Improving models of care for diabetes in pregnancy: Experience of current practice in Far North Queensland, Australia

Aims: To map health practitioners' experiences and describe knowledge regarding screening and management of Diabetes in Pregnancy (DIP) in Far North Queensland, Australia. Methods: Mixed methods including a cross-sectional survey (101 respondents) and 8 focus groups with 61 health practitioners. All participants provided clinical care for women with DIP. Results: A wide range of healthcare professionals participated; 96% worked with Indigenous women, and 63% were from regional or remote work settings. Universal screening for gestational diabetes at 24-28 weeks gestation was reported as routine with 87% using a 75g Oral Glucose Tolerance Test. Early screening for DIP was reported by 61% although there was large variation in screening methods and who should be screened < 24 weeks. Health practitioners were confident providing lifestyle advice (88%), dietary and blood glucose monitoring education (67%, 81%) but only 50% were confident giving insulin education. Electronic medical records were used by 80% but 55% also used paper records. Dissatisfaction with information from hospitals was reported by 40%. In the focus groups improving communication and information technology systems were identified as key areas. Other barriers described were difficulties in care coordination and access for remote women. Conclusion: Communication, information technology systems, coordination of care and education for health professionals are key areas that will be addressed by a complex health systems intervention being undertaken by the DIP Partnership in North Queensland

Improving models of care for diabetes in pregnancy:Experience of current practice in Far North Queensland, Australia

Aims: To map health practitioners' experiences and describe knowledge regarding screening and management of Diabetes in Pregnancy (DIP) in Far North Queensland, Australia. Methods: Mixed methods including a cross-sectional survey (101 respondents) and 8 focus groups with 61 health practitioners. All participants provided clinical care for women with DIP. Results: A wide range of healthcare professionals participated; 96% worked with Indigenous women, and 63% were from regional or remote work settings. Universal screening for gestational diabetes at 24-28 weeks gestation was reported as routine with 87% using a 75 g Oral Glucose Tolerance Test. Early screening for DIP was reported by 61% although there was large variation in screening methods and who should be screened <24 weeks. Health practitioners were confident providing lifestyle advice (88%), dietary, and blood glucose monitoring education (67%, 81%) but only 50% were confident giving insulin education. Electronic medical records were used by 80% but 55% also used paper records. Dissatisfaction with information from hospitals was reported by 40%. In the focus groups improving communication and information technology systems were identified as key areas. Other barriers described were difficulties in care coordination and access for remote women. Conclusions: Communication, information technology systems, coordination of care, and education for health professionals are key areas that will be addressed by a complex health systems intervention being undertaken by the DIP Partnership in North Queensland.Anna McLean, Renae Kirkham, Sandra Campbell, Cherie Whitbread, Jennifer Barret

New regionalism and planning for water quality improvement in the Great Barrier Reef, Australia

New regionalism encompasses a diversity of approaches to address regional planning problems. Within Australia, the Great Barrier Reef Water Quality Protection Plan was developed to enhance water quality within the World Heritage-listed Great Barrier Reef, and the plan gave responsibility to regional, natural resource management bodies to undertake several actions. This paper evaluates these initiatives in the light of the emerging theory of new regionalism and highlights six main lessons: up-scaling of the catchment approach to a reef-wide approach is essential in order to improve water quality, but must be complemented by cross-regional collaboration; new governance and institutional arrangements and strengthened partnerships must be effectively integrated; culture and history are important in determining the most effective management approaches; pilot projects must move to comprehensive and strategic implementation; science is important but needs to incorporate other branches of knowledge; and economic incentives are important in encouraging the implementation of best practices, but delivery needs to be flexible. We conclude that the new regional approach is appropriate for addressing complex, multi-scale problems such as water quality, and has incorporated several key principles of new regionalism, but that the process must move quickly to a higher level of commitment and application. © 2010 The Authors. Journal compilation © 2010 Institute of Australian Geographers

From climate-smart agriculture to climate-smart landscapes

<p>Abstract</p> <p>Background</p> <p>For agricultural systems to achieve climate-smart objectives, including improved food security and rural livelihoods as well as climate change adaptation and mitigation, they often need to be take a landscape approach; they must become ‘climate-smart landscapes’. Climate-smart landscapes operate on the principles of integrated landscape management, while explicitly incorporating adaptation and mitigation into their management objectives.</p> <p>Results</p> <p>An assessment of climate change dynamics related to agriculture suggests that three key features characterize a climate-smart landscape: climate-smart practices at the field and farm scale; diversity of land use across the landscape to provide resilience; and management of land use interactions at landscape scale to achieve social, economic and ecological impacts. To implement climate-smart agricultural landscapes with these features (that is, to successfully promote and sustain them over time, in the context of dynamic economic, social, ecological and climate conditions) requires several institutional mechanisms: multi-stakeholder planning, supportive landscape governance and resource tenure, spatially-targeted investment in the landscape that supports climate-smart objectives, and tracking change to determine if social and climate goals are being met at different scales. Examples of climate-smart landscape initiatives in Madagascar’s Highlands, the African Sahel and Australian Wet Tropics illustrate the application of these elements in contrasting contexts.</p> <p>Conclusions</p> <p>To achieve climate-smart landscape initiatives widely and at scale will require strengthened technical capacities, institutions and political support for multi-stakeholder planning, governance, spatial targeting of investments and multi-objective impact monitoring.</p