Integrating preconception care for women with diabetes into primary care: a qualitative study

Abstract

BackgroundNational guidelines emphasise the need to deliver preconception care to women of childbearing age. However, uptake of the services among women with diabetes in the UK is low. Questions arising include how best to deliver preconception care and what the respective roles of primary versus secondary caregivers might be. AimTo explore the perspective of GPs and secondary care health professionals on the role of GPs in delivering preconception care to women with diabetes. Design of studyQualitative, cross-sectional study. SettingA London teaching hospital and GP practices in the hospital catchment area. MethodSemi-structured interviews with GPs and members of the preconception care team in secondary care. Thematic analysis using the framework approach. ResultsGPs and secondary care professionals differ in their perception of the number of women with diabetes requiring preconception care and the extent to which preconception care should be integrated into GPs' roles. Health professionals agreed that GPs have a significant role to play and that delivery of preconception care is best shared between primary and secondary care. However, the lack of clear guidelines and shared protocols detailing the GP's role presents a challenge to implementing 'shared' preconception care. ConclusionGPs should be more effectively involved in providing preconception care to women with diabetes. Organisational and policy developments are required to support GPs in playing a role in preconception care. This study's findings stress the importance of providing an integrated approach to ensure continuity of care and optimal pregnancy preparation for women with diabetes.

Preconception care for women with type 2 diabetes mellitus: A mixed-methods study of provider knowledge and practice

“…Practitioners noted that a checklist within the routine medical software would not only offer a cognitive aid to instigate preconception care but would aid in its efficiency and quality. Other studies have also cited the use of checklists and software reminders, in addition to patient brochures, handouts and waiting room posters as practical systems developments to support preconception care [26,27,42]. Consultations for other reasons, such as attendance for infertility, were described as common opportunities for the provision of preconception care.…”

Effect of implementation of a preconception counselling resource for women with diabetes: A population based study

“…As GPs are often the sole providers of diabetes care in type 2 diabetes, our study highlights the urgent need for primary care to further engage in preconception counselling for women with diabetes, especially those with type 2 diabetes. A recent study reported that GPs and secondary care professionals differ in their perception of the number of women with diabetes requiring preconception care and regarding the role of GPs in that care [28]. A greater awareness of the importance of preconception counselling is needed and all healthcare professionals must avail of every opportunity to have that 'conversation' with women.…”

Preconception care for women with type 1 or type 2 diabetes mellitus: a mixed-methods study exploring uptake of preconception care

“…The full citations of the studies that were excluded from the review are given in Appendix 3. Of the 18 studies that were included (which are described in detail in Table 2), 13 [26][27][28][30][31][32][33][34]37,38,40,42,43 addressed the experiences and perceptions of women only, four 29,35,36,39 addressed the experiences and perceptions of healthcare practitioners only and one study 41 addressed the experiences and perceptions of women and practitioners. It is of note that there are relatively few studies that have explored the views of practitioners responsible for providing care to women with diabetes mellitus in pregnancy.…”

“…It is of note that there are relatively few studies that have explored the views of practitioners responsible for providing care to women with diabetes mellitus in pregnancy. The largest majority of studies (n = 9) 30,33,34,36,37,[40][41][42][43] were based in a UK context, six [27][28][29]31,35,39 were based in the USA and one study each was based in Australia, 32 Ireland 38 and Sweden. 26 The study based in Australia 32 is distinct because it focused specifically on the experiences of women living in rural and relatively isolated communities.…”