Diabetes care in remote Australia

The antenatal, postpartum and inter-pregnancy period

R. Kirkham, N. Trap-Jensen, J. A. Boyle, F. Barzi, E. L.M. Barr, C. Whitbread, P. Van Dokkum, M. Kirkwood, C. Connors, E. Moore, P. Zimmet, S. Corpus, A. J. Hanley, K. O'Dea, J. Oats, H. D. McIntyre, A. Brown, J. E. Shaw, L. Maple-Brown

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    Background: Aboriginal and Torres Strait Islander women experience high rates of diabetes in pregnancy (DIP), contributing to health risks for mother and infant, and the intergenerational cycle of diabetes. By enhancing diabetes management during pregnancy, postpartum and the interval between pregnancies, the DIP Partnership aims to improve health outcomes and reduce risks early in the life-course. We describe a mixed methods formative study of health professional's perspectives of antenatal and post-partum diabetes screening and management, including enablers and barriers to care. 

    Methods: Health professionals involved in providing diabetes care in pregnancy, from a range of health services across the Northern Territory, completed the survey (n = 82) and/or took part in interviews and/or focus groups (n = 62). 

    Results: Qualitative findings highlighted factors influencing the delivery of care as reported by health professionals, including: whose responsibility it is, access to care, the baby is the focus and pre-conception care. The main challenges were related to: disjointed systems and confusion around whose role it is to provide follow-up care beyond six weeks post-partum. Quantitative findings indicated that the majority of health professionals reported confidence in their own skills to manage women in the antenatal period (62%, 40/79) and slightly lower rates of confidence in the postpartum interval (57%, 33/58). 

    Conclusion: These findings regarding whose role it is to provide postpartum care, along with opportunities to improve communication pathways and follow up care have informed the design of a complex health intervention to improve health systems and the provision of DIP related care.

    Original languageEnglish
    Article number389
    Pages (from-to)1-10
    Number of pages10
    JournalBMC Pregnancy and Childbirth
    Volume19
    DOIs
    Publication statusPublished - 28 Oct 2019

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    Postpartum Period
    Pregnancy in Diabetics
    Pregnancy
    Health
    Aftercare
    Northern Territory
    Postnatal Care
    Birth Intervals
    Confusion
    Focus Groups
    Health Services
    Communication
    Mothers
    Interviews

    Cite this

    Kirkham, R. ; Trap-Jensen, N. ; Boyle, J. A. ; Barzi, F. ; Barr, E. L.M. ; Whitbread, C. ; Van Dokkum, P. ; Kirkwood, M. ; Connors, C. ; Moore, E. ; Zimmet, P. ; Corpus, S. ; Hanley, A. J. ; O'Dea, K. ; Oats, J. ; McIntyre, H. D. ; Brown, A. ; Shaw, J. E. ; Maple-Brown, L. / Diabetes care in remote Australia : The antenatal, postpartum and inter-pregnancy period. In: BMC Pregnancy and Childbirth. 2019 ; Vol. 19. pp. 1-10.
    @article{c6b27d36c8c3459583b36c60c3095e1d,
    title = "Diabetes care in remote Australia: The antenatal, postpartum and inter-pregnancy period",
    abstract = "Background: Aboriginal and Torres Strait Islander women experience high rates of diabetes in pregnancy (DIP), contributing to health risks for mother and infant, and the intergenerational cycle of diabetes. By enhancing diabetes management during pregnancy, postpartum and the interval between pregnancies, the DIP Partnership aims to improve health outcomes and reduce risks early in the life-course. We describe a mixed methods formative study of health professional's perspectives of antenatal and post-partum diabetes screening and management, including enablers and barriers to care. Methods: Health professionals involved in providing diabetes care in pregnancy, from a range of health services across the Northern Territory, completed the survey (n = 82) and/or took part in interviews and/or focus groups (n = 62). Results: Qualitative findings highlighted factors influencing the delivery of care as reported by health professionals, including: whose responsibility it is, access to care, the baby is the focus and pre-conception care. The main challenges were related to: disjointed systems and confusion around whose role it is to provide follow-up care beyond six weeks post-partum. Quantitative findings indicated that the majority of health professionals reported confidence in their own skills to manage women in the antenatal period (62{\%}, 40/79) and slightly lower rates of confidence in the postpartum interval (57{\%}, 33/58). Conclusion: These findings regarding whose role it is to provide postpartum care, along with opportunities to improve communication pathways and follow up care have informed the design of a complex health intervention to improve health systems and the provision of DIP related care.",
    keywords = "Antenatal, Diabetes in pregnancy, Healthcare services, Indigenous, Postpartum",
    author = "R. Kirkham and N. Trap-Jensen and Boyle, {J. A.} and F. Barzi and Barr, {E. L.M.} and C. Whitbread and {Van Dokkum}, P. and M. Kirkwood and C. Connors and E. Moore and P. Zimmet and S. Corpus and Hanley, {A. J.} and K. O'Dea and J. Oats and McIntyre, {H. D.} and A. Brown and Shaw, {J. E.} and L. Maple-Brown",
    year = "2019",
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    Kirkham, R, Trap-Jensen, N, Boyle, JA, Barzi, F, Barr, ELM, Whitbread, C, Van Dokkum, P, Kirkwood, M, Connors, C, Moore, E, Zimmet, P, Corpus, S, Hanley, AJ, O'Dea, K, Oats, J, McIntyre, HD, Brown, A, Shaw, JE & Maple-Brown, L 2019, 'Diabetes care in remote Australia: The antenatal, postpartum and inter-pregnancy period', BMC Pregnancy and Childbirth, vol. 19, 389, pp. 1-10. https://doi.org/10.1186/s12884-019-2562-6

