Background and aims: The Northern Territory and Far North Queensland (FNQ) Diabetes in Pregnancy (DIP) Partnership is a collaboration between health care providers, researchers and policy makers that aims to improve systems of care for women with diabetes in pregnancy, and improve health outcomes by reducing risk associated with diabetes in pregnancy as early as possible in the life course.
Method: The DIP Partnership was expanded to FNQ in 2016 and includes the establishment of a DIP clinical register and implementation of models of care activities to improve the screening, management and follow up of women with DIP. Formative work was undertaken in early 2017 using a mixed methods approach including a cross-sectional survey (101 respondents) and 8 focus groups (61 participants) to map FNQ health practitioners' experiences and describe knowledge regarding screening and management of diabetes in pregnancy.
Results: From October 2016 to December 2017, DIP and birth information was available for 383 women in the FNQ DIP clinical register. Of those women, 32.1% (n=123) identified as Aboriginal and/or Torres Strait Islander. Twenty three percent of Aboriginal and/or Torres Strait Islander women had Type 2 diabetes (n=29) compared to 4% (n=10) of non-Indigenous women. Women with Type 2 diabetes were more likely to require caesarean section (64% vs 35%) and have a large for gestational age baby (26% vs 12%). In the health practitioner survey, early screening for DIP was reported by 61%, however, there was large variation in screening methods and who should be screened <24 weeks. In the focus groups, several barriers were identified as impacting on the effective management of diabetes in pregnancy including communication, differing information technology systems and care coordination when women accessed care between health services, particularly for women living in remote areas.
Conclusion: Improving communication and care coordination are priorities for the models of care intervention, as well as continuing to improve early screening and post-partum follow up of women with DIP in FNQ.