Diabetes prevention intervention doubles screening rates in high-risk women
Click Here to Manage Email Alerts
Screening rates for diabetes doubled in several Australian primary care practices after the implementation of a prevention intervention targeting women who were previously diagnosed with gestational diabetes, according to recent findings.
“Primary care practices play an important role in looking after the health of women and their families in the community,” Sharleen L. O’Reilly, BSc, PhD, RD, an associate professor in human nutrition at University College Dublin, told Healio. “As a result, they are well-placed to follow women after they have had a pregnancy with gestational diabetes and provide preventive health care with the aim of reducing this high-risk group's risk of developing type 2 diabetes.”
In a mixed-methods study, O’Reilly and colleagues conducted the GooD4Mum Quality Improvement Collaborative (QIC) intervention over a 12-month period. They used the Normalization Process Theory framework, which included clinical audits, semi-structured interviews with health service staff and focus groups with stakeholders, in 15 mixed urban and rural multidisciplinary primary care practices.
The framework “was key to unpacking the implementation 'black box' of what went on in practices,” O’Reilly said.
All practices provided treatment to women with previous gestational diabetes.
The intervention was comprised of four stages:
- defining quality improvement aims and measures and disseminating the QIC handbook to every practice;
- pinpointing change principles and ideas to address underlying causes of the evidence-to-practice gaps;
- developing activities to drive the intervention, action periods and four 90-minute online interactive learning workshops; and
- performing small local-level tests of change using Plan-Do-Study-Act cycles.
During four 3-month periods, each practice was required to submit a minimum of one Plan-Do-Study-Act report for each quarter, with an audit at the start of each quarter and a final audit.
Two members of each staff would serve as “champions for the intervention,” according to O’Reilly. One member was a general practitioner (GP) and the other member was typically a nurse, manager or another GP.
In total, 481 women were involved in the GooD4Mum intervention, and 38 Plan-Do-Study-Act cycles were reported.
The average proportion of diabetes screening increased from 26% at baseline to 61% after 12 months of the intervention (P = .0002), according to O’Reilly and colleagues. They reported in Family Practice that one in 10 women received a diabetes prevention planning consultation by the end of the intervention, an improvement from baseline (10% vs. 1%). Postpartum screening also increased from 43% to 60%.
The main themes of improvement identified in interviews and focus groups were recognizing mothers as stakeholders within their care, staff collectively creating the care process, practice staff identifying a long-term community care perspective, and “feedback being used as feedforward,” according to the researchers.
“We found that where practices actively participated in the quality improvement collaborative process, they were the ones that implemented, normalized and routinized the improvement, and subsequently reaped the benefits,” O’Reilly said.
The researchers have received additional funding from the National Health and Medical Research Council of Australia to expand this study into a randomized controlled trial later this year.