Abstract
Abstract
Background
Hyperemesis gravidarum (HG) is characterised by severe nausea and vomiting during pregnancy that can substantially impair daily functioning and lead to serious complications if untreated. Despite this burden, care of women with HG is often fragmented across multiple services, with many experiencing repeated emergency department presentations and limited continuity of maternity care. In response to this system challenge, the state Ministry of Health in New South Wales (NSW) launched an initiative in 2020 to support adoption or HG-adaptation of three existing models of care across 15 Local Health Districts (LHDs). This study aimed to assess initiative fidelity and to identify key barriers and enablers influencing HG model of care uptake.
Methods
Fifteen one-hour interviews were conducted with key implementation stakeholders over two months in late 2023. A tailored interview guide was informed by district implementation documentation and circulated to interviewees ahead of time. Interviews were audio-recorded, transcribed verbatim, and de-identified. Interview data was supplemented by written model of care summaries for each LHD. Transcripts and summaries were analysed using content and inductive thematic analysis in NVivo.
Results
Implementation and adaptation of models of care was variable, with most districts adopting at least two approaches. Hospital in the Home (HiTH) was implemented in all districts, while Early Pregnancy Assessment Services (EPAS) were less frequently utilised and Maternity in the Home not implemented at all. Other services including maternity-led outpatient and virtual care models were identified and were commonly utilised to complement HiTH and EPAS HG models, particularly in regional settings. Key implementation enablers included strong local leadership and resource sharing, while major barriers related to workforce culture and capacity, geographic dispersion of patients and services, and unclear clinical oversight, particularly for non-maternity services.
Conclusions
A range of flexible, locally adapted and complementary HG care models were identified to support effective HG management. Workforce factors, including role clarity, capacity, and readiness for change, were key determinants of implementation success. Strengthening integrated, multidisciplinary approaches, enhancing workforce capability, and building on fit for purpose models within LHDs will be critical to improving continuity, equity, and sustainability of care for women with HG.