Having gestational diabetes (GDM) is the single strongest population risk predictor for Type 2 Diabetes (T2DM). GDM and T2DM pose tremendous potential health and economic burdens with increasing incidence worldwide. Primary care-based systematic postnatal screening and lifestyle modification programs are needed for women who have had gestational diabetes. Current rates of diabetes screening postnatally are low -just 30%- and uptake of lifestyle modification programs is unknown. Australian Primary Care Collaboratives are effective in improving quality of diabetes and diabetes prevention care and 25% GPs have been involved in a collaborative.
To audit changes and explore influencing factors in guideline-led diabetes prevention care during a quality improvement project for women with previous gestational diabetes, called GooD4Mum.
Five Medicare Locals (MLs) from rural and metro Victoria participated in the 12 month GooD4Mum project. Within each ML, five GP practices were recruited. Practice audits, learning workshops, Plan-Do-Study-Act cycles and collaborative support were the key project activities. Diabetes prevention guideline implementation was assessed using a concurrent mixed method approach (quantitative audits, qualitative interviews and focus groups).
GooD4Mum audit data showed average screening rates more than doubled from 26% to 61% within 12 months. In addition, 1 in 10 women registered within practices received a diabetes prevention planning consultation during the project. Critical knowledge exchange activities were the building of local champions, software optimization, design and delivery of templates, pathways and information sharing forums; and managing the effects of MLs transitioning to Primary Health Networks. The observable factors from the ML perspective were: leadership by identified practice staff, reminder systems in action and practice staff driving the process collectively. Theoretical analysis provided insight into the factors that supported the building of improved care.
GooD4Mum appears to be a viable pathway for scaling-up diabetes prevention care into primary care systems.