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Dunne P, Carvalho M, Byrne M, Murphy AW, O'Reilly S. Maternity Dietitians' Perspectives on Delivering Gestational Diabetes Care, and Postpartum Follow-Up in Ireland: A Qualitative Study. J Acad Nutr Diet 2024; 124:1134-1148. [PMID: 38158178 DOI: 10.1016/j.jand.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 12/22/2023] [Accepted: 12/26/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Medical nutrition therapy is recognized as the cornerstone to optimal glycemic management of gestational diabetes (GDM) during pregnancy and registered dietitian nutritionists (RDNs) are central to delivery of this, yet data are lacking on their views of the barriers and enablers to performing this role. OBJECTIVE This qualitative study aimed to explore the perspectives of RDNs providing medical nutrition therapy to people with GDM across the Republic of Ireland. DESIGN Focus groups and semistructured interviews were conducted with RDNs from maternity settings whose roles included providing dietetics services to people with GDM. PARTICIPANTS AND SETTING Five focus groups and 2 semistructured interviews were conducted with 16 RDNs from 13 maternity sites, whose roles included medical nutrition therapy to people with GDM, in Ireland in February to March 2021. A topic guide addressing GDM management, postpartum care, and future type 2 diabetes prevention was followed. DATA ANALYSIS Data from focus groups and interviews were analyzed using reflexive thematic analysis. RESULTS RDNs collectively viewed their role as central to supporting people with GDM. Three themes were generated: Theme 1-a complex layered role-addressed complexities in dietetics practice. Theme 2 highlighted challenges in providing optimum care with sub themes of huge changes with COVID-19, care is not equal, and no defined postpartum pathway. Theme three reported on framing future health needs through sub themes of the 6-week check is a missed opportunity, people need to understand their risk, and more integrated care and type 2 diabetes prevention is needed. CONCLUSIONS RDNs recognize the need for continuity of care in pregnancy and postpartum for people diagnosed with GDM. However, perceived disparities in allocation of dietetics services for GDM and an absence of agreed care pathways were seen as barriers to optimum care. Collaboration and communication across primary and secondary care settings are essential and require improvement.
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Affiliation(s)
- Pauline Dunne
- School of Agriculture and Food Science, University College Dublin, Belfield, Dublin, Ireland
| | - Márcia Carvalho
- Health Behaviour Change Research Group, School of Psychology, University of Galway, Galway, Ireland
| | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, University of Galway, Galway, Ireland
| | - Andrew W Murphy
- Health Research Board Primary Care Clinical Trials Network Ireland, University of Galway, Galway, Ireland
| | - Sharleen O'Reilly
- School of Agriculture and Food Science, University College Dublin, Belfield, Dublin, Ireland.
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Absalom G, Zinga J, Margerison C, Abbott G, O'Reilly S, van der Pligt P. Associations of a current Australian model of dietetic care for women diagnosed with gestational diabetes and maternal and neonatal health outcomes. BMC Health Serv Res 2023; 23:971. [PMID: 37684621 PMCID: PMC10485944 DOI: 10.1186/s12913-023-09924-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/16/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is a significant public health burden in Australia. Subsequent strain on healthcare systems is widespread and current models of care may not be adequate to provide optimal healthcare delivery. This study aimed to assess a current model of dietetic care with maternal and neonatal outcomes. METHODS Hospital medical record data from The Women's Hospital, Melbourne, for women with GDM (n = 1,185) (July 2105-May 2017) was retrospectively analysed. Adjusted linear and logistic regression were used to analyse associations between the number of dietitian consultations and maternal and neonatal health outcomes. RESULTS Half of all women (50%) received two consultations with a dietitian. 19% of women received three or more consultations and of these women, almost twice as many were managed by medical nutrition therapy (MNT) and pharmacotherapy (66%) compared with MNT alone (34%). Higher odds of any maternal complication among women receiving 3 + consultations compared to those receiving zero (OR = 2.33 [95% CI: 1.23, 4.41], p = 0.009), one (OR = 1.80 [95% CI: 1.09, 2.98], p = 0.02), or two (OR = 1.65 [95% CI: 1.04, 2.60], p = 0.03) consultations were observed. Lower odds of infant admission to the Neonatal Intensive Care Unit (NICU) were observed among women receiving one (OR = 0.38 [95% CI: 0.18, 0.78], p = 0.008), two (OR = 0.37 [95% CI: 15 0.19, 0.71], p = 0.003), or three + consultations (OR = 0.43 [95% CI: 0.21, 0.88], p = 0.02), compared to no consultations. CONCLUSION The optimal schedule of dietitian consultations for women with GDM in Australia remains largely unclear. Alternate delivery of education for women with GDM such as telehealth and utilisation of digital platforms may assist relieving pressures on the healthcare system and ensure optimal care for women during pregnancy.
