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Table 1 Barriers to implementing healthcare according to local guidelines for women during and after a pregnancy complicated by diabetes in regional and remote Australia, identified in formative work with healthcare professionals and stakeholders

From: Improving systems of care during and after a pregnancy complicated by hyperglycaemia: A protocol for a complex health systems intervention

System factors Lack of clarity around roles of healthcare providers in administering diabetes screening tests and providing follow-up care in the postpartum period
Insufficient involvement of medical specialists
Disjointed communication pathways between hospital and primary care
Inconsistent access to electronic health records
Reliance on handheld medical record, which women may not bring to appointments
Siloed approaches to provision of care
High staff turnover
Small Aboriginal health workforce
Lack of systematic processes for referrals
Unavailability of transport for women to attend for postpartum care
Reported low numbers of women presenting for preconception counselling
Requirement for many women to travel large distances to access care, with reluctance to leave other children behind
Long waiting times at hospital clinics
Healthcare practitioner factors Inconsistency in use of local guidelines
Low health practitioner confidence in delivering care
Lack of consistency of practitioner knowledge regarding criteria for screening for hyperglycaemia in early pregnancy
Patient factors Prioritising needs of family over women’s own postpartum health
Low perceived future risk of T2DM amongst women
Limited time or motivation for women to attend for postpartum care