McLean Anna, Kirkham Renae, Campbell Sandra, Whitbread Cherie, Barrett Jennifer, Connors Christine, Boyle Jacqueline, Brown Alex, Mein Jacqueline, Wenitong Mark, McIntyre H David, Barzi Federica, Oats Jeremy, Sinha Ashim, Maple-Brown Louise
Cairns Hospital, North Cairns, QLD, Australia.
Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, University Drive North, Casuarina, NT, Australia.
Front Public Health. 2019 Jul 19;7:192. doi: 10.3389/fpubh.2019.00192. eCollection 2019.
To map health practitioners' experiences and describe knowledge regarding screening and management of Diabetes in Pregnancy (DIP) in Far North Queensland, Australia. Mixed methods including a cross-sectional survey (101 respondents) and 8 focus groups with 61 health practitioners. All participants provided clinical care for women with DIP. A wide range of healthcare professionals participated; 96% worked with Indigenous women, and 63% were from regional or remote work settings. Universal screening for gestational diabetes at 24-28 weeks gestation was reported as routine with 87% using a 75 g Oral Glucose Tolerance Test. Early screening for DIP was reported by 61% although there was large variation in screening methods and who should be screened <24 weeks. Health practitioners were confident providing lifestyle advice (88%), dietary, and blood glucose monitoring education (67%, 81%) but only 50% were confident giving insulin education. Electronic medical records were used by 80% but 55% also used paper records. Dissatisfaction with information from hospitals was reported by 40%. In the focus groups improving communication and information technology systems were identified as key areas. Other barriers described were difficulties in care coordination and access for remote women. Communication, information technology systems, coordination of care, and education for health professionals are key areas that will be addressed by a complex health systems intervention being undertaken by the DIP Partnership in North Queensland.
为梳理澳大利亚昆士兰远北地区医疗从业者在妊娠期糖尿病（DIP）筛查与管理方面的经验并描述相关知识。采用了混合研究方法，包括一项横断面调查（101名受访者）以及与61名医疗从业者开展的8次焦点小组访谈。所有参与者均为患有妊娠期糖尿病的女性提供临床护理。参与的医疗专业人员种类繁多；96%的人与原住民女性合作，63%来自地区或偏远工作场所。据报告，在妊娠24 - 28周进行妊娠期糖尿病的普遍筛查是常规做法，87%的人使用75克口服葡萄糖耐量试验。61%的人报告进行了妊娠期糖尿病的早期筛查，不过在筛查方法以及24周前应由谁进行筛查方面存在很大差异。医疗从业者在提供生活方式建议（88%）、饮食和血糖监测教育（67%、81%）方面信心十足，但只有50%的人对提供胰岛素教育有信心。80%的人使用电子病历，但55%的人也使用纸质病历。40%的人报告对医院提供的信息不满意。在焦点小组访谈中，改善沟通和信息技术系统被确定为关键领域。所描述的其他障碍包括护理协调困难以及偏远地区女性就医不便。沟通、信息技术系统、护理协调以及对医疗专业人员的教育是北昆士兰妊娠期糖尿病合作组织正在开展的一项复杂卫生系统干预措施将解决的关键领域。