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Affiliation(s)
- Gina Absalom
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia
| | - Julia Zinga
- Department of Nutrition & Dietetics, Royal Women's Hospital, Parkville, VIC, Australia
| | - Claire Margerison
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Gavin Abbott
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Sharleen O'Reilly
- School of Agriculture and Food Science, University College Dublin, Belfield, Dublin 4, Ireland
| | - Paige van der Pligt
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia.
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Barnes RA, Morrison M, Flack JR, Ross GP, Smart CE, Collins CE, MacDonald‐Wicks L. Medical nutrition therapy for gestational diabetes mellitus in Australia: What has changed in 10 years and how does current practice compare with best practice? J Hum Nutr Diet 2022; 35:1059-1070. [PMID: 35384099 PMCID: PMC9790639 DOI: 10.1111/jhn.13013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 03/29/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND The present study aimed to report Australian dietetic practice regarding management of gestational diabetes mellitus (GDM) and to make comparisons with the findings from a 2009 survey of dietitians and with the Academy of Nutrition and Dietetics Evidence-Based Nutrition Practice Guidelines (NPG). METHODS Cross-sectional surveys were conducted in 2019 and 2009 of dietitians providing medical nutrition therapy (MNT) to women with GDM in Australia. The present study compares responses on demographics, dietetic assessment and interventions, and guideline use in 2019 vs. 2009. RESULTS In total, 149 dietitians (2019) and 220 (2009) met survey inclusion criteria. In both surveys >60% of respondents reported dietary interventions aiming for >45% energy from carbohydrate, 15%-25% energy from protein and 15%-30% energy from fat. Many variations in MNT found in 2009 continued to be evident in 2019, including the percentage of energy from carbohydrate aimed for (30%-65% in 2019 vs. 20%-75% in 2009) and the wide range in the recommended minimum daily carbohydrate intake (40-220 and 60-300 g). Few dietitians reported aiming for the NPG minimum of 175 g of carbohydrate daily in both surveys (32% in 2019 vs. 26% in 2009). There were, however, some significant increases in MNT consistent with NPG recommendations in 2019 vs. 2009, including the minimum frequency of visits provided (49%, n = 61 vs. 33%, n = 69; p < 0.001) and provision of gestational weight gain advice (59%, n = 95 vs. 40%, n = 195; p < 0.05). CONCLUSIONS Although many dietitians continue to provide MNT consistent with existing NPG, there is a need to support greater uptake, especially for recommendations regarding carbohydrate intake.
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Affiliation(s)
- Robyn A. Barnes
- Diabetes CentreBankstown‐Lidcombe HospitalBankstownNSWAustralia,School of Health Sciences, College of Health, Medicine and WellbeingThe University of NewcastleCallaghanNSWAustralia
| | - Melinda Morrison
- Diabetes NSW & ACTGlebeNSWAustralia,Diabetes AustraliaCanberraACTAustralia
| | - Jeff R. Flack
- Diabetes CentreBankstown‐Lidcombe HospitalBankstownNSWAustralia,Faculty of MedicineUniversity of New South WalesSydneyNSWAustralia,School of MedicineWestern Sydney UniversitySydneyNSWAustralia
| | - Glynis P. Ross
- Diabetes CentreBankstown‐Lidcombe HospitalBankstownNSWAustralia,Faculty of Medicine and HealthUniversity of SydneySydneyNSWAustralia
| | - Carmel E. Smart
- School of Health Sciences, College of Health, Medicine and WellbeingThe University of NewcastleCallaghanNSWAustralia,Department of Paediatric Endocrinology and DiabetesJohn Hunter Children's HospitalNewcastleNSWAustralia
| | - Clare E. Collins
- School of Health Sciences, College of Health, Medicine and WellbeingThe University of NewcastleCallaghanNSWAustralia,Priority Research Centre in Physical Activity and NutritionThe University of NewcastleCallaghanNSWAustralia
| | - Lesley MacDonald‐Wicks
- School of Health Sciences, College of Health, Medicine and WellbeingThe University of NewcastleCallaghanNSWAustralia,Priority Research Centre in Physical Activity and NutritionThe University of NewcastleCallaghanNSWAustralia
