Delivery of maternal health care in Indigenous primary care services

baseline data for an ongoing quality improvement initiative

Alice Rumbold, Ross Stewart Bailie, Damin Si, Michelle Dowden, Catherine Kennedy, Rhonda Cox, Lynette Ruth O'donoghue, H LIDDLE, Ru Kwedza, Sandra Thompson, Hugh Burke, Alexander Brown, Tarun Weeramanthri, Christine Connors

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    Abstract

    Background: Australia's Aboriginal and Torres Strait Islander (Indigenous) populations have disproportionately high rates of adverse perinatal outcomes relative to other Australians. Poorer access to good quality maternal health care is a key driver of this disparity. The aim of this study was to describe patterns of delivery of maternity care and service gaps in primary care services in Australian Indigenous communities.

    Methods: We undertook a cross-sectional baseline audit for a quality improvement intervention. Medical records of 535 women from 34 Indigenous community health centres in five regions (Top End of Northern Territory 13, Central Australia 2, Far West New South Wales 6, Western Australia 9, and North Queensland 4) were audited. The main outcome measures included: adherence to recommended protocols and procedures in the antenatal and postnatal periods including: clinical, laboratory and ultrasound investigations; screening for gestational diabetes and Group B Streptococcus; brief intervention/advice on health-related behaviours and risks; and follow up of identified health problems.

    Results: The proportion of women presenting for their first antenatal visit in the first trimester ranged from 34% to 49% between regions; consequently, documentation of care early in pregnancy was poor. Overall, documentation of routine antenatal investigations and brief interventions/advice regarding health behaviours varied, and generally indicated that these services were underutilised. For example, 46% of known smokers received smoking cessation advice/counselling; 52% of all women received antenatal education and 51% had investigation for gestational diabetes. Overall, there was relatively good documentation of follow up of identified problems related to hypertension or diabetes, with over 70% of identified women being referred to a GP/Obstetrician.

    Conclusion:
    Participating services had both strengths and weaknesses in the delivery of maternal health care. Increasing access to evidence-based screening and health information (most notably around smoking cessation) were consistently identified as opportunities for improvement across services.
    Original languageEnglish
    Pages (from-to)1-10
    Number of pages10
    JournalBMC Pregnancy and Childbirth
    Volume11
    Issue number16
    DOIs
    Publication statusPublished - 2011

    Fingerprint

    Quality Improvement
    Primary Health Care
    Documentation
    Delivery of Health Care
    Gestational Diabetes
    Smoking Cessation
    Health
    Prenatal Education
    Northern Territory
    Community Health Centers
    Western Australia
    New South Wales
    Queensland
    Streptococcus agalactiae
    Quality of Health Care
    Health Behavior
    First Pregnancy Trimester
    Population Groups
    Medical Records
    Counseling

    Cite this

    Rumbold, Alice ; Bailie, Ross Stewart ; Si, Damin ; Dowden, Michelle ; Kennedy, Catherine ; Cox, Rhonda ; O'donoghue, Lynette Ruth ; LIDDLE, H ; Kwedza, Ru ; Thompson, Sandra ; Burke, Hugh ; Brown, Alexander ; Weeramanthri, Tarun ; Connors, Christine. / Delivery of maternal health care in Indigenous primary care services : baseline data for an ongoing quality improvement initiative. In: BMC Pregnancy and Childbirth. 2011 ; Vol. 11, No. 16. pp. 1-10.
    @article{29dd0571f93148539eb7e9e46e73db3a,
    title = "Delivery of maternal health care in Indigenous primary care services: baseline data for an ongoing quality improvement initiative",
    abstract = "Background: Australia's Aboriginal and Torres Strait Islander (Indigenous) populations have disproportionately high rates of adverse perinatal outcomes relative to other Australians. Poorer access to good quality maternal health care is a key driver of this disparity. The aim of this study was to describe patterns of delivery of maternity care and service gaps in primary care services in Australian Indigenous communities.Methods: We undertook a cross-sectional baseline audit for a quality improvement intervention. Medical records of 535 women from 34 Indigenous community health centres in five regions (Top End of Northern Territory 13, Central Australia 2, Far West New South Wales 6, Western Australia 9, and North Queensland 4) were audited. The main outcome measures included: adherence to recommended protocols and procedures in the antenatal and postnatal periods including: clinical, laboratory and ultrasound investigations; screening for gestational diabetes and Group B Streptococcus; brief intervention/advice on health-related behaviours and risks; and follow up of identified health problems.Results: The proportion of women presenting for their first antenatal visit in the first trimester ranged from 34{\%} to 49{\%} between regions; consequently, documentation of care early in pregnancy was poor. Overall, documentation of routine antenatal investigations and brief interventions/advice regarding health behaviours varied, and generally indicated that these services were underutilised. For example, 46{\%} of known smokers received smoking cessation advice/counselling; 52{\%} of all women received antenatal education and 51{\%} had investigation for gestational diabetes. Overall, there was relatively good documentation of follow up of identified problems related to hypertension or diabetes, with over 70{\%} of identified women being referred to a GP/Obstetrician.Conclusion: Participating services had both strengths and weaknesses in the delivery of maternal health care. Increasing access to evidence-based screening and health information (most notably around smoking cessation) were consistently identified as opportunities for improvement across services.",
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    author = "Alice Rumbold and Bailie, {Ross Stewart} and Damin Si and Michelle Dowden and Catherine Kennedy and Rhonda Cox and O'donoghue, {Lynette Ruth} and H LIDDLE and Ru Kwedza and Sandra Thompson and Hugh Burke and Alexander Brown and Tarun Weeramanthri and Christine Connors",
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    doi = "10.1186/1471-2393-11-16",
    language = "English",
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    Rumbold, A, Bailie, RS, Si, D, Dowden, M, Kennedy, C, Cox, R, O'donoghue, LR, LIDDLE, H, Kwedza, R, Thompson, S, Burke, H, Brown, A, Weeramanthri, T & Connors, C 2011, 'Delivery of maternal health care in Indigenous primary care services: baseline data for an ongoing quality improvement initiative', BMC Pregnancy and Childbirth, vol. 11, no. 16, pp. 1-10. https://doi.org/10.1186/1471-2393-11-16

