Background: There are multiple barriers to providing optimal care to women with hyperglycaemia in pregnancy in regional and remote Australia. Between 2016 and 2019 a multi-component health systems intervention was implemented in Australia’s Northern Territory (NT) and Far North Queensland (FNQ) aiming to improve care. Components included providing clinician education, improving recall and reminder systems, enhancing policies and guidelines, and embedding use of the NT and FNQ Diabetes in Pregnancy (DIP) Clinical Register in practice. The current study evaluates the health professional-reported impact of this intervention.
Methods: This mixed-methods evaluation was underpinned by the RE-AIM framework. Clinicians involved in the care of women with hyperglycaemia in pregnancy in NT and FNQ were surveyed prior to and following implementation. Constructs explored included usual practice, confidence in providing care, and satisfaction with care pathways and communication between services. Changes between baseline and post-intervention survey data was analysed using Pearson’s Chi-squared test or Fisher’s exact test. Following the final survey, qualitative semi-structured interviews were conducted with clinicians at six primary care evaluation sites and three tertiary referral hospitals, in addition to policymakers and study implementation team. Interviews explored participants’ awareness of and engagement with the health systems intervention, and perceived impact on practice and systems of care. Qualitative data was analysed using a hybrid inductive-deductive method.
Findings: 183 and 137 participants completed the survey at baseline and follow-up, respectively. 46 participated in interviews. Practitioners “very confident” or “confident” in providing care increased (care during pregnancy - baseline 60.1%, post-intervention 72.3%, p=0.003; care postpartum - baseline 56.9%, post-intervention 72.4%, p=0.01). Improvements in glucose screening, including reported increases in use of recommended tests (72.0% using recommended first trimester screening test at baseline, 94.8% post-intervention, p<0.001) and timing of screening (28.3% screening at appropriate interval after gestational diabetes at baseline, 66.7% post-intervention, p<0.001), suggested improved practitioner knowledge. Health practitioners highly valued the hyperglycaemia in pregnancy clinician network which had developed as a result of the intervention. The NT and FNQ DIP Clinical Register supplied data that supported the allocation of additional resources to the care of women with hyperglycaemia in pregnancy.
Conclusions: A multi-component health systems intervention has resulted in a strong clinician network for providing care to women with hyperglycaemia in pregnancy in regional and remote Australia, with health practitioners reporting improvements in their own practice. Changes to practice will also be evaluated through an audit of primary care health records.