    Diabetes care in remote Australia : The antenatal, postpartum and inter-pregnancy period. / Kirkham, R.; Trap-Jensen, N.; Boyle, J. A.; Barzi, F.; Barr, E. L.M.; Whitbread, C.; Van Dokkum, P.; Kirkwood, M.; Connors, C.; Moore, E.; Zimmet, P.; Corpus, S.; Hanley, A. J.; O'Dea, K.; Oats, J.; McIntyre, H. D.; Brown, A.; Shaw, J. E.; Maple-Brown, L.

    In: BMC Pregnancy and Childbirth, Vol. 19, 389, 28.10.2019, p. 1-10.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - Diabetes care in remote Australia

    T2 - The antenatal, postpartum and inter-pregnancy period

    AU - Kirkham, R.

    AU - Trap-Jensen, N.

    AU - Boyle, J. A.

    AU - Barzi, F.

    AU - Barr, E. L.M.

    AU - Whitbread, C.

    AU - Van Dokkum, P.

    AU - Kirkwood, M.

    AU - Connors, C.

    AU - Moore, E.

    AU - Zimmet, P.

    AU - Corpus, S.

    AU - Hanley, A. J.

    AU - O'Dea, K.

    AU - Oats, J.

    AU - McIntyre, H. D.

    AU - Brown, A.

    AU - Shaw, J. E.

    AU - Maple-Brown, L.

    PY - 2019/10/28

    Y1 - 2019/10/28

    N2 - Background: Aboriginal and Torres Strait Islander women experience high rates of diabetes in pregnancy (DIP), contributing to health risks for mother and infant, and the intergenerational cycle of diabetes. By enhancing diabetes management during pregnancy, postpartum and the interval between pregnancies, the DIP Partnership aims to improve health outcomes and reduce risks early in the life-course. We describe a mixed methods formative study of health professional's perspectives of antenatal and post-partum diabetes screening and management, including enablers and barriers to care. Methods: Health professionals involved in providing diabetes care in pregnancy, from a range of health services across the Northern Territory, completed the survey (n = 82) and/or took part in interviews and/or focus groups (n = 62). Results: Qualitative findings highlighted factors influencing the delivery of care as reported by health professionals, including: whose responsibility it is, access to care, the baby is the focus and pre-conception care. The main challenges were related to: disjointed systems and confusion around whose role it is to provide follow-up care beyond six weeks post-partum. Quantitative findings indicated that the majority of health professionals reported confidence in their own skills to manage women in the antenatal period (62%, 40/79) and slightly lower rates of confidence in the postpartum interval (57%, 33/58). Conclusion: These findings regarding whose role it is to provide postpartum care, along with opportunities to improve communication pathways and follow up care have informed the design of a complex health intervention to improve health systems and the provision of DIP related care.

    AB - Background: Aboriginal and Torres Strait Islander women experience high rates of diabetes in pregnancy (DIP), contributing to health risks for mother and infant, and the intergenerational cycle of diabetes. By enhancing diabetes management during pregnancy, postpartum and the interval between pregnancies, the DIP Partnership aims to improve health outcomes and reduce risks early in the life-course. We describe a mixed methods formative study of health professional's perspectives of antenatal and post-partum diabetes screening and management, including enablers and barriers to care. Methods: Health professionals involved in providing diabetes care in pregnancy, from a range of health services across the Northern Territory, completed the survey (n = 82) and/or took part in interviews and/or focus groups (n = 62). Results: Qualitative findings highlighted factors influencing the delivery of care as reported by health professionals, including: whose responsibility it is, access to care, the baby is the focus and pre-conception care. The main challenges were related to: disjointed systems and confusion around whose role it is to provide follow-up care beyond six weeks post-partum. Quantitative findings indicated that the majority of health professionals reported confidence in their own skills to manage women in the antenatal period (62%, 40/79) and slightly lower rates of confidence in the postpartum interval (57%, 33/58). Conclusion: These findings regarding whose role it is to provide postpartum care, along with opportunities to improve communication pathways and follow up care have informed the design of a complex health intervention to improve health systems and the provision of DIP related care.

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    KW - Diabetes in pregnancy

    KW - Healthcare services

    KW - Indigenous

    KW - Postpartum

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