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Yadav UN, Davis JM, Bennett-Brook K, Coombes J, Wyber R, Pearson O. A rapid review to inform the policy and practice for the implementation of chronic disease prevention and management programs for Aboriginal and Torres Strait Islander people in primary care. Health Res Policy Syst 2024; 22:34. [PMID: 38509612 PMCID: PMC10956197 DOI: 10.1186/s12961-024-01121-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/10/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND More than 35% of Aboriginal and Torres Strait Islander adults live with cardiovascular disease, diabetes, or chronic kidney disease. There is a pressing need for chronic disease prevention and management among Aboriginal and Torres Strait Islander people in Australia. Therefore, this review aimed to synthesise a decade of contemporary evidence to understand the barriers and enablers of chronic disease prevention and management for Aboriginal and Torres Strait Islander People with a view to developing policy and practice recommendations. METHODS We systematically searched for peer-reviewed published articles between January 2014 to March 2023 where the search was performed using subject headings and keywords related to "Aboriginal and Torres Strait Islander peoples," "Chronic Disease," and "Primary Health Care". Quality assessment for all included studies was conducted using the Aboriginal and Torres Strait Islander Quality Appraisal Tool. The data were extracted and summarised using a conventional content analysis approach and applying strength-based approaches. RESULTS Database searches identified 1653 articles where 26 met inclusion criteria. Studies varied in quality, primarily reporting on 14 criteria of the Aboriginal and Torres Strait Islander Quality Appraisal Tool. We identified six key domains of enablers and barriers of chronic disease prevention and management programs and implied a range of policy and practice options for improvement. These include culturally acceptable and safe services, patient-provider partnerships, chronic disease workforce, primary health care service attributes, clinical care pathways, and accessibility to primary health care services. This review also identified the need to address social and cultural determinants of health, develop the Aboriginal and Torres Strait Islander and non-Indigenous chronic disease workforce, support multidisciplinary teams through strengthening clinical care pathways, and engage Aboriginal and Torres Strait Islander communities in chronic disease prevention and management program design and delivery. CONCLUSION Enabling place-based partnerships to develop contextual evidence-guided strategies that align with community priorities and aspirations, with the provision of funding mechanisms and models of care through policy and practice reforms will strengthen the chronic disease prevention and management program for Aboriginal and Torres Strait Islander people.
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Affiliation(s)
- Uday Narayan Yadav
- National Centre for Aboriginal and Torres Strait Islander Wellbeing Research, Australian National University, Canberra, ACT, Australia.
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia.
| | | | | | | | - Rosemary Wyber
- National Centre for Aboriginal and Torres Strait Islander Wellbeing Research, Australian National University, Canberra, ACT, Australia
- Telethon Kids Institute, Perth, WA, Australia
| | - Odette Pearson
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- Faculty of Health and Medical Science, University of Adelaide, Adelaide, SA, Australia
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Walker C, Begum T, Boyle JA, Ward J, Barzi F. Preconception Health of Indigenous Peoples in Australia, Canada, New Zealand, and the United States: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:345. [PMID: 38541344 PMCID: PMC10969840 DOI: 10.3390/ijerph21030345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/23/2024] [Accepted: 02/28/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND There is increasing recognition of the importance of the preconception period for addressing reproductive and intergenerational health inequities and supporting improved maternal and child health outcomes. This study aimed to understand the extent and type of evidence that exists in relation to preconception health for Indigenous peoples living in high-income countries with similar experiences of colonisation, namely, Australia, New Zealand, Canada, and the United States. METHODS This review was conducted as per the JBI methodology and PRISMA Extension for Scoping Reviews. A comprehensive search of PubMed, CINAHL [EBSCO], Ovid Embase, Scopus, and the Wiley Cochrane Library was conducted using keywords and index terms. We included research in English published between January 2010 and June 2023 on quantitative and qualitative primary studies. Data were extracted using a standardised tool, and the analysis included quantitative descriptions and qualitative content analysis. RESULTS We identified 360 potential studies and included 57 articles in the review. Most studies were from the United States (n = 36, 63.2%) and Australia (n = 13, 22.8%), and they commonly reported associations between preconception health risk factors and maternal or child health outcomes (n = 27, 48.2%) or described the development, implementation, or evaluation of preconception health interventions (n = 26, 46.4%). Common preconception health areas were pre-pregnancy body mass index or weight (n = 34), alcohol (n = 16), diet (n = 14), physical activity (n = 12), and diabetes (n = 11). Most studies focused exclusively on women (n = 46, 80.7%), and very few included men (n = 3, 5.3%). The study populations were mostly urban and rural (n = 25, 43.9%) or rural only (n = 14, 24.6%); however, the geographical remoteness was often unclear (n = 14, 24.6%). CONCLUSIONS While there was some research relating to the preconception health of Indigenous peoples, this review identified considerable research gaps. There is a need for dedicated research into preconception health risk factors and reproductive health outcomes, attitudes and awareness of preconception health, and preconception health interventions for Indigenous peoples.
