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Postnatal care following hypertensive disorders of pregnancy : qualitative study of views and experiences of primary and secondary care clinicians
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Bick, Debra, Silverio, Sergio A., Bye, Amanda and Chang, Yan-Shing (2020) Postnatal care following hypertensive disorders of pregnancy : qualitative study of views and experiences of primary and secondary care clinicians. BMJ Open, 10 (1). e034382. doi:10.1136/bmjopen-2019-034382 ISSN 2044-6055.
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Official URL: http://dx.doi.org/10.1136/bmjopen-2019-034382
Abstract
Objectives: To explore clinicians’ views and experiences of caring for postnatal women who had hypertensive disorders of pregnancy [HDP], awareness of relevant National Institute for Health and Care Excellence [NICE] guidance to inform their postnatal management, the extent to which NICE guidance was implemented, barriers and facilitators to implementation, and how care could enhanced to support women’s future health.
Design: A qualitative study using semi-structured interviews. Thematic analysis was utilised for coding and theme generation.
Setting: Four National Health Service [NHS] maternity units and three general practice clinics in South-East and South-West London.
Participants: A maximum variation, purposive sample of 20 clinicians with experience of providing postnatal care to women following HDP.
Results: Four main themes were generated. Variation in knowledge and clinical practice; Communication and education; Provision of care; Locus of responsibility for care. Perceived barriers to implementation of NICE guidance included lack of postnatal care plans and pathways, poor continuity of care, poor anti-hypertensive medication management, uncertainty around responsibility for postnatal care and women’s lack of awareness of the importance of postnatal follow-up for their future health. Some clinicians considered women were discharged from in-patient care too soon, as primary care clinicians did not have specialist knowledge of HDP management. Most clinicians acknowledged the need for better planning, communication and co-ordination of care across health settings.
Conclusions: Evidence of longer-term consequences for women’s health following HDP is accumulating, with potential for NICE guidance to support better outcomes for women if implemented. Clinicians responsible for postnatal care following HDP should ensure they are familiar with relevant NICE guidance, able to implement recommendations, and involve women in decisions about ongoing care and why this is important. The continued low priority and resources allocated to postnatal services will continue to promote missed opportunities to improve outcomes for women, their infants and families.
| Item Type: | Journal Article | ||||||||
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| Subjects: | R Medicine > RG Gynecology and obstetrics | ||||||||
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Pregnancy -- Complications, Pregnant women -- Medical care, Hypertension in pregnancy, Toxemia of pregnancy, Primary care (Medicine), Medicine, Preventive | ||||||||
| Journal or Publication Title: | BMJ Open | ||||||||
| Publisher: | BMJ | ||||||||
| ISSN: | 2044-6055 | ||||||||
| Official Date: | 2020 | ||||||||
| Dates: |
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| Volume: | 10 | ||||||||
| Number: | 1 | ||||||||
| Article Number: | e034382 | ||||||||
| DOI: | 10.1136/bmjopen-2019-034382 | ||||||||
| Status: | Peer Reviewed | ||||||||
| Publication Status: | Published | ||||||||
| Access rights to Published version: | Open Access (Creative Commons) | ||||||||
| Date of first compliant deposit: | 19 December 2019 | ||||||||
| Date of first compliant Open Access: | 20 December 2019 | ||||||||
| RIOXX Funder/Project Grant: |
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