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Payne E, Palmer G, Rollo M, Ryan K, Harrison S, Collins C, Wynne K, Brown LJ, Schumacher T. Rural healthcare delivery and maternal and infant outcomes for diabetes in pregnancy: A systematic review. Nutr Diet 2022; 79:48-58. [PMID: 35128769 PMCID: PMC9303965 DOI: 10.1111/1747-0080.12722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/31/2021] [Accepted: 01/01/2022] [Indexed: 12/17/2022]
Abstract
AIM The aim of this systematic review was to examine the literature regarding rural healthcare delivery for women with any type of diabetes in pregnancy, and subsequent maternal and infant outcomes. METHODS Eight databases were searched in September 2020, including Medline, EMCare, CINAHL, EMBASE, Maternity and Infant Care, Cochrane, Rural and Remote Health and Aboriginal and Torres Strait Islander Health bibliography. Studies from high-income countries in rural, regional or remote areas with interventions conducted during the antenatal period were included. Intervention details were reported using the template for intervention description and replication template. Two reviewers independently assessed for risk of bias using the RoB2 and ROBINS I tools. RESULTS Three articles met the inclusion criteria: two conducted in Australia and one in the United States. A multidisciplinary approach was reported in two of the included studies, which were modified specifically for their respective rural settings. All three studies reported rates of caesarean section, birthweight (grams) and gestational age at birth as maternal and infant outcomes. One study was considered at moderate risk of bias, and two studies were at serious risk of bias. CONCLUSION There is a significant gap in research relating to healthcare delivery for women with diabetes in pregnancy in rural areas. This lack of research is concerning given that 19% of individuals in high-income countries reside rurally. Further research is required to understand the implications of healthcare delivery models for diabetes in pregnancy in rural areas.
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Affiliation(s)
- Ellen Payne
- Department of Rural HealthCollege of Health, Medicine and Wellbeing, University of NewcastleTamworthNew South WalesAustralia
- School of Health SciencesCollege of Health, Medicine and Wellbeing, The University of NewcastleTamworthNew South WalesAustralia
| | - Gwendolyn Palmer
- Obstetrics and Gynaecology DepartmentThe Tweed HospitalNew South WalesAustralia
| | - Megan Rollo
- School of Health SciencesCollege of Health, Medicine and Wellbeing, The University of NewcastleTamworthNew South WalesAustralia
- Priority Research Centre in Physical Activity and NutritionUniversity of NewcastleTamworthNew South WalesAustralia
| | - Kate Ryan
- Diabetes UnitTamworth Rural Referral HospitalTamworthNew South WalesAustralia
| | - Sandra Harrison
- Diabetes UnitTamworth Rural Referral HospitalTamworthNew South WalesAustralia
| | - Clare Collins
- School of Health SciencesCollege of Health, Medicine and Wellbeing, The University of NewcastleTamworthNew South WalesAustralia
- Priority Research Centre in Physical Activity and NutritionUniversity of NewcastleTamworthNew South WalesAustralia
| | - Katie Wynne
- School of Medicine and Public HealthCollege of Health, Medicine and Wellbeing, University of NewcastleTamworthNew South WalesAustralia
- Department of Diabetes and EndocrinologyJohn Hunter HospitalNewcastleNew South WalesAustralia
| | - Leanne J Brown
- Department of Rural HealthCollege of Health, Medicine and Wellbeing, University of NewcastleTamworthNew South WalesAustralia
- Priority Research Centre in Physical Activity and NutritionUniversity of NewcastleTamworthNew South WalesAustralia
| | - Tracy Schumacher
- Department of Rural HealthCollege of Health, Medicine and Wellbeing, University of NewcastleTamworthNew South WalesAustralia
- Priority Research Centre in Physical Activity and NutritionUniversity of NewcastleTamworthNew South WalesAustralia
- Priority Research Centre for Health BehaviourUniversity of NewcastleTamworthNew South WalesAustralia