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Affiliation(s)
- Clara Walker
- UQ Poche Centre for Indigenous Health, The University of Queensland, Toowong, QLD 4066, Australia
- Centre for Health Research, University of Southern Queensland, Toowoomba, QLD 4350, Australia
| | - Tahmina Begum
- UQ Poche Centre for Indigenous Health, The University of Queensland, Toowong, QLD 4066, Australia
| | - Jacqueline A Boyle
- Eastern Health Clinical School, Monash University, Box Hill, VIC 3128, Australia
| | - James Ward
- UQ Poche Centre for Indigenous Health, The University of Queensland, Toowong, QLD 4066, Australia
| | - Federica Barzi
- UQ Poche Centre for Indigenous Health, The University of Queensland, Toowong, QLD 4066, Australia
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Wood AJ, Lee I, Barr ELM, Barzi F, Boyle JA, Connors C, Moore E, Oats JJN, McIntyre HD, Titmuss A, Simmonds A, Zimmet PZ, Brown ADH, Corpus S, Shaw JE, Maple‐Brown LJ. Postpartum uptake of diabetes screening tests in women with gestational diabetes: The PANDORA study. Diabet Med 2023; 40:e14999. [PMID: 36336995 PMCID: PMC10946515 DOI: 10.1111/dme.14999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 09/21/2022] [Accepted: 10/23/2022] [Indexed: 11/09/2022]
Abstract
AIMS To determine rates and predictors of postpartum diabetes screening among Aboriginal and/or Torres Strait Islander and non-Indigenous women with gestational diabetes mellitus (GDM). METHODS PANDORA is a prospective longitudinal cohort of women recruited in pregnancy. Postpartum diabetes screening rates at 12 weeks (75-g oral glucose tolerance test (OGTT)) and 6, 12 and 18 months (OGTT, glycated haemoglobin [HbA1C ] or fasting plasma glucose) were assessed for women with GDM (n = 712). Associations between antenatal factors and screening with any test (OGTT, HbA1C , fasting plasma glucose) by 6 months postpartum were examined using Cox proportional hazards regression. RESULTS Postpartum screening rates with an OGTT by 12 weeks and 6 months postpartum were lower among Aboriginal and/or Torres Strait Islander women than non-Indigenous women (18% vs. 30% at 12 weeks, and 23% vs. 37% at 6 months, p < 0.001). Aboriginal and/or Torres Strait Islander women were more likely to have completed a 6-month HbA1C compared to non-Indigenous women (16% vs. 2%, p < 0.001). Screening by 6 months postpartum with any test was 41% for Aboriginal and/or Torres Strait Islander women and 45% for non-Indigenous women (p = 0.304). Characteristics associated with higher screening rates with any test by 6 months postpartum included, insulin use in pregnancy, first pregnancy, not smoking and lower BMI. CONCLUSIONS Given very high rates of type 2 diabetes among Aboriginal and Torres Strait Islander women, early postpartum screening with the most feasible test should be prioritised to detect prediabetes and diabetes for intervention.
