Poster Presentation Australasian Diabetes in Pregnancy Society and Society of Obstetric Medicine Australia and New Zealand Joint Scientific Meeting 2021

Gestational Diabetes Mellitus (GDM) care re-imagined - 2: Education and clinical review delivery to support a radical model of care change (#68)

Shelley Wilkinson 1 , Josephine G Laurie 2 3 , David McIntyre 2 3 4
  1. School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland
  2. Obstetric Medicine, Mater Mothers' Hospital, Brisbane, Queensland, Australia
  3. Mater Clinical Unit, The University of Queensland , Brisbane, Queensland , Australia
  4. Mater Research Institute-The University of Queensland, Brisbane

Introduction: We present the key steps from the implementation of a multifaceted digital solution in our busy and under-resourced GDM service.

Method: Collaborative design led by Obstetric Medicine, including Dietetics, Diabetes Education, Midwifery and Obstetrics, and consultation with Administrative Services, Interpreting Services, and Pharmacy progressed this service redesign project. 

Steps taken included: 1. Mapping of women’s journey through the standard GDM model of care, 2. Identification of barriers to service access, occasions of variations in care delivered, duplication of processes, and inefficient use of time and/or resources and 3. Review of profession-specific appointment scheduling guidelines.

Innovations and process changes aimed to overcome identified barriers and included a co-creation process with women from four common interpreted languages. Appointment attendances, video views, adherence and clinical outcomes have been monitored to assess model of care adoption and acceptance.

Results: 

The new model of care was introduced in stages between June and November 2020. It involved:

  1. Changes to results acknowledgement of an abnormal GTT (timing; process; staff responsibility);
  2. Initial ‘education’ contact (via email; delivery of URLs to two instructional videos);
  3. Courier of glucometer to women, with NDSS registration;
  4. Smartphone app to enable asynchronous BGL sharing, monitoring, and clinician feedback;
  5. Standardised ‘introduction to GDM’ video in six languages, with culturally-appropriate dietary advice; and
  6. Joint dietitian and diabetes educator appointments for first two face-to-face clinic visits at day 7 and 14 post diagnosis.
  7. Removal of “GDM schedule” with increased access to urgent dietitian and insulin commencement appointments.

GDM clinic attendance rate has increased from 60 to 95%. Average views of the videos have been 120/month (but one group has been viewed 250/month) since release.

Conclusion: A multifaceted digital solution integrated into a radical model of care change demonstrates positive initial feedback and process outcomes.  

 

The authors have presented 3 inter linked abstracts for review;

  1. Gestational Diabetes Mellitus (GDM) care re-imagined – 1: Integration of a digital solution into a radical model of care change 
  2. Gestational Diabetes Mellitus (GDM) care re-imagined - 2: Education and clinical review delivery to support a radical model of care change
  3. Insulin wastage in GDM - Is sustainability a pipe dream?