Kirkham Renae, Whitbread Cherie, Connors Christine, Moore Elizabeth, Boyle Jacqueline A, Richa Richa, Barzi Federica, Li Shu, Dowden Michelle, Oats Jeremy, 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
Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Darwin, Australia.
Royal Darwin Hospital, Darwin, Australia.
PLoS One. 2017 Aug 4;12(8):e0179487. doi: 10.1371/journal.pone.0179487. eCollection 2017.
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.
在澳大利亚，原住民孕妇患糖尿病的比例远高于非原住民女性。原住民健康状况的背景，包括地处偏远和条件不利，带来了更多挑战。2011年建立了一个临床登记系统，以改善护理协调，并作为一种流行病学和质量保证工具。本文介绍了一项过程评估的结果，该评估确定了哪些方面运作良好、持续存在的挑战以及改进的机会。
将临床登记系统的数据与北领地助产士数据收集进行比较。2016年还对该地区113名卫生专业人员进行了横断面调查，以评估登记系统的使用情况和价值；五个焦点小组（49名医疗保健专业人员）记录了护理模式的改进情况。
2012年1月至2015年12月，1410名妇女被转诊至该登记系统，其中48%为原住民。2014年，登记系统中的妇女占助产士数据收集中患有妊娠期糖尿病的原住民妇女的75%，占患有既往糖尿病的原住民妇女的100%。自登记系统启动以来，在采用新诊断标准（2014年）之前，助产士数据收集中报告的原住民妇女妊娠期糖尿病患病率增加了80%（2011 - 2013年）。由于大多数妇女符合两项诊断标准（2012年为81%，2015年为74%），因此标准的变化不太可能导致这种增加。超过一半（57%）的调查受访者表示，自登记系统建立以来，他们对妊娠期糖尿病流行病学的了解有所改善。然而，只有32%的调查受访者认为该登记系统改善了护理协调。还强调了需要加强整合和提高认识以增加使用。
尽管尚未报告该登记系统改善了护理协调，但在一个常规收集的全辖区妊娠数据集中，它有助于提高高危原住民妇女妊娠期糖尿病的报告患病率。因此，它有助于更好地了解流行病学和疾病负担，未来可能有助于改善管理和结果。在背景方面面临类似挑战且有妊娠期糖尿病高危人群的地区，可能会从实施登记系统的这一经验中受益。
