MacKay Diana, Freeman Natasha, Boyle Jacqueline A, Campbell Sandra, McLean Anna, Peiris David, Corpus Sumaria, Connors Christine, Moore Elizabeth, Wenitong Mark, Silver Bronwyn, McIntyre H David, Shaw Jonathan E, Brown Alex, Kirkham Renae, Maple-Brown Louise
Division of Wellbeing and Preventable Chronic Disease, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
Department of Endocrinology, Royal Darwin Hospital, Darwin, Northern Territory, Australia.
Int J Gynaecol Obstet. 2021 Nov;155(2):179-194. doi: 10.1002/ijgo.13850. Epub 2021 Sep 4.
To identify successes to date and opportunities for improvement in the implementation of a complex health systems intervention aiming to improve prenatal and postpartum care and health outcomes for women with hyperglycemia in pregnancy in regional and remote Australia.
A qualitative evaluation, underpinned by the RE-AIM framework (reach, effectiveness, adoption, implementation, maintenance), was conducted mid-intervention. Semi-structured interviews were conducted with the participants, who included clinicians, regional policymakers and managers, and study implementation staff.
Interviewees (n = 45) reported that the early phase of the intervention had resulted in the establishment of a clinician network, increased clinician awareness of hyperglycemia in pregnancy, and improvements in management, including earlier referral for specialist care and a focus on improving communication with women. Enablers of implementation included existing relationships with stakeholders and alignment of the intervention with health service priorities. Challenges included engaging remote clinicians and the labor-intensive nature of maintaining a clinical register of women with hyperglycemia in pregnancy.
The early phase of this health systems intervention has had a positive perceived impact on systems of care for women with hyperglycemia in pregnancy. Findings have informed modifications to the intervention, including the development of a communication and engagement strategy.
确定迄今为止在澳大利亚地区和偏远地区实施一项旨在改善妊娠期间患有高血糖症妇女的产前和产后护理及健康结局的复杂卫生系统干预措施方面所取得的成功经验以及改进机会。
在干预中期进行了一项基于RE-AIM框架（覆盖范围、有效性、采用情况、实施情况、维持情况）的定性评估。对包括临床医生、地区政策制定者和管理人员以及研究实施人员在内的参与者进行了半结构化访谈。
受访者（n = 45）报告称，干预的早期阶段促成了临床医生网络的建立，提高了临床医生对妊娠期间高血糖症的认识，并改善了管理，包括更早转诊至专科护理以及注重改善与女性的沟通。实施的促成因素包括与利益相关者的现有关系以及干预措施与卫生服务优先事项的一致性。挑战包括吸引偏远地区的临床医生以及维护妊娠期间患有高血糖症妇女的临床登记册的劳动密集性质。
这项卫生系统干预措施的早期阶段对妊娠期间患有高血糖症妇女的护理系统产生了积极的感知影响。研究结果为干预措施的调整提供了依据，包括制定沟通和参与策略。
