disadvantage. A clinical register was established in 2011 to improve care coordination, and as an epidemiological and quality assurance tool. This paper presents results from a process evaluation identifying what worked well, persisting challenges and opportunities for improvement. Methods: Clinical register data were compared to the Northern Territory Midwives Data Collection. A cross-sectional survey of 113 health professionals across the region was also conducted in 2016 to assess use and value of the register; and five focus groups (49 healthcare professionals) documented improvements to models of care. Results: From January 2012 to December 2015, 1,410 women were referred to the register, 48% of whom were Aboriginal. In 2014, women on the register represented 75% of those on the Midwives Data Collection for Aboriginal women with gestational diabetes and 100% for Aboriginal women with pre-existing diabetes. Since commencement of the register, an 80% increase in reported prevalence of gestational diabetes among Aboriginal women in the Midwives Data Collection occurred (2011–2013), prior to adoption of new diagnostic criteria (2014). As most women met both diagnostic criteria (81% in 2012 and 74% in 2015) it is unlikely that the changes in criteria contributed to this increase. Over half (57%) of survey respondents reported improvement in knowledge of the epidemiology of diabetes in pregnancy since establishment of the register. However, only 32% of survey respondents thought that the register improved care-coordination. The need for improved integration and awareness to increase use was also highlighted. Conclusion: Although the register has not been reported to improve care coordination, it has contributed to increased reported prevalence of gestational diabetes among high risk Aboriginal women, in a routinely collected jurisdiction-wide pregnancy dataset. It has therefore contributed to an improved understanding of epidemiology and disease burden and may in future contribute to improved management and outcomes. Regions with similar challenges in context and high risk populations for diabetes in pregnancy may benefit from this experience of implementing a register.

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