Menzies School of Health Research, Charles Darwin University, Darwin 0810, Australia.
Department of Endocrinology, Royal Darwin Hospital, Darwin 0810, Australia.
Int J Environ Res Public Health. 2024 Aug 28;21(9):1139. doi: 10.3390/ijerph21091139.
The Northern Territory (NT) and Far North Queensland (FNQ) have a high proportion of Aboriginal and Torres Strait Islander women birthing who experience hyperglycaemia in pregnancy. A multi-component health systems intervention to improve antenatal and postpartum care in these regions for women with hyperglycaemia in pregnancy was implemented between 2016 and 2019. We explored health professional perspectives on the impact of the intervention on healthcare. The RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance) underpinned this mixed-methods evaluation. Clinicians were surveyed before ( = 183) and following ( = 137) implementation. The constructs explored included usual practice and satisfaction with care pathways and communication between services. Clinicians, policymakers and the implementation team were interviewed ( = 36), exploring the impact of the health systems intervention on practice and systems of care. Survey and interview participants reported improvements in clinical practice and systems of care. Self-reported glucose screening practices improved, including the use of recommended tests (72.0% using recommended first-trimester screening test at baseline, 94.8% post-intervention, < 0.001) and the timing of postpartum diabetes screening (28.3% screening at appropriate interval after gestational diabetes at baseline, 66.7% post-intervention, < 0.001). Health professionals reported multiple improvements to care for women with hyperglycaemia in pregnancy following the health systems intervention.
北领地（NT）和远北昆士兰（FNQ）有很大比例的土著和托雷斯海峡岛民妇女在怀孕期间经历高血糖。2016 年至 2019 年，在这些地区实施了一项多组分卫生系统干预措施，以改善患有妊娠高血糖的妇女的产前和产后护理。我们探讨了卫生专业人员对干预措施对医疗保健影响的看法。RE-AIM 框架（范围、有效性、采用、实施、维护）为这项混合方法评估提供了基础。临床医生在实施前（= 183）和实施后（= 137）进行了调查。探索的结构包括常规做法以及对护理途径和服务之间沟通的满意度。对临床医生、政策制定者和实施团队进行了访谈（= 36），探讨卫生系统干预对实践和护理系统的影响。调查和访谈参与者报告说，临床实践和护理系统得到了改善。自我报告的葡萄糖筛查做法有所改善，包括使用推荐的测试（基线时 72.0%使用推荐的孕早期筛查测试，干预后 94.8%，<0.001）和产后糖尿病筛查的时间（基线时妊娠糖尿病后适当间隔筛查 28.3%，干预后 66.7%，<0.001）。卫生专业人员报告说，在实施卫生系统干预措施后，对患有妊娠高血糖的妇女的护理有了多项改进。