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Affiliation(s)
- Anna J. Wood
- Menzies School of Health ResearchCharles Darwin UniversityCasuarinaNorthern TerritoryAustralia
- Department of EndocrinologyRoyal Darwin HospitalDarwinNorthern TerritoryAustralia
| | - I‐Lynn Lee
- Menzies School of Health ResearchCharles Darwin UniversityCasuarinaNorthern TerritoryAustralia
| | - Elizabeth L. M. Barr
- Menzies School of Health ResearchCharles Darwin UniversityCasuarinaNorthern TerritoryAustralia
- Baker Heart and Diabetes InstituteMelbourneVictoriaAustralia
| | - Federica Barzi
- Menzies School of Health ResearchCharles Darwin UniversityCasuarinaNorthern TerritoryAustralia
| | - Jacqueline A. Boyle
- Menzies School of Health ResearchCharles Darwin UniversityCasuarinaNorthern TerritoryAustralia
- Monash Centre for Health Research and ImplementationMonash UniversityClaytonVictoriaAustralia
| | - Christine Connors
- Top End Health ServiceNorthern Territory Department of HealthCasuarinaNorthern TerritoryAustralia
| | - Elizabeth Moore
- Aboriginal Medical Services Alliance Northern TerritoryNorthern TerritoryDarwinAustralia
| | - Jeremy J. N. Oats
- Melbourne School of Population and Global HealthUniversity of MelbourneMelbourneVictoriaAustralia
| | - Harold D. McIntyre
- Mater ResearchThe University of QueenslandSouth BrisbaneQueenslandAustralia
| | - Angela Titmuss
- Menzies School of Health ResearchCharles Darwin UniversityCasuarinaNorthern TerritoryAustralia
- Department of Paediatrics, Division of WomenChildren and Youth, Royal Darwin HospitalCasuarinaNorthern TerritoryAustralia
| | - Alison Simmonds
- Menzies School of Health ResearchCharles Darwin UniversityCasuarinaNorthern TerritoryAustralia
| | - Paul Z. Zimmet
- Department of DiabetesCentral Clinical School, Monash UniversityClaytonVictoriaAustralia
| | - Alex D. H. Brown
- University of AdelaideAdelaideSouth AustraliaAustralia
- South Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
| | - Sumaria Corpus
- Aboriginal and Torres Strait Islander Advisory GroupMenzies School of Health Research, Charles Darwin UniversityCasuarinaNorthern TerritoryAustralia
| | | | - Louise J. Maple‐Brown
- Menzies School of Health ResearchCharles Darwin UniversityCasuarinaNorthern TerritoryAustralia
- Department of EndocrinologyRoyal Darwin HospitalDarwinNorthern TerritoryAustralia
- Aboriginal and Torres Strait Islander Advisory GroupMenzies School of Health Research, Charles Darwin UniversityCasuarinaNorthern TerritoryAustralia
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Ayers BL, Bogulski CA, Bennett-Milburn A, Fisher A, Netwon M, McElfish PA. Dietary Practices during Pregnancy in a Marshallese Community: A Mixed Methods Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6360. [PMID: 35681944 PMCID: PMC9180099 DOI: 10.3390/ijerph19116360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/11/2022] [Accepted: 05/16/2022] [Indexed: 12/10/2022]
Abstract
Dietary practices during pregnancy play a pivotal role in the health of women and their children and set the foundation for long-term health. Marshallese women have disproportionally higher rates of maternal and infant health disparities, yet little is known about the dietary practices during their pregnancy. The purpose of this study was to identify dietary practices during pregnancy among Marshallese women. From March 2019 to March 2020, a purposive sample of 33 pregnant Marshallese participants participated in a mixed methods study. Two primary themes emerged: (1) traditional beliefs about a healthy diet during pregnancy; and (2) dietary change during pregnancy. Within the first theme, four subthemes emerged: (1) should eat; (2) should not eat; (3) challenges to traditional diet; and (4) spiritual dietary customs during pregnancy. Within the second theme, three subthemes emerged: (1) a healthy diet for my baby; (2) autonomy and diet; and (3) sugar-sweetened beverages. The transition in discourse from traditional customs of dietary practices to an individualistic discourse highlights that acculturation is a complex process that should be included in maternal health education and interventions. Findings from this study provide insight into potential considerations for future interventions aiming to improve maternal and child health outcomes among Marshallese.
