1396-P: Lessons Learned from Implementing a Dietician-Led Low Risk Model of Care

Research from the U.S. and Australia indicates that individualized medical nutrition therapy provided by a Registered Dietician over a minimum of three appointments can reduce pharmacotherapy requirements for women with GDM. We used an implementation science approach to develop a dietician-led model of care for low risk GDM women. Our evaluation used a pre-post intervention comparison, with primary outcomes of pharmacotherapy use and adherence to clinical guidelines which includes the recommendation of three dietician appointments. Although there were significantly more women who received best-practice dietetic care in the post-intervention cohort, pharmacotherapy use increased (Table). However, other changes over time need to be considered when interpreting these results. Women in the post-intervention cohort were more likely to: have been diagnosed before 24 weeks; have had previous GDM; and be prescribed metformin (Table). Lessons learned included: timing of dietician appointments; ongoing facilitation of the implementation process; workforce engagement; lower targets for commencing pharmacotherapy; and increased surveillance of low-risk women, all of which may have resulted in higher pharmacotherapy conversion rates. Our results have highlighted the importance of measuring process outcomes alongside clinical outcomes and using an implementation science approach when aiming to provide best-practice care.