Implementation of a diabetes in pregnancy clinical register in a complex setting: Findings from a process evaluation.
Implementation of a diabetes in pregnancy clinical register in a complex setting: Findings from a process evaluation.
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DOI：
10.1371/journal.pone.0179487
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Northern Territory Diabetes in Pregnancy Partnership
中科院分区：
文献类型：
--
作者：
Kirkham R;Whitbread C;Connors C;Moore E;Boyle JA;Richa R;Barzi F;Li S;Dowden M;Oats J;Inglis C;Cotter M;McIntyre HD;Kirkwood M;Van Dokkum P;Svenson S;Zimmet P;Shaw JE;O'Dea K;Brown A;Maple-Brown L;Northern Territory Diabetes in Pregnancy Partnership
在澳大利亚，土著妇女的妊娠期糖尿病发病率比非土著妇女高得不成比例。土著健康状况带来了其他挑战，包括偏远和不利条件。2011年建立了临床登记册，以改善护理协调，并作为流行病学和质量保证工具。本文介绍了过程评估的结果，确定了哪些工作良好，持续存在的挑战和改进的机会。临床登记数据与北领地助产士数据收集进行了比较。2016年还对该地区113名卫生专业人员进行了一项横断面调查，以评估登记册的使用和价值；五个重点小组(49名卫生保健专业人员)记录了护理模式的改进。从2012年1月至2015年12月，有1,410名妇女登记在册，其中48%是土著人。2014年，登记在册的妇女占患有妊娠期糖尿病的土著妇女助产士数据收集的75%，占患有既往糖尿病的土著妇女的100%。自登记开始以来，助产士数据收集中土著妇女中报告的妊娠期糖尿病患病率增加了80%(2011-2013年)，在采用新的诊断标准之前(2014年)。由于大多数女性同时符合这两个诊断标准(2012年为81%，2015年为74%)，标准的变化不太可能导致这一增长。超过一半(57%)的调查受访者报告说，自建立登记以来，对妊娠期糖尿病流行病学的了解有所改善。然而，只有32%的调查受访者认为登记改善了护理协调。还强调需要改进一体化和提高认识，以增加使用。虽然没有报告登记以改善护理协调，但在整个司法管辖区例行收集的怀孕数据集中，这有助于增加高危土著妇女中报告的妊娠期糖尿病患病率。因此，它有助于更好地了解流行病学和疾病负担，并在未来可能有助于改进管理和成果。具有类似背景挑战和妊娠期糖尿病高危人群的地区可以从实施登记的经验中受益。
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. 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. 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. 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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