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Affiliation(s)
- Britni L. Ayers
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR 72703, USA; (C.A.B.); (M.N.); (P.A.M.)
| | - Cari A. Bogulski
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR 72703, USA; (C.A.B.); (M.N.); (P.A.M.)
| | - Ashlea Bennett-Milburn
- Bell Engineering Center, University of Arkansas Fayetteville, 800 W. Dickson St., Fayetteville, AR 72701, USA;
| | - Anna Fisher
- Department of Pediatrics, The University of Utah, 295 Chipeta Way, Salt Lake City, UT 84103, USA;
| | - Morda Netwon
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR 72703, USA; (C.A.B.); (M.N.); (P.A.M.)
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR 72703, USA; (C.A.B.); (M.N.); (P.A.M.)
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Wicik K, Bahrami B, Halliday M, Henderson T, Roulston T, Ullrich K. Rates of diabetic retinopathy screening in pregnant patients with type 1 and type 2 diabetes in a predominantly Indigenous Central Australian population. Aust N Z J Obstet Gynaecol 2021; 62:364-369. [PMID: 34882788 DOI: 10.1111/ajo.13467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pregnancy is a risk factor for the progression of diabetic retinopathy (DR) in women with pre-gestational diabetes. Australian screening guidelines recommend DR screening in the first trimester of pregnancy. The rates of DR screening in pregnant patients with pre-gestational diabetes are unknown in Australia. AIM To determine the rates of DR screening in pregnant women with pre-gestational diabetes at Alice Springs Hospital Diabetes Antenatal Care and Education (DANCE) clinic. MATERIALS AND METHODS Retrospective review of women with pre-gestational diabetes who attended the DANCE clinic between July 2016 and June 2020. RESULTS There were 146 pregnancies in 144 individual women included in this review. There were 93% (n = 134) who identified as Aboriginal but not Torres Strait Islander. DR screening was performed in 23 (16%) pregnancies, in which DR was present in six (26%) and no retinal abnormality was found in 17 (74%). Of seven (5%) women who had a history of DR, only three had a screen during the pregnancy period. The location of the DR screen included Alice Springs Hospital (17%, n = 4), Alice Springs general practice clinics (35%, n = 8) and remote NT community clinics outside of Alice Springs (39%, n = 9). The trimesters in which women received their DR screens were: trimester 1, 45%, n = 10; trimester 2, 39%, n = 9; trimester 3, 17%, n = 4. CONCLUSION The minority of pregnant women who attend the DANCE clinic at Alice Springs Hospital received DR screening in adherence with national guidelines.
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Affiliation(s)
- Karolina Wicik
- Department of Obstetrics and Gynaecology, Alice Springs Hospital, The Gap, Northern Territory, Australia
| | - Bobak Bahrami
- Department of Ophthalmology, Alice Springs Hospital, The Gap, Northern Territory, Australia
| | - Megan Halliday
- Department of Obstetrics and Gynaecology, Alice Springs Hospital, The Gap, Northern Territory, Australia
| | - Tim Henderson
- Department of Ophthalmology, Alice Springs Hospital, The Gap, Northern Territory, Australia
| | - Tania Roulston
- Flinders University, Bedford Park, South Australia, Australia
| | - Katja Ullrich
- Department of Ophthalmology, Alice Springs Hospital, The Gap, Northern Territory, Australia
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Uwambaye P, Nyiringango G, Musabwasoni SMG, Husain A, Nessa K, Razzaque MS. COVID-19 Pandemic: Adaptation in Antenatal Care for Better Pregnancy Outcomes. Front Glob Womens Health 2021; 1:599327. [PMID: 34816170 PMCID: PMC8593964 DOI: 10.3389/fgwh.2020.599327] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 10/20/2020] [Indexed: 12/13/2022] Open
Affiliation(s)
- Peace Uwambaye
- Department of Preventive & Community Dentistry, School of Dentistry, University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | - Gerard Nyiringango
- Department of Nursing, School of Nursing and Midwifery, University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | - Sandra Marie Grace Musabwasoni
- Department of Midwifery, School of Nursing and Midwifery, University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | - Ali Husain
- Department of Pathology, Lake Erie College of Osteopathic Medicine, Erie, PA, United States
