Who is taking responsibility for the initial follow-up screening test for women with recent gestational diabetes?
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Other Title
Authors
Tippler, Helen Hayes
Author ORCID Profiles (clickable)
Degree
Master of Nursing
Grantor
Eastern Institute of Technology (EIT)
Date
2018
Supervisors
Papps, Elaine
Manhire, Kathy
Manhire, Kathy
Type
Masters Thesis
Ngā Upoko Tukutuku (Māori subject headings)
Keyword
New Zealand
gestational diabetes
postpartum follow-up screening
HbA1c
primary health care
interviews
gestational diabetes
postpartum follow-up screening
HbA1c
primary health care
interviews
ANZSRC Field of Research Code (2020)
Citation
Tippler, H. H. (2018). Who is taking responsibility for the initial follow-up screening test for women with recent gestational diabetes? (Unpublished document submitted in partial fulfilment of the requirements for the degree of Master of Nursing). Eastern Institute of Technology (EIT), New Zealand https://hdl.handle.net/10652/6048
Abstract
BACKGROUND
While the majority of women recover from gestational diabetes mellitus (GDM) once the pregnancy is over, an HbA1c blood test three months postpartum is recommended to ensure that the gestational diabetes has resolved, with an annual HbA1c screening thereafter, due to the increased risk of developing T2DM in later life. This research aimed to identify who is taking responsibility for ensuring the initial follow-up screening test is ordered and completed.
METHODS
Participants for this study were primary health care or secondary care professionals who worked with women either during the pregnancy or in the postpartum period and were recruited via email invitation distributed by the New Zealand Nurses Organisation and the New Zealand Primary Health Care Organisation. Interviews were conducted in the form of a 20-30 minute telephone survey using a semi-structed format. Questions included demographic data followed by simple yes/no questions relating years of experience working with women with GDM, other health professionals they work in conjunction with, awareness of follow-up protocols and guidelines, and discharge practices currently in place before more in-depth opinions were sought about the subject.
RESULTS
Three main themes were identified: Lack of Knowledge, Communication Breakdown and a need for Improving the Service. Primary health care participants lacked a general knowledge regarding GDM, processes for identifying women who had had GDM and the follow-up guidelines for the initial postpartum screening test. Both primary and secondary care participants were unclear as to who was responsible for the initial follow-up screening test for women with recent GDM, and while communication amongst secondary care health professionals, by way of a multi-disciplinary team (MDT) approach for the care of the women with GDM was systematic and effective, there was a general lack of communication around GDM between secondary care providers and primary health care providers. There was also a lack of communication between health care professionals and the women regarding the
necessity of the initial postpartum screening test. Areas to improve the uptake of the initial postpartum screening test include: written educational material, a clear guidance in discharge letters, data collection and effective recall systems and pathways.
CONCLUSION
While the Ministry of Health (2014) guidelines state that the initial follow-up screening test responsibility lies in primary health care, this is not occurring. Findings from the participants interviewed, showed that this test was generally undertaken in secondary care with only incidental screening undertaken within primary health care. This research has highlighted a need for education in primary health care regarding GDM, ongoing risks for the mother and baby involved and improved processes for follow-up postpartum screening.
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