    Delivery of maternal health care in Indigenous primary care services : baseline data for an ongoing quality improvement initiative. / Rumbold, Alice; Bailie, Ross Stewart; Si, Damin; Dowden, Michelle; Kennedy, Catherine; Cox, Rhonda; O'donoghue, Lynette Ruth; LIDDLE, H; Kwedza, Ru; Thompson, Sandra; Burke, Hugh; Brown, Alexander; Weeramanthri, Tarun; Connors, Christine.

    In: BMC Pregnancy and Childbirth, Vol. 11, No. 16, 2011, p. 1-10.

    Research output: Contribution to journalArticleResearchpeer-review

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    T1 - Delivery of maternal health care in Indigenous primary care services

    T2 - baseline data for an ongoing quality improvement initiative

    AU - Rumbold, Alice

    AU - Bailie, Ross Stewart

    AU - Si, Damin

    AU - Dowden, Michelle

    AU - Kennedy, Catherine

    AU - Cox, Rhonda

    AU - O'donoghue, Lynette Ruth

    AU - LIDDLE, H

    AU - Kwedza, Ru

    AU - Thompson, Sandra

    AU - Burke, Hugh

    AU - Brown, Alexander

    AU - Weeramanthri, Tarun

    AU - Connors, Christine

    PY - 2011

    Y1 - 2011

    N2 - Background: Australia's Aboriginal and Torres Strait Islander (Indigenous) populations have disproportionately high rates of adverse perinatal outcomes relative to other Australians. Poorer access to good quality maternal health care is a key driver of this disparity. The aim of this study was to describe patterns of delivery of maternity care and service gaps in primary care services in Australian Indigenous communities.Methods: We undertook a cross-sectional baseline audit for a quality improvement intervention. Medical records of 535 women from 34 Indigenous community health centres in five regions (Top End of Northern Territory 13, Central Australia 2, Far West New South Wales 6, Western Australia 9, and North Queensland 4) were audited. The main outcome measures included: adherence to recommended protocols and procedures in the antenatal and postnatal periods including: clinical, laboratory and ultrasound investigations; screening for gestational diabetes and Group B Streptococcus; brief intervention/advice on health-related behaviours and risks; and follow up of identified health problems.Results: The proportion of women presenting for their first antenatal visit in the first trimester ranged from 34% to 49% between regions; consequently, documentation of care early in pregnancy was poor. Overall, documentation of routine antenatal investigations and brief interventions/advice regarding health behaviours varied, and generally indicated that these services were underutilised. For example, 46% of known smokers received smoking cessation advice/counselling; 52% of all women received antenatal education and 51% had investigation for gestational diabetes. Overall, there was relatively good documentation of follow up of identified problems related to hypertension or diabetes, with over 70% of identified women being referred to a GP/Obstetrician.Conclusion: Participating services had both strengths and weaknesses in the delivery of maternal health care. Increasing access to evidence-based screening and health information (most notably around smoking cessation) were consistently identified as opportunities for improvement across services.

    AB - Background: Australia's Aboriginal and Torres Strait Islander (Indigenous) populations have disproportionately high rates of adverse perinatal outcomes relative to other Australians. Poorer access to good quality maternal health care is a key driver of this disparity. The aim of this study was to describe patterns of delivery of maternity care and service gaps in primary care services in Australian Indigenous communities.Methods: We undertook a cross-sectional baseline audit for a quality improvement intervention. Medical records of 535 women from 34 Indigenous community health centres in five regions (Top End of Northern Territory 13, Central Australia 2, Far West New South Wales 6, Western Australia 9, and North Queensland 4) were audited. The main outcome measures included: adherence to recommended protocols and procedures in the antenatal and postnatal periods including: clinical, laboratory and ultrasound investigations; screening for gestational diabetes and Group B Streptococcus; brief intervention/advice on health-related behaviours and risks; and follow up of identified health problems.Results: The proportion of women presenting for their first antenatal visit in the first trimester ranged from 34% to 49% between regions; consequently, documentation of care early in pregnancy was poor. Overall, documentation of routine antenatal investigations and brief interventions/advice regarding health behaviours varied, and generally indicated that these services were underutilised. For example, 46% of known smokers received smoking cessation advice/counselling; 52% of all women received antenatal education and 51% had investigation for gestational diabetes. Overall, there was relatively good documentation of follow up of identified problems related to hypertension or diabetes, with over 70% of identified women being referred to a GP/Obstetrician.Conclusion: Participating services had both strengths and weaknesses in the delivery of maternal health care. Increasing access to evidence-based screening and health information (most notably around smoking cessation) were consistently identified as opportunities for improvement across services.

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