Meloncelli Nina, Barnett Adrian, de Jersey Susan
School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia.
Nutrition and Dietetics, Allied Health, Sunshine Coast University Hospital, Birtinya, Queensland, Australia.
Aust N Z J Obstet Gynaecol. 2020 Feb;60(1):115-122. doi: 10.1111/ajo.13032. Epub 2019 Jul 10.
In 2014, updated screening and diagnostic criteria for gestational diabetes (GDM) were introduced across Australia. Many states including Queensland introduced clinical guidelines to include these changes and other recommendations for GDM management. While it is understood that GDM diagnosis has increased, it is unknown whether resources or service delivery have changed, or whether health services have implemented the guidelines.
To understand the staff resourcing, models of care, level of guideline implementation and barriers and enablers to implementing the guideline across Queensland Health GDM services.
A 22-item electronic survey containing multiple choice and open-ended questions was disseminated to healthcare professionals involved in GDM care across 14 Hospital and Health Services (HHS) in Queensland between August and October 2017.
Fifty-three surveys were included for analysis. Between 2014 and 2016, Queensland GDM diagnosis increased by an average of 33%, yet only eight out of 14 HHS reported increases to staff resourcing. Full implementation of the GDM guideline was reported by 41% of metropolitan compared with 29% for regional and 25% for rural/remote services. Guideline recommendations were inconsistently delivered for physical activity advice, minimum schedule of dietetics appointments and psychosocial support. The most common barrier to guideline implementation was staff resourcing (85%), whereas enablers included staff/teamwork (42%), staff resourcing (21%), local protocols (21%) and staff education/knowledge (15%).
Increased staff funding as well as an implementation science-driven process for guideline implementation is required to ensure that the increasing number of women with GDM can receive evidence-based care.
2014年，澳大利亚各地引入了妊娠期糖尿病（GDM）的最新筛查和诊断标准。包括昆士兰州在内的许多州都出台了临床指南，将这些变化及其他妊娠期糖尿病管理建议纳入其中。虽然已知妊娠期糖尿病的诊断率有所上升，但资源或服务提供是否发生了变化，以及卫生服务机构是否实施了这些指南尚不清楚。
了解昆士兰卫生署妊娠期糖尿病服务中，工作人员配置、护理模式、指南实施水平以及实施指南的障碍和促进因素。
2017年8月至10月期间，向昆士兰州14家医院及卫生服务机构（HHS）中参与妊娠期糖尿病护理的医疗专业人员发放了一份包含多项选择题和开放式问题的22项电子调查问卷。
共纳入53份调查问卷进行分析。2014年至2016年期间，昆士兰州妊娠期糖尿病的诊断率平均上升了33%，但14家HHS中只有8家报告增加了工作人员配置。据报告，41%的大都市地区完全实施了妊娠期糖尿病指南，而地区和农村/偏远地区服务的这一比例分别为29%和25%。在体育活动建议、营养门诊的最低安排和心理社会支持方面，指南建议的执行情况不一致。指南实施最常见的障碍是人员配置（85%），而促进因素包括员工/团队合作（42%）、人员配置（21%）、当地规程（21%）和员工教育/知识（15%）。
需要增加工作人员资金，并采用基于实施科学的流程来实施指南，以确保越来越多的妊娠期糖尿病女性能够获得循证护理。
