An implementation science approach for developing and implementing a dietitian-led model of care for gestational diabetes: a pre-post study

• Published in: BMC pregnancy and childbirth 2020-11, Vol.20 (1), p.661-661, Article 661
• Main Authors: Meloncelli, Nina, Barnett, Adrian, de Jersey, Susan
• Format: Article
• Language: English
• Subjects: Adult; Appointments and Schedules; Blood Glucose - analysis; Collaboration; Delivery of Health Care, Integrated - organization & administration; Diabetes, Gestational - blood; Diabetes, Gestational - diagnosis; Diabetes, Gestational - therapy; Dietitian; Dietitians; Drug therapy; Female; Gestational diabetes; Health Plan Implementation - organization & administration; Humans; Hypoglycemic Agents - therapeutic use; I-PARIHS; Implementation Science; Implementation science framework; Model of care; Models, Organizational; Nutrition research; Nutritionists - organization & administration; Obstetrics; Patient Compliance - statistics & numerical data; Patient Education as Topic - organization & administration; Physicians; Pregnancy; Professional Role; Program Evaluation; Prospective Studies; Science; Womens health
• ISSN: 1471-2393; 1471-2393
• DOI: 10.1186/s12884-020-03352-6

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. 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. Adherence to the dietetic schedule of appointments was significantly increased from 29 to 82% (p