Question

case study : A pregnant woman who weighs 140 kgs, recently diagnosed with gestational diabetics has been advised that she cannot have her baby at the local hospital. She lives in Bacchus Marsh( regional melbourne ) with her husband with no other immediate family close by.

1. Define the health issues for the person or the target group involved as they access primary care.

2. What are the primary health services available to this target group in the local area? What is the philosophy of their care?

3. Who is employed within this service?

4. What elements of this primary health service are involved in health promotion, prevention, cure and rehabilitation?

5. What publication, web services and other methods are used by this primary health service to communicate their services to their target groups?

6. Using the key social determinants of health as guides consider which of these: Socioeconomic position, Early life, Social exclusion, Social capital, Employment and work, Housing, and Residential environment could contribute to health inequalities for this target person or group.

7. Are there any other specific areas of health challenges facing this community?

Answer 1

1. Health issues for the person and the Target group:

Gestational Diabetes: Diabetes is a group of metabolic diseases where by a person has high blood sugar level due to an inability to produce or inability to metabolize sufficient quantities of the hormone insulin. Diabetes during pregnancy is called Gestational Diabetes. it is the diabetic condition that is diagnosed first time during pregnancy .

Target group: Pregnant women with Gestational Diabetes. As they acess the primary care , They may have the symptoms and signs of :

*unusual thirst

* frequent urination

* sugar in urine

* bladder, vaginal or skin infections

* fatigue and nausea

* blurred vision .

If it is untreated, the diabetic condition  may affect the fetus , can result in premature birth , still birth, excessive birth weight or other complications.  

2. The available primary health services in the local area ,for the pregnant women with Gestational Diabetes, are:

* Treatment and support services for Gestational Diabetes mellitus (GDM).

* Education on Home care management of Diabetes for the pregnant woman and family.

* Medical and lifestyle management for the pregnant women with type 1 and type 2 diabetes.

* Referral services

Philosophy : Gestational diabetes mellitus is a significant health risk as it can cause imparment in fetal health and  increase the risk of women  for developing Type 2 Diabetes in later life. The Diabetes services provides both in patient and out patient management of pregnant women with Diabetes.  

3. A team of health professionals and allied discipline members are involved in the health services for Pregnant women with Gestational Diabetes mellitus. They are:

*Diabetologist/ endocrinologist

* Diabetes nurse practitioner

* Diabetes educators

* Allied health professionals such as Dietition, Exercise physiologist, Podiatrists , Psychologists etc.

4. Elements of primary health services:

* Health promotion services for the women prior to pregnancy, to be fit for pregnancy and to prepare for pregnancy through Regular physical activity, by maintaining the proper  body weight etc.

Promotion of healthy eating during pregnancy

* Early detection and management of Diabetes during pregnancy

* GDM screening services

* constant monitoring for maternal complications

* Referral services for the women who are in risk of complications.

* Counselling on nutrition and exercise

* Planned delivery and associated services

* fetal monitoring and neonatal care.

* Assistance for breast feeding services. Educational services for mother regarding the importance of exclusive breast feeding.  

5. Publication and web services:

Victorian Maternity and Newborn Clinical Network ( VMNCN) can provide with clarification of enquiries.

Telemedicine for Gestational Diabetes in Melbourne : Provides the support services for pregnant women with Diabetes.  

Neonatal e Hand book : for care during hypoglycemia in neonates.

6. Key social determinants: The main risk factors or the social determinants that increases the chance of Gestational diabetes are:

* Family history of Diabetes

* Non white race: Hispanic women, American Indian, Asian American, black women, Pacific islanders

* Overweight and obesity and lack of physical activity.  

* History of Polycystic ovarian Syndrome

* Age > 40 years

7. Health challenges of the community:

* High blood pressure and preeclampsia

* Risk of surgical delivery C - section

* Obesity and type 2 diabetes mellitus in future