| | - Kamrun Nessa
- Department of Obstetrics & Gynecology, Chittagong Medical College Hospital, Chittagong, Bangladesh
| | - Mohammed S Razzaque
- Department of Preventive & Community Dentistry, School of Dentistry, University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda.,Department of Pathology, Lake Erie College of Osteopathic Medicine, Erie, PA, United States
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7
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MacKay D, Freeman N, Boyle JA, Campbell S, McLean A, Peiris D, Corpus S, Connors C, Moore E, Wenitong M, Silver B, McIntyre HD, Shaw JE, Brown A, Kirkham R, Maple-Brown L. Improving systems of prenatal and postpartum care for hyperglycemia in pregnancy: A process evaluation. Int J Gynaecol Obstet 2021; 155:179-194. [PMID: 34331708 DOI: 10.1002/ijgo.13850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE 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. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Diana MacKay
- 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
| | - Natasha Freeman
- Division of Wellbeing and Preventable Chronic Disease, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Jacqueline A Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sandra Campbell
- College of Nursing and Midwifery, Charles Darwin University, Cairns, Queensland, Australia
| | - Anna McLean
- Division of Wellbeing and Preventable Chronic Disease, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Diabetes and Endocrinology, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia
| | - David Peiris
- Centre for Health Systems Science, The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Sumaria Corpus
- Danila Dilba Health Service, Darwin, Northern Territory, Australia
| | - Christine Connors
- Population & Primary Health Care, Top End Health Service, Northern Territory Department of Health, Darwin, Northern Territory, Australia
| | - Elizabeth Moore
- Aboriginal Medical Services Alliance Northern Territory, Darwin, Northern Territory, Australia
| | - Mark Wenitong
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Bronwyn Silver
- Central Australian Aboriginal Congress, Alice Springs, Northern Territory, Australia
| | - H David McIntyre
- Clinical Unit, Mater Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Jonathan E Shaw
- Aboriginal Health Domain, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Alex Brown
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Faculty of Health and Medical Science, University of Adelaide, Adelaide, South Australia, Australia
| | - Renae Kirkham
- Division of Wellbeing and Preventable Chronic Disease, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Louise Maple-Brown
- 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
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Laurie JG, McIntyre HD. A Review of the Current Status of Gestational Diabetes Mellitus in Australia-The Clinical Impact of Changing Population Demographics and Diagnostic Criteria on Prevalence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E9387. [PMID: 33333879 PMCID: PMC7765268 DOI: 10.3390/ijerph17249387] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/08/2020] [Accepted: 12/10/2020] [Indexed: 12/12/2022]
Abstract
The current status of gestational diabetes mellitus in Australia reveals an almost quadrupling prevalence over the last decade. A narrative review of the current Australian literature reveals unique challenges faced by Australian maternity clinicians when addressing this substantial disease burden in our diverse population. Rising rates of maternal overweight and obesity, increasing maternal age and the diversity of ethnicity are key epidemiological impactors, overlaid by the 2015 changes in screening and diagnostic parameters. Our vast land mass and the remote location of many at risk women requires innovative and novel ideas for pathways to diagnose and effectively manage women with gestational diabetes mellitus. By modifying and modernizing models of care for women with gestational diabetes mellitus, we have the ability to address accessibility, resource management and our acute response to global events such as the COVID 19 pandemic. With continuing research, education and robust discourse, Australia is well placed to meet current and future challenges in the management of gestational diabetes mellitus.
