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Table 1 NT DIP Partnership activities

From: Health service changes to address diabetes in pregnancy in a complex setting: perspectives of health professionals

Barriers identified in 2012 Activities and impact of NT DIP Partnership
Communication
 Breakdown between tertiary and primary health services referral pathway difficult, unsuitable specialist clinic times
- Workshops and regional meetings resulted in an increased understanding of roles and priorities of different disciplines from tertiary and primary health care settings and increased contact between clinicians; created congenial relationships and enhanced case conferencing and discussion.
- Engagement of clinicians in process of development of referral pathways resulted in an increased uptake of referral pathways and care plans.
Access
 Lack of access for remote clients to specialist services (e.g. dietitians), food insecurity
- Increased access to specialist services through telehealth and allied health outreach visits resulted in enhanced local health professionals’ knowledge.
- Establishment of nutrition in pregnancy working group resulted in the development of nutrition education resources.
- Partnership activities resulted in midwives taking on the role of commencing blood glucose monitoring with the women. All NT diabetes services are now able to provide home blood glucose monitoring equipment to women. Women are now more likely to have blood glucose profiles when attending appointments. Prior to this, women presenting for the first time at the antenatal clinic with a diabetes diagnosis, rarely came with a glucose monitoring profile.
Education
 Health professionals reported knowledge gaps, no structured education available, resources for women not easily located
- Partnership staff delivered workshops, education sessions and presentations at hospital for a grand rounds, Primary Health Network events, university undergraduates and conferences across the NT, facilitated by primary health and tertiary organisations.
- On-line learning modules were developed for health professionals.
- Investigators revised local guidelines to be in line with ADIPS and WHO, and incorporated them into Central Australian Rural Practitioners Association (CARPA) Standard Treatment Manual (6th Edition) and the Minymaku Kutju Tjukurpa – Women’s Business Manual (5th Edition).
- Educational activities have heightened awareness of early detection of DIP leading to the development of a clinic in one Aboriginal Medical Health Service for women to attend to have an OGTT (either antenatal or post-partum).
- Educational activities have resulted in an increased awareness of testing and reporting of DIP, with annual increases in numbers of women with DIP being reported by NT Midwives Data Collection.
Coordination and Transition of Care
Unsure of who was involved in management of women and who was responsible for co-ordinating the care. between primary and tertiary health services.
- Patient Journey Modelling and educational partnership activities resulted in increased clinician contact which enhanced the coordination and transition of care.
- Workshops and regional meetings resulted in specialist clinic time revised in order to suit assessment and treatment modalities with minimal ‘out of community’ time for the women.
- Workshops and regional meetings resulted in care-coordination becoming part of clinical care at outpatient clinics with a meeting at the end of each clinic for multi-disciplinary team members to collaborate on a plan of care for complex cases.
- Electronic care plans for diabetes in pregnancy were developed for use in primary health care.
- The clinical register generates a weekly working list for monitoring the care coordination of women with diabetes in pregnancy at each hospital in the NT.