向妊娠期间和妊娠后并发高血糖的妇女提供的护理：多组分卫生系统干预的影响

IF 7.6 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific Pub Date : 2025-03-13 DOI:10.1016/j.lanwpc.2025.101514

Diana MacKay , Jacqueline A. Boyle , Sandra Campbell , Natasha Freeman , Anna McLean , Denella Hampton , Cherie Whitbread , Paula Van Dokkum , Kirby Murtha , Christine Connors , Elizabeth Moore , Ashim Sinha , Yvonne Cadet-James , Sharni Cardona , Jeremy Oats , H David McIntyre , Anthony J. Hanley , Alex Brown , Jonathan E. Shaw , Renae Kirkham , Louise Maple-Brown

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引用次数: 0

摘要

原住民和托雷斯海峡岛民妇女在怀孕期间经历了不成比例的高血糖负担。2016年至2019年期间，在澳大利亚北领地（NT）和远北昆士兰（FNQ）实施了一项旨在改善产前和产后护理的多成分卫生系统干预措施。组成部分包括临床医生教育、改进召回制度、加强政策和指南，以及将妊娠糖尿病临床登记纳入护理系统。对该方案进行了评估，以确定对临床实践和孕产妇健康的影响。方法分析来自初级保健临床记录和DIP临床登记的妊娠期高血糖妇女的数据，以评估产前和产后糖尿病检测的变化；糖化血红蛋白/血糖水平;药物使用;体重检查，体重和身体质量指数；以及产后避孕、吸烟和母乳喂养。研究结果：北领地的临床实践得到改善，包括有高血糖危险因素的妇女在妊娠早期推荐的75 g口服葡萄糖耐量试验(土著和托雷斯海峡岛民妇女11.7%至26.5%,p <；0.001;非土著妇女6.2%至19.3%,p <；0.001)。在北领地，土著和托雷斯海峡岛民妇女产后糖尿病监测（56%至68%，p = 0.039）和避孕药具使用（41%至60%，p = 0.001）增加。在FNQ中，T2D妇女产后血糖监测增加(土著和托雷斯海峡岛民26%至68%，p = 0.002；50%至100%非土著，p = 0.008)，尽管产前保健指标没有改善。解释：在多组分卫生系统干预后，NT和FNQ对妊娠期高血糖妇女的护理方面有所改善。本研究由澳大利亚国家卫生和医学研究委员会（NHMRC）全球慢性疾病联盟基金1092968资助。

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Care provided to women during and after a pregnancy complicated by hyperglycaemia: the impacts of a multi-component health systems intervention

Background

Aboriginal and Torres Strait Islander women experience a disproportionate burden of hyperglycaemia in pregnancy. A multi-component health systems intervention aiming to improve antenatal and postpartum care was implemented across Australia’s Northern Territory (NT) and Far North Queensland (FNQ) between 2016 and 2019. Components included clinician education, improving recall systems, enhancing policies and guidelines, and embedding Diabetes in Pregnancy (DIP) Clinical Registers in systems of care. This program was evaluated to determine impacts on clinical practice and maternal health.

Methods

Data for women with hyperglycaemia in pregnancy from primary care clinical records and the DIP Clinical Registers were analysed to assess changes in: antenatal and postpartum diabetes testing; HbA1c/glucose levels; medication use; weight checks performed, weight and body mass index; and postpartum contraception, smoking and breastfeeding.

Findings

Clinical practice in the NT improved, including increased uptake of the recommended first trimester 75 g oral glucose tolerance test among women with hyperglycaemia risk factors (Aboriginal and Torres Strait Islander women 11.7% to 26.5%, p < 0.001; non-Indigenous women 6.2% to 19.3%, p < 0.001). In the NT, postpartum diabetes monitoring (56% to 68%, p = 0.039) and contraceptive use (41% to 60%, p = 0.001) increased among Aboriginal and Torres Strait Islander women. In FNQ, postpartum glucose monitoring increased among women with T2D (26% to 68% Aboriginal and Torres Strait Islander, p = 0.002; 50% to 100% non-Indigenous, p = 0.008), although there were no improvements in antenatal care indicators.

Interpretation

Aspects of care for women with hyperglycaemia in pregnancy improved in the NT and FNQ following a multi-component health systems intervention.

Funding

This study is funded by the Australian National Health and Medical Research Council (NHMRC) Global Alliance for Chronic Diseases Grant 1092968.

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来源期刊

The Lancet Regional Health: Western Pacific Medicine-Pediatrics, Perinatology and Child Health

CiteScore

8.80

自引率

2.80%

发文量

305

审稿时长

11 weeks

期刊介绍： The Lancet Regional Health – Western Pacific, a gold open access journal, is an integral part of The Lancet's global initiative advocating for healthcare quality and access worldwide. It aims to advance clinical practice and health policy in the Western Pacific region, contributing to enhanced health outcomes. The journal publishes high-quality original research shedding light on clinical practice and health policy in the region. It also includes reviews, commentaries, and opinion pieces covering diverse regional health topics, such as infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, aging health, mental health, the health workforce and systems, and health policy.