- Project led by Derby Hospitals NHS Foundation Trust.
- Focused on pre-pregnancy care in primary and secondary care settings.
- Aimed to raise awareness of the need for pre-pregnancy care for women with diabetes, among women themselves along with professionals such as pharmacists, health visitors and fertility clinicians.
- Developed an innovative model of community-based pre-pregnancy care for women with diabetes, tailored to individual needs.
The Derby Hospitals NHS Foundation Trust team wanted to educate women with diabetes about the importance of pre-pregnancy care and to raise awareness of the issue with health professionals. Their aims were to:
- improve access to pre-pregnancy care, particularly for hard to reach groups
- deliver a better pre-pregnancy care experience
- increase the number of women receiving pre-pregnancy care
- improve pregnancy outcomes.
The intervention involved:
- sending written information to women with diabetes aged 18-45
- an initial consultation in a hospital or community-based clinic, focusing on reducing the risks associated with diabetes and pregnancy
- a personalised care plan involving primary and secondary care services
- focusing consultants' time on seeing only those at highest risk
- providing continuity of care, with women seen by the same team members in the antenatal service once pregnant.
Who was involved
The project was delivered by a multidisciplinary team and spanned the boundaries of primary and secondary care and clinical specialities.
The intervention improved the effectiveness, efficiency and timeliness of pre-pregnancy care for women with diabetes:
- activity doubled and median waiting time reduced from 13 to 5 weeks despite a 50% increase in capacity
- proportion of missed appointments reduced from 18% to 5%
- after 12 months, pre-pregnancy care rate rose from 48% to 70% and stillbirth rate reduced from 6% to 0%
- greater engagement with women from traditionally hard to reach groups, particularly young adults and South Asian women from low socio-economic groups
- cost savings of £61,000.
Having a database and input from a finance manager was invaluable for evaluating impact and cost savings. However the involvement of a health economist would have further added to the evaluation.