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Affiliation(s)
- Josephine G Laurie
- Department of Obstetric Medicine, Mater Mothers’ Hospital Brisbane, Queensland and Mater Clinical Unit, The University of Queensland, South Brisbane, QLD 4101, Australia
| | - H. David McIntyre
- Department of Obstetric Medicine, Mater Mothers’ Hospital Brisbane, Queensland and Mater Research Institute, The University of Queensland, South Brisbane, QLD 4101, Australia;
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MacKay D, Kirkham R, Freeman N, Murtha K, Van Dokkum P, Boyle J, Campbell S, Barzi F, Connors C, O'Dea K, Oats J, Zimmet P, Wenitong M, Sinha A, Hanley AJ, Moore E, Peiris D, McLean A, Davis B, Whitbread C, McIntyre HD, Mein J, McDermott R, Corpus S, Canuto K, Shaw JE, Brown A, Maple-Brown L. Improving systems of care during and after a pregnancy complicated by hyperglycaemia: A protocol for a complex health systems intervention. BMC Health Serv Res 2020; 20:814. [PMID: 32867837 PMCID: PMC7461356 DOI: 10.1186/s12913-020-05680-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 08/21/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Many women with hyperglycaemia in pregnancy do not receive care during and after pregnancy according to standards recommended in international guidelines. The burden of hyperglycaemia in pregnancy falls disproportionately upon Indigenous peoples worldwide, including Aboriginal and Torres Strait Islander women in Australia. The remote and regional Australian context poses additional barriers to delivering healthcare, including high staff turnover and a socially disadvantaged population with a high prevalence of diabetes. METHODS A complex health systems intervention to improve care for women during and after a pregnancy complicated by hyperglycaemia will be implemented in remote and regional Australia (the Northern Territory and Far North Queensland). The Theoretical Domains Framework was used during formative work with stakeholders to identify intervention components: (1) increasing workforce capacity, skills and knowledge and improving health literacy of health professionals and women; (2) improving access to healthcare through culturally and clinically appropriate pathways; (3) improving information management and communication; (4) enhancing policies and guidelines; (5) embedding use of a clinical register as a quality improvement tool. The intervention will be evaluated utilising the RE-AIM framework at two timepoints: firstly, a qualitative interim evaluation involving interviews with stakeholders (health professionals, champions and project implementers); and subsequently a mixed-methods final evaluation of outcomes and processes: interviews with stakeholders; survey of health professionals; an audit of electronic health records and clinical register; and a review of operational documents. Outcome measures include changes between pre- and post-intervention in: proportion of high risk women receiving recommended glucose screening in early pregnancy; diabetes-related birth outcomes; proportion of women receiving recommended postpartum care including glucose testing; health practitioner confidence in providing care, knowledge and use of relevant guidelines and referral pathways, and perception of care coordination and communication systems; changes to health systems including referral pathways and clinical guidelines. DISCUSSION This study will provide insights into the impact of health systems changes in improving care for women with hyperglycaemia during and after pregnancy in a challenging setting. It will also provide detailed information on process measures in the implementation of such health system changes.
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Affiliation(s)
- D MacKay
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Royal Darwin Hospital, Darwin, Australia
| | - R Kirkham
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - N Freeman
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - K Murtha
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - P Van Dokkum
- Baker Heart & Diabetes Institute Central Australia, Alice Springs, Australia
| | - J Boyle
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - S Campbell
- College of Nursing and Midwifery, Charles Darwin University, Cairns, Australia
| | - F Barzi
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - C Connors
- Top End Health Service, Northern Territory Department of Health, Darwin, Australia
| | - K O'Dea
- Population School of Health Research, University of South Australia, Adelaide, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - J Oats
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - P Zimmet
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, Australia
| | - M Wenitong
- Apunipima Cape York Health Council, Bungalow, Australia
| | - A Sinha
- Cairns and Hinterland Hospital and Health Service, Cairns, Australia
| | - A J Hanley
- Department of Nutritional Sciences, Faculty of Medicine and the Dalla Lana School of Public Health, The University of Toronto, Toronto, Canada
| | - E Moore
- Aboriginal Medical Services Alliance Northern Territory, Darwin, Australia
| | - D Peiris
- The George Institute for Global Health, Sydney, Australia
| | - A McLean
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Cairns and Hinterland Hospital and Health Service, Cairns, Australia
| | - B Davis
- Cairns and Hinterland Hospital and Health Service, Cairns, Australia
| | - C Whitbread
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Royal Darwin Hospital, Darwin, Australia
| | - H D McIntyre
- Mater Medical Research Institute, University of Queensland, Brisbane, Australia
| | - J Mein
- Wuchopperen Health Service, Cairns, Australia
| | - R McDermott
- Centre for Chronic Disease Prevention, Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Australia
| | - S Corpus
- Danila Dilba Health Service, Darwin, Australia
| | - K Canuto
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - J E Shaw
- Aboriginal Health Domain, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - A Brown
- South Australian Health and Medical Research Institute, Adelaide, Australia
- Faculty of Health and Medical Science, University of Adelaide, Adelaide, Australia
| | - L Maple-Brown
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
- Royal Darwin Hospital, Darwin, Australia.
