Abstract：
OBJECTIVE: The oral glucose tolerance test is the \'gold standard\' for detecting gestational diabetes in Australian and International guidelines. Test completion in regional, rural and remote regions may be as low as 50%. We explored challenges and enablers for regional, rural and remote antenatal clinicians providing gestational diabetes screening to better understand low oral glucose tolerance test completion.
METHODS: We conducted a qualitative descriptive study using semi-structured interviews. Participants eligible for the study were doctors or midwives providing antenatal care in regional, rural and remote Western Australia, between August 2019 and November 2020. Interviews were recorded digitally and transcribed into a Word document. We conducted a thematic analysis after initial categorisation and deduction of themes through workshops involving the research team.
RESULTS: We found a diversity of viewpoints on oral glucose tolerance test reliability for detecting gestational diabetes. Themes that emerged were; good collaboration between antenatal clinicians is required for successful screening; screening occurs throughout pregnancy using various tests; clinicians make significant efforts to address barriers; clinicians prioritise therapeutic relationships.
CONCLUSIONS: Effective universal screening for gestational diabetes in regional, rural and remote Western Australia is difficult and more complex in practice than guidelines imply. Detecting gestational diabetes requires creative solutions, early identification of at risk women and trust and collaboration between clinicians and women. SO WHAT?: Detection of gestational diabetes in regional, rural and remote Western Australia remains poorly completed. New strategies are required to adequately identify women at risk of adverse birth outcomes relating to hyperglycaemia in pregnancy.
METHODS: We conducted a qualitative descriptive study using semi-structured interviews. Participants eligible for the study were doctors or midwives providing antenatal care in regional, rural and remote Western Australia, between August 2019 and November 2020. Interviews were recorded digitally and transcribed into a Word document. We conducted a thematic analysis after initial categorisation and deduction of themes through workshops involving the research team.
RESULTS: We found a diversity of viewpoints on oral glucose tolerance test reliability for detecting gestational diabetes. Themes that emerged were; good collaboration between antenatal clinicians is required for successful screening; screening occurs throughout pregnancy using various tests; clinicians make significant efforts to address barriers; clinicians prioritise therapeutic relationships.
CONCLUSIONS: Effective universal screening for gestational diabetes in regional, rural and remote Western Australia is difficult and more complex in practice than guidelines imply. Detecting gestational diabetes requires creative solutions, early identification of at risk women and trust and collaboration between clinicians and women. SO WHAT?: Detection of gestational diabetes in regional, rural and remote Western Australia remains poorly completed. New strategies are required to adequately identify women at risk of adverse birth outcomes relating to hyperglycaemia in pregnancy.
摘要：
目的：口服葡萄糖耐量试验是澳大利亚和国际指南中检测妊娠期糖尿病的“金标准”。在区域内完成测试,农村和偏远地区可能低至50%。我们探讨了区域，农村和偏远产前临床医生提供妊娠期糖尿病筛查，以更好地了解低口服葡萄糖耐量试验的完成情况。
方法：我们使用半结构化访谈进行了定性的描述性研究。符合研究条件的参与者是在地区提供产前护理的医生或助产士，农村和偏远的西澳大利亚，2019年8月至2020年11月。访谈以数字方式记录并转录为Word文档。我们通过研究团队参与的研讨会对主题进行了初步分类和演绎后，进行了主题分析。
结果：我们发现口服葡萄糖耐量试验检测妊娠期糖尿病的可靠性存在多种观点。出现的主题是：成功筛查需要产前临床医生之间的良好合作；使用各种测试在整个怀孕期间进行筛查；临床医生为解决障碍做出了重大努力；临床医生优先考虑治疗关系。
结论：在区域内对妊娠期糖尿病进行有效的普遍筛查，农村和偏远的西澳大利亚州在实践中比指南所暗示的要困难和复杂。检测妊娠糖尿病需要创造性的解决方案，早期识别处于危险中的妇女以及临床医生和妇女之间的信任和合作。那又怎样？：在区域内检测到妊娠糖尿病，农村和偏远的西澳大利亚仍然很难完成。需要新的策略来充分识别妊娠中存在与高血糖相关的不良分娩结局风险的妇女。
方法：我们使用半结构化访谈进行了定性的描述性研究。符合研究条件的参与者是在地区提供产前护理的医生或助产士，农村和偏远的西澳大利亚，2019年8月至2020年11月。访谈以数字方式记录并转录为Word文档。我们通过研究团队参与的研讨会对主题进行了初步分类和演绎后，进行了主题分析。
结果：我们发现口服葡萄糖耐量试验检测妊娠期糖尿病的可靠性存在多种观点。出现的主题是：成功筛查需要产前临床医生之间的良好合作；使用各种测试在整个怀孕期间进行筛查；临床医生为解决障碍做出了重大努力；临床医生优先考虑治疗关系。
结论：在区域内对妊娠期糖尿病进行有效的普遍筛查，农村和偏远的西澳大利亚州在实践中比指南所暗示的要困难和复杂。检测妊娠糖尿病需要创造性的解决方案，早期识别处于危险中的妇女以及临床医生和妇女之间的信任和合作。那又怎样？：在区域内检测到妊娠糖尿病，农村和偏远的西澳大利亚仍然很难完成。需要新的策略来充分识别妊娠中存在与高血糖相关的不良分娩结局风险的妇女。
