Thursday, 5 November 2015

Improving maternal health care for Aboriginal and Torres Strait Islander women in Australian-first study

SPHPM’s Jacqueline Boyle, Melanie Gibson-Helm, Helena Teede and Sanjeeva Ranasinha from the Monash Centre for Health Research and Implementation (MCHRI) and their collaborators Ross Bailie and Alice Rumbold from the Menzies School of Health Research and University of Adelaide have been published this week in the Medical Journal of Australia for their research into improving metabolic screening during pregnancy at primary health care centres (PHCs) attended by Aboriginal and Torres Strait Islander women.

The study is unique in linking 76 PHCs in different locations across Australia over five years in a large-scale continuous quality improvement (CQI) initiative. Internationally it is also one of a kind, as previous CQI research in pregnancy has been hospital-based, only involved one health service or region, or has not focused on metabolic screening.

The study was part of the Audit and Best Practice for Chronic Disease (ABCD) National Research Partnership which aimed to improve care provided by PHCs serving Aboriginal and Torres Strait Islander populations by using a CQI framework, a participatory approach to research and partnerships across the health system. CQI tools, training and support were provided to PHCs enabling them to identify and address issues related to systems and processes that commonly affect provision of care.

The study measured improvements by PHCs in screening for metabolic risk factors after participation in CQI activities. Women attending PHCs after one or more CQI cycles were more likely to receive assessment of body mass index, blood pressure and diabetes as recommended by national pregnancy care guidelines.

Attending to perinatal risk factors, such as diabetes and high blood pressure in pregnancy, obesity and excess gestational weight gain, is important for optimising maternal and infant health outcomes. Pregnancy is also a key period for implementing strategies to prevent development of long-term adverse health outcomes, such as obesity and diabetes for the mother and baby.

In Australia, Aboriginal and Torres Strait Islander women have a greater risk of adverse pregnancy outcomes such as low birth weight, premature birth and perinatal death.

Later in life, cardiovascular disease and diabetes are major contributors to the difference in life expectancy between Aboriginal and Torres Strait Islander women and other women in Australia. Effective, long-term strategies addressing health service level barriers are needed to ensure that Aboriginal and Torres Strait Islander women receive all components of recommended pregnancy care.

Dr Boyle said the findings are encouraging and suggest a successful approach for achieving further improvement in pregnancy care provision.

“Many women attended for pregnancy care early and regularly, representing important opportunities to support better health. The ability of health centres to provide all components of recommended pregnancy care is vital for reducing disparities in pregnancy outcomes, giving babies a healthy start to life and improving the health of women,” she said.

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