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Wood A, MacKay D, Fitzsimmons D, Derkenne R, Kirkham R, Boyle JA, Connors C, Whitbread C, Welsh A, Brown A, Shaw JE, Maple-Brown L. Primary Health Care for Aboriginal Australian Women in Remote Communities after a Pregnancy with Hyperglycaemia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030720. [PMID: 31979123 PMCID: PMC7037226 DOI: 10.3390/ijerph17030720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 01/20/2020] [Accepted: 01/20/2020] [Indexed: 01/24/2023]
Abstract
Background: Hyperglycaemia in pregnancy contributes to adverse outcomes for women and their children. The postpartum period is an opportune time to support women to reduce cardiometabolic and diabetes risk in subsequent pregnancies. Aims: To identify strengths and gaps in current care for Aboriginal women after a pregnancy complicated by hyperglycaemia. Methods: A retrospective review of the 12 month postpartum care provided by primary health centres in remote Australia in 2013–2014 identified 195 women who experienced hyperglycaemia in pregnancy (gestational diabetes (GDM) (n = 147), type 2 diabetes (T2D) (n = 39), and unclear diabetes status (n = 9)). Results: Only 80 women (54%) with GDM had postpartum glycaemic checks. Of these, 32 women were diagnosed with prediabetes (n = 24) or diabetes (n = 8). Compared to women with GDM, women with T2D were more likely to have their weight measured (75% vs. 52%, p <0.01), and smoking status documented as “discussed” (65% vs. 34%, p < 0.01). Most women (97%) accessed the health centre at least once in the 12 month postpartum period but, during these visits, only 52% of women had service provision, either structured or opportunistic, related to diabetes. Conclusion: High rates of dysglycaemia among women screened for T2D after GDM in the 12 month postpartum period highlight the need for increased screening and early intervention to prevent the development of T2D and its complications. Whilst a clear strength was high postpartum attendance, many women did not attend health services for diabetes screening or management.
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Affiliation(s)
- Anna Wood
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia; (A.W.)
- Endocrinology Department, Division of Medicine, Royal Darwin Hospital, Darwin, NT 0810, Australia
| | - Diana MacKay
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia; (A.W.)
- Endocrinology Department, Division of Medicine, Royal Darwin Hospital, Darwin, NT 0810, Australia
| | - Dana Fitzsimmons
- Northern Territory Department of Health, Darwin, NT 8000, Australia
| | - Ruth Derkenne
- Northern Territory Department of Health, Darwin, NT 8000, Australia
| | - Renae Kirkham
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia; (A.W.)
| | - Jacqueline A. Boyle
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia; (A.W.)
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia
| | | | - Cherie Whitbread
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia; (A.W.)
| | - Alison Welsh
- Northern Territory Department of Health, Darwin, NT 8000, Australia
| | - Alex Brown
- South Australia Health and Medical Research Institute, Adelaide, SA 5000, Australia
- Faculty of Health and Medical Science, University of Adelaide, Adelaide, SA 5005, Australia
| | - Jonathan E. Shaw
- Aboriginal Health Domain, Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia;
| | - Louise Maple-Brown
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia; (A.W.)
- Endocrinology Department, Division of Medicine, Royal Darwin Hospital, Darwin, NT 0810, Australia
- Correspondence:
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