Reduced insulin requirements and improved BGL control have been documented in a study validating American Nutrition Practice Guidelines (NPG) that included a Dietitian appointment schedule (minimum 4 appointments)(1). No Australian GDM NPGs exist and systematic delivery of dietetic care for GDM does not occur (2,3).
Dissemination of guidelines alone does not change practice(4). The assessment of influencing factors and implementation and evaluation design must be systematic and theory-driven(5). This paper describes assessment of an evidence-practice gap and the planned intervention to implement a schedule of Dietitian consults for Mater Mothers’ Hospital GDM patients.
The Theoretical Domains Framework(5) guided investigation of barriers at individual, team, organisational levels(6). Data sources included routinely collected hospital data (2009-11), staff surveys, and clinic observation. Dietetic visits were compared with American NPG. GDM clinic staff (n=42) were surveyed about NPG knowledge and belief in the influence of dietetic counselling on previously reported positive associated outcomes.
Women’s lack of awareness of the benefits of scheduled contact with a dietitian and staff’s unfamiliarity with NPGs and current practice was identified. Most staff believed regular dietetic contact could influence diet, but fewer believed contact could influence BGLs, pharmacotherapy requirements, and care costs, and only about half felt contact could influence GWG or macrosomia. There was a significant shortfall in Dietitian resources to allow all GDM patients to be reviewed. Other barriers included lack of dedicated clinic space and exclusion from the clinic carepath. The MMH Dietitian saw 88%, 94.7%, and 92.5% of GDM women for an initial consult (2009-11) and few had a subsequent appointment (<1%, 5.6%, and 5%).
Behaviour change theories(6,7) have been mapped onto the identified barriers. Project funding has been obtained for Dietitian time. The primary process outcome will be uptake of the new dietetic schedule and the primary clinical outcome will be effect of the NPG schedule on requirement for pharmacotherapy.