An implementation science approach for developing and implementing a dietitian-led model of care for gestational diabetes: a pre-post study.
Background: There is strong evidence that women with gestational diabetes mellitus (GDM) who receive a minimum of three appointments with a dietitian may require medication less often. The aim of this study was to evaluate the impact of a dietitian-led model of care on clinical outcomes and to under...
| Publicado en: | BMC Pregnancy & Childbirth Vol. 20; no. 1 |
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| Autores principales: | , , |
| Formato: | research Journal Article |
| Publicado: |
BioMed Central
11/3/2020
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=146807403&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 146807403 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 14712393 1CII jtl: BMC Pregnancy & Childbirth issn: 14712393 maglogo: N pubinfo: dt: 11/3/2020 vid: 20 iid: 1 pid: 24147 pub: BioMed Central artinfo: ui: 146807403 146807403 NLM33143693 146807403 10.1186/s12884-020-03352-6 NLM33143693 146807403 ppct: 1 formats: tig: atl: An implementation science approach for developing and implementing a dietitian-led model of care for gestational diabetes: a pre-post study. aug: au: MELONCELLI, Nina BARNETT, Adrian de JERSEY, Susan affil: School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, Queensland, Australia sug: subj: Dietitians Administration Diabetes Mellitus, Gestational Therapy Health Care Delivery, Integrated Administration Health and Welfare Planning Administration Professional Role Pregnancy Management Diabetes Mellitus, Gestational Blood Blood Glucose Analysis Patient Education Administration Prospective Studies Human Appointments and Schedules Adult Diabetes Mellitus, Gestational Diagnosis Patient Compliance Hypoglycemic Agents Therapeutic Use Female Program Evaluation Comparative Studies Multicenter Studies Evaluation Research Validation Studies Impact of Events Scale Scales Questionnaires Adult: 19-44 years Female ab: Background: There is strong evidence that women with gestational diabetes mellitus (GDM) who receive a minimum of three appointments with a dietitian may require medication less often. The aim of this study was to evaluate the impact of a dietitian-led model of care on clinical outcomes and to understand the utility of the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework as a prospective tool for implementation.Methods: This was a pre-post intervention study measuring outcomes before-and-after changing a gestational diabetes (GDM) model of care and included women with GDM managed at a large, regional hospital in Queensland, Australia. The i-PARIHS framework was used to develop, implement and evaluate a dietitian-led model of care which increased dietetic input for women with GDM to a minimum of one initial education and two review appointments. The outcomes were adherence to the schedule of appointments, clinician perspective of the implementation process, pharmacotherapy use, gestational age at commencement of pharmacotherapy and birth weight. Pre- and post- comparisons of outcomes were made using t-tests and chi-squared tests.Results: Adherence to the dietetic schedule of appointments was significantly increased from 29 to 82% (p < 0.001) but pharmacotherapy use also increased by 10% (p = 0.10). There were significantly more women in the post-intervention group who were diagnosed with GDM prior to 24 weeks gestation, a strong independent predictor of pharmacotherapy use. Infant birthweight remained unchanged. The i-PARIHS framework was used as a diagnostic tool and checklist in the model of care development phase; a facilitation tool during the implementation phase; and during the evaluation phase was used as a reflection tool to identify how the i-PARIHS constructs and their interactions that may have impacted on clinical outcomes.Conclusions: The i-PARIHS framework was found to be useful in the development, implementation and evaluation of a dietitian-led model of care which saw almost 90% of women with GDM meet the minimum schedule of dietetic appointments. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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