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Evaluation of the implementation of a best practice gestational diabetes model of care in two Australian metropolitan services. JBI Evid Implement 2021; 20:10-20. [PMID: 34670955 DOI: 10.1097/xeb.0000000000000295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND AIMS Dissemination and local adaptation of best practice models of care are often poorly achieved in knowledge translation processes. Understanding and documenting the iterative cycles of improvement can elucidate barriers, enablers and benefits of the process for future adoption and service integration improvements. This project examined the process of local adaptation for a third stage translation of a gestational diabetes dietetic model of care through collaboration with two Queensland (Australia) hospitals. METHODS Using a hub (research team)-spoke (sites) model, two Queensland Hospital and Health Service Districts were supported to assess and address evidence-practice dietetic model of care gaps in their gestational diabetes mellitus (GDM) services. Sites selected demonstrated strong GDM team cohesiveness and project commitment. The project phases were: Consultation; Baseline; Transition; Implementation; and Evaluation. RESULTS Despite strong site buy-in and use of a previously successful model of care dissemination and adoption strategy, unexpected global, organisational, team and individual barriers prevented successful implementation of the model of care at both sites. Barriers included challenges with ethics and governance requirements for health service research, capacity to influence and engage multidisciplinary teams, staff turnover and coronavirus disease 2019's (COVID-19's) disruption to service delivery. CONCLUSION This third iteration of the dissemination of a best practice model of nutrition care for GDM in two Queensland Hospital and Health Service Districts did not achieve successful clinical or process outcomes. However, valuable learnings and recommendations regarding future clinical and research health service redesign aligned with best practice are suggested.
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Meloncelli N, Barnett A, de Jersey S. An implementation science approach for developing and implementing a dietitian-led model of care for gestational diabetes: a pre-post study. BMC Pregnancy Childbirth 2020; 20:661. [PMID: 33143693 PMCID: PMC7607700 DOI: 10.1186/s12884-020-03352-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/22/2020] [Indexed: 11/18/2022] Open
Abstract
Background There is strong evidence that women with gestational diabetes mellitus (GDM) who receive a minimum of three appointments with a dietitian may require medication less often. The aim of this study was to evaluate the impact of a dietitian-led model of care on clinical outcomes and to understand the utility of the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework as a prospective tool for implementation. Methods This was a pre-post intervention study measuring outcomes before-and-after changing a gestational diabetes (GDM) model of care and included women with GDM managed at a large, regional hospital in Queensland, Australia. The i-PARIHS framework was used to develop, implement and evaluate a dietitian-led model of care which increased dietetic input for women with GDM to a minimum of one initial education and two review appointments. The outcomes were adherence to the schedule of appointments, clinician perspective of the implementation process, pharmacotherapy use, gestational age at commencement of pharmacotherapy and birth weight. Pre- and post- comparisons of outcomes were made using t-tests and chi-squared tests. Results Adherence to the dietetic schedule of appointments was significantly increased from 29 to 82% (p < 0.001) but pharmacotherapy use also increased by 10% (p = 0.10). There were significantly more women in the post-intervention group who were diagnosed with GDM prior to 24 weeks gestation, a strong independent predictor of pharmacotherapy use. Infant birthweight remained unchanged. The i-PARIHS framework was used as a diagnostic tool and checklist in the model of care development phase; a facilitation tool during the implementation phase; and during the evaluation phase was used as a reflection tool to identify how the i-PARIHS constructs and their interactions that may have impacted on clinical outcomes. Conclusions The i-PARIHS framework was found to be useful in the development, implementation and evaluation of a dietitian-led model of care which saw almost 90% of women with GDM meet the minimum schedule of dietetic appointments. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-020-03352-6.
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Affiliation(s)
- Nina Meloncelli
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, Queensland, Australia. .,Nutrition and Dietetics, Allied Health, Sunshine Coast University Hospital, Birtinya, Queensland, Australia.
