Results of the first recorded evaluation of a national gestational diabetes mellitus register: Challenges in screening, registration, and follow-up for diabetes risk.

OBJECTIVE: Gestational Diabetes Mellitus (GDM) increases the risk of type 2 diabetes. A register can be used to follow-up high risk women for early intervention to prevent progression to type 2 diabetes. We evaluate the performance of the world's first national gestational diabetes register. RESEARCH DESIGN AND METHODS: Observational study that used data linkage to merge: (1) pathology data from the Australian states of Victoria (VIC) and South Australia (SA); (2) birth records from the Consultative Council on Obstetric and Paediatric Mortality and Morbidity (CCOPMM, VIC) and the South Australian Perinatal Statistics Collection (SAPSC, SA); (3) GDM and type 2 diabetes register data from the National Gestational Diabetes Register (NGDR). All pregnancies registered on CCOPMM and SAPSC for 2012 and 2013 were included-other data back to 2008 were used to support the analyses. Rates of screening for GDM, rates of registration on the NGDR, and rates of follow-up laboratory screening for type 2 diabetes are reported. RESULTS: Estimated GDM screening rates were 86% in SA and 97% in VIC. Rates of registration on the NGDR ranged from 73% in SA (2013) to 91% in VIC (2013). During the study period rates of screening at six weeks postpartum ranged from 43% in SA (2012) to 58% in VIC (2013). There was little evidence of recall letters resulting in screening 12 months follow-up. CONCLUSIONS: GDM Screening and NGDR registration was effective in Australia. Recall by mail-out to young mothers and their GP's for type 2 diabetes follow-up testing proved ineffective.

Middleware Supporting Next Generation Data Analytics in Australia.

In Australia, as a result of the distributed, often private nature of health provision, tight privacy legislation, even tighter organizational policies, access to data covering the whole patient journey of care is a common aspiration that has been almost impossible to achieve. Access to primary care data in a manner that is record-linkable has been a particular challenge. Since 2006 The University of Melbourne has been developing GRHANITE™ Middleware and GRHANITE™ Data Linkage technologies designed to overcome these barriers. With over 10% of Australian primary care data now being routinely extracted utilising this technology, we believe the principal technical challenges have now been overcome. We believe this technology to be at the forefront ethically of providing data for research. This poster describes the principal issues involved and the approaches taken in the technical solution underpinning GRHANITE™.

Primary care informatics and integrated care.

This chapter gives an educational overview of: * The biopsychosocial model of primary health care and longitudinal relationships; * Management of undifferentiated problems and chronic illness within the clinical relationship; * Patient-centred care in the context of health promotion, early detection and effective care of patients with chronic illness; * Inter-professional networks, connectedness, connectivity and interoperability; * Record linkage and health information sharing/exchange for clinical, audit, quality assurance, professional development and research purposes.