Poster Presentation Australian Diabetes in Pregnancy Society 2018

A cross-sectional survey of gestational diabetes management in Queensland (#104)

Nina Meloncelli , Adrian Barnett , Susan de Jersey

In 2015, Queensland Health published a Clinical Guideline for gestational diabetes mellitus (GDM) which included updated screening and diagnostic criteria and comprehensive recommendations for the multidisciplinary management of GDM. While it is understood that the updated criteria has resulted in increased GDM diagnosis, it is unknown whether resources or service delivery has changed or whether health services implemented the Guideline.  The aim of this study was to examine the staff resourcing, models of care, level of Guideline implementation, and barriers and enablers to implementing the Guideline across Queensland Health GDM services. A 22-item electronic questionnaire was sent to Queensland Health facilities between August and October 2017 with follow-up phone calls for questions involving staff resourcing. There were 53 respondents across 14 Queensland Hospital and Health Services (HHS) included. Regarding staff resourcing, 64% of the HHS had 0.1 full time equivalent (FTE) staff hours or less available for a diabetes educator and 93% had less than 0.1 FTE for a dietitian. The FTE allocated for endocrinologists or physicians ranged from 0.0 – 0.6 FTE, with 0.2 FTE the most common. Many rural and remote sites relied on telehealth to access specialist care. Between 2014 and 2016, 8 out of 14 HHS had some increase to FTE. Full implementation of the GDM Guideline was reported by 41% of Metropolitan compared with 29% for regional and 25% for rural/remote services. Guideline recommendations of physical activity advice, minimum schedule of dietetics appointments and psychosocial support were inconsistently delivered. The most common barrier to guideline implementation was staff resourcing (85%), whereas enablers included the staff or team work (42%), staff resourcing (21%), local protocols (21%) and education/knowledge (15%). This survey is an important step to understanding the gaps in GDM service and management across Queensland and the use of clinical guidelines. Equity of access to best practice care GDM across geographic regions likely requires greater resources and a greater understanding of effective models of care.