| | - Adrian Barnett
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Susan de Jersey
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, Australia
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Young AM, Olenski S, Wilkinson SA, Campbell K, Barnes R, Cameron A, Hickman I. Knowledge Translation in Dietetics: A Survey of Dietitians' Awareness and Confidence. CAN J DIET PRACT RES 2020; 81:49-53. [PMID: 31512498 DOI: 10.3148/cjdpr-2019-027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This study aimed to determine dietitians' familiarity with knowledge translation (KT), confidence in undertaking KT, and preferences for receiving KT training. An online questionnaire was designed and disseminated to all dietitians working across hospital and health services in Queensland, Australia, for completion over a 6-week period (April-May 2018). Of the 124 respondents, 69% (n = 85) reported being familiar with KT, but only 28% (n = 35) reported being confident in applying KT to their practice. Higher confidence was reported with problem identification, evidence appraisal, and adapting evidence to local context, compared with implementation, evaluation, and dissemination. Almost all respondents reported an interest in learning more about KT (n = 121, 98%), with a preference for easily accessible and short "snippets" of training aimed at beginner-intermediate level. Lack of management support, difficulty attending multi-day courses, cost, travel requirements, and lack of quarantined time were reported barriers to attending KT training. There is a high awareness and interest but low confidence in undertaking KT amongst dietitians. This highlights an opportunity for workforce development to prepare dietitians to be skilled and confident in KT. Training and support needs to be low-cost and multi-modal to meet diverse needs.
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Affiliation(s)
- Adrienne M Young
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Samantha Olenski
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Shelley A Wilkinson
- Department of Dietetics and Foodservices, Mater Group, South Brisbane, QLD, Australia.,Mater Research Institute-University of Queensland, South Brisbane, QLD, Australia
| | - Katrina Campbell
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Woolloongabba, QLD, Australia.,Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia
| | - Rhiannon Barnes
- Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Ashley Cameron
- Department of Speech Pathology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Ingrid Hickman
- Mater Research Institute-University of Queensland, South Brisbane, QLD, Australia.,Department of Nutrition and Dietetics, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
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8
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Absalom G, Zinga J, Margerison C, van der Pligt P. Associations of dietetic management with maternal and neonatal health outcomes in women diagnosed with gestational diabetes: a retrospective cohort study. J Hum Nutr Diet 2019; 32:728-736. [PMID: 31322776 DOI: 10.1111/jhn.12682] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND In 2010, the recommended diagnostic thresholds for gestational diabetes mellitus (GDM) were amended, which has increased GDM diagnoses, as well as pressure on the services involved in GDM management, specifically impacting dietetic workloads. The present study examined the associations between dietetic intervention in women with GDM and maternal and neonatal health outcomes. METHODS The present study involved 1233 adult women with GDM who delivered at The Royal Women's Hospital (RWH), Melbourne, Australia, between July 2015 and May 2017. Retrospective data assessing GDM-care (therapy type, diagnosis time and model of care, maternal and neonatal health outcomes, and outpatient dietetic consultations) were retrieved from patient medical records. Unadjusted and adjusted linear and logistic regression were used to assess associations of GDM care dietetic intervention and GDM care and dietetic intervention with maternal and neonatal health outcomes. RESULTS Women receiving dietetic intervention had a decreased likelihood of infant admission to the neonatal intensive care unit or special care nursery than women who not receiving dietetic intervention [adjusted odds ratio (OR) = 0.41, 95% confidence interval (CI) = 0.22-0.75; P = 0.004). Women requiring pharmacotherapy were more likely to experience maternal complications (adjusted OR = 3.13, 95% CI = 2.23-4.41; P < 0.001) and had a greater number of dietetic consultations (β-coefficient = 0.28, 95% CI = 0.17-0.39; P < 0.001) compared to women managed through diet. CONCLUSIONS Dietetic intervention plays a key role in optimising maternal and neonatal health outcomes for women with GDM. Exploring further the impact of dietetic intervention in women diagnosed with GDM is key with respect to understanding the optimal delivery of care for these women. The type and number of consultations included in a dietetic intervention should be investigated further.
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Affiliation(s)
- G Absalom
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, VIC, Australia
| | - J Zinga
- Department of Nutrition & Dietetics, The Royal Women's Hospital, Parkville, VIC, Australia
| | - C Margerison
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - P van der Pligt
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
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Meloncelli N, Barnett A, de Jersey S. Staff resourcing, guideline implementation and models of care for gestational diabetes mellitus management. Aust N Z J Obstet Gynaecol 2019; 60:115-122. [PMID: 31292956 DOI: 10.1111/ajo.13032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 06/06/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND 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. AIMS 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. MATERIALS AND METHODS 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. RESULTS 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%). CONCLUSIONS 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.
