Table 2 Documented systems changes
Baseline (2012) | Current (2016) |
|---|---|
Communication | |
Centralised specialist clinics in tertiary hospital Poor communication between services (with opportunities to improve use of telemedicine) | - Systemic integration of telemedicine into health services - Regular case conferencing with remote clinics through telehealth - Clinical Register reports circulated quarterly with information around prevalence of DIP across regions - Improved referral pathways - Enhanced awareness by PHC clinicians of availability of hospital-based specialists for phone advice and case conferences |
Access | |
Limited engagement of diabetes and allied health specialists in remote settings and limited access to these specialist services close to home for remote women | - Regular outreach visits and telehealth by specialists (including dieticians) - Increased capacity of Primary Health Care clinicians to manage DIP in remote communities with support by phone/telehealth from hospital-specialists (hub and spoke model) |
Education | |
Minimal DIP educational activities for Health Professionals Limited self-management educational resources available for women Limited access to glucose monitors | - Regular DIP educational forums for Health Professionals (including a focus on preconception care and postpartum care) - DIP educational resource for women - Free access to glucose monitors |
Coordination and Transition of Care | |
Remote clients required to travel to access specialist care | - Specialist clinic times changed to better meet the needs of remote clients - Electronic care plans used in primary health care. - Multi-disciplinary collaboration at outreach meetings to coordinate care provided to complex cases |
Clinical Guidelines | |
Use of a standard treatment manual, based on the Australian Diabetes in Pregnancy Society guidelines Different guidelines used in Primary Health Care and hospital and in different regions within the NT | -Adoption of International Association of Diabetes in Pregnancy Study Groups and World Health Organisation guidelines (which have a lower threshold for diagnosis and earlier screening) -Guidelines were aligned between Primary Health Care and hospital to be consistent between guidelines and across all NT regions -Strong promotion of guidelines in education sessions |