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Affiliation(s)
- Nina Meloncelli
- 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
| | - Adrian Barnett
- School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Susan de Jersey
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Nutrition and Dietetics and Centre for Allied Health Research, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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10
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Wilkinson SA, O'Brien M, McCray S, Harvey D. Implementing a best-practice model of gestational diabetes mellitus care in dietetics: a qualitative study. BMC Health Serv Res 2019; 19:122. [PMID: 30764823 PMCID: PMC6376709 DOI: 10.1186/s12913-019-3947-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 02/04/2019] [Indexed: 11/25/2022] Open
Abstract
Background Translating research into clinical practice is challenging for health services. Emerging approaches in implementation science recognise the need for a theory–driven approach to identify and overcome barriers to guideline adherence. However, many clinicians do not have the capacity, confidence, or expertise to realise change in their local settings. Recently, two regional sites participated in a facilitated implementation project of an evidence-based model of gestational diabetes mellitus (GDM) care in dietetics, supported by a team at a metropolitan centre. This study describes (i) stakeholder experiences’, and (ii) learnings to inform implementation of the model of care (MOC) across Queensland. Methods This qualitative descriptive study utilised semi-structured telephone interviews with staff involved in implementation of the MOC project at two regional sites. Eight participants were recruited; five participants were from one site. Interviews were transcribed and analysed to identify recurrent themes. Results Four main themes were derived: (1) catalyst for positive change, (2) managing project logistics, (3) overcoming barriers, and (4) achieving change. Conclusions A model of external facilitated implementation using an evidence-based decision making tool is an effective method of fostering health service change and is acceptable to staff. Key elements of the facilitation were building confidence and capacity in local implementers, through regular contact, encouraging local networking, linking to higher management support and assessing and/or influencing workplace or organizational culture. However, the balance between delivering clinical care while participating in a service change project proved challenging to many participants.
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Affiliation(s)
- Shelley A Wilkinson
- Department of Dietetics and Foodservices, Mater Health, Level 3 Salmon Building, Mater Health Services, Raymond Terrace, South Brisbane, Queensland, 4101, Australia. .,Mater Research Institute - University of Queensland, Mothers, Babies and Women's Theme, Brisbane, Australia.
| | - Maxine O'Brien
- Alcohol and Other Drugs Services, Darling Downs Hospital and Health Service, Toowoomba, 4350, Australia.,Darling Downs Hospital and Health Service, Toowoomba, 4350, Australia
| | - Sally McCray
- Department of Dietetics and Foodservices, Mater Health, Level 3 Salmon Building, Mater Health Services, Raymond Terrace, South Brisbane, Queensland, 4101, Australia.,Mater Research Institute - University of Queensland, Mothers, Babies and Women's Theme, Brisbane, Australia
| | - Desley Harvey
- Cairns and Hinterland Hospital and Health Service and College of Healthcare Sciences, James Cook University, Cairns, 4870, Australia
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11
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Wilkinson SA, Donaldson E, McCray SJ. Re-evaluating the nutritional awareness, knowledge and eating behaviours of women attending a tertiary maternity hospital following iterative service redesign. Nutr Diet 2018; 75:372-380. [DOI: 10.1111/1747-0080.12475] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 08/12/2018] [Accepted: 08/17/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Shelley A. Wilkinson
- Department of Nutrition and Dietetics; Mater Group; Brisbane Queensland Australia
- Mater Research Institute; University of Queensland; Brisbane Queensland Australia
| | - Elin Donaldson
- Department of Nutrition and Dietetics; Mater Group; Brisbane Queensland Australia
| | - Sally J. McCray
- Department of Nutrition and Dietetics; Mater Group; Brisbane Queensland Australia
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12
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Porter J, Ottrey E. Process evaluation of implementing Protected Mealtimes under clinical trial conditions. J Adv Nurs 2018; 74:1955-1963. [PMID: 29700844 DOI: 10.1111/jan.13693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2018] [Indexed: 11/26/2022]
Abstract
AIM To evaluate the implementation of Protected Mealtimes and contrast the findings with implementation fidelity. BACKGROUND Protected Mealtimes is a systems approach developed to address the issue of malnutrition in hospitalized patients. Previous studies have used a pre--post study design, with no high-quality trials previously undertaken to measure the effect of the intervention. DESIGN A prospective, stepped-wedge cluster randomized controlled trial was undertaken October-November 2015. This process evaluation was conducted using qualitative and quantitative methods to explain discrepancies between expected and observed clinical trial outcomes. METHODS Qualitative data were collected using focus groups with the healthcare team and contrasted with fidelity data. Quantitative data were collected using attendance lists, audits and observations and analysed descriptively. Concept-driven coding was undertaken using a framework derived from studies citing the Theoretical Domains Framework. FINDINGS Staff training in the trial protocol was viewed positively, however, not all staff attended. Staff were generally enthusiastic about Protected Mealtimes with many programme aspects successfully implemented. Limited staffing resources, particularly of nursing staff, hindered implementation. The presence of trial observers affected staff morale by increasing feelings of stress and anxiety. CONCLUSION Process data allowed challenges for the implementation of Protected Mealtimes under clinical trial conditions to be described. Given our inability to implement the trial protocol fully due to the complexity of the mealtime environment and the lack of efficacy on nutritional intake, alternative approaches should be considered to resolve the problem of hospital malnutrition.
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Affiliation(s)
- Judi Porter
- Department of Nutrition, Dietetics & Food, Monash University, Notting Hill, Vic., Australia
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Vic., Australia
| | - Ella Ottrey
- Department of Nutrition, Dietetics & Food, Monash University, Notting Hill, Vic., Australia
- Dietetics Department, Eastern Health, Box Hill, Vic., Australia
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13
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Wilkinson SA, McCray SJ, Kempe A, Sellwood B. Clinically relevant improvements achieved from a facilitated implementation of a gestational diabetes model of care. Nutr Diet 2018; 75:271-282. [PMID: 29392816 DOI: 10.1111/1747-0080.12404] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 10/26/2017] [Accepted: 11/30/2017] [Indexed: 11/28/2022]
Abstract
AIM Medical nutrition therapy is a cornerstone treatment in gestational diabetes; however, most Australian women diagnosed with gestational diabetes do not receive this. The project evaluated adaptation of a successful evidence-based gestational diabetes model of care implementation from a tertiary centre into regional sites with varied demographics, population size and service capacity. METHODS The project used a hub (project team)-spoke (sites) model in Far North Queensland (Site 1) and regional South-East Queensland (Site 2). Sites selected demonstrated strong gestational diabetes team cohesiveness and project commitment. The project phases were consultation, baseline, transition and implementation. A best practice decision tree tool was provided to assess/manage barriers to the model of care and clinical outcomes captured through a project database. RESULTS Role clarification of site members, management engagement, site visits, decision tree and database refinement were completed in the project's first phase. Unexpected organisational and team barriers prevented timeline implementation as planned. Sites negotiated relevant reallocation of resources to achieve project deliverables. The proportion of women seen according to best practice increased from 3.5 to 87.8% (P < 0.001) (Site 1) and nil to 4.8% (P = 0.09) (Site 2), and those on medication dropped by 3.4 (Site 1) and 9.1% (Site 2). CONCLUSIONS This project demonstrates a successful implementation using a facilitated and rigorous approach. Support, engagement and tools at many levels were keys to success at both sites. The present study illustrates the opportunities and challenges of conducting implementation research within routine clinical care, particularly in resource-challenged sites.
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Affiliation(s)
- Shelley A Wilkinson
- Department of Nutrition and Dietetics, Mater Group, South Brisbane, Queensland, Australia.,Mater Research Institute, University of Queensland, South Brisbane, Queensland, Australia
| | - Sally J McCray
- Department of Nutrition and Dietetics, Mater Group, South Brisbane, Queensland, Australia
| | - Alison Kempe
- Cairns Diabetes Centre, Cairns and Hinterland Hospital and Health Service District, Queensland, Australia
| | - Bernadette Sellwood
- Department of Nutrition and Dietetics, Cairns and Hinterland Hospital and Health Service District, Queensland, Australia
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14
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O'Reilly SL. Translational research: The ingredients are only the start of the recipe for better dietetic practice. Nutr Diet 2016. [DOI: 10.1111/1747-0080.12308] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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15
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Lawrence RL, Wall CR, Bloomfield FH, Crowther CA. Dietetic management of gestational diabetes in New Zealand: A cross-sectional survey. Nutr Diet 2016; 74:95-104. [DOI: 10.1111/1747-0080.12311] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 07/05/2016] [Indexed: 11/30/2022]
Affiliation(s)
| | - Clare R. Wall
- Faculty of Medical and Health Sciences; University of Auckland; Auckland New Zealand
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