Practice nurses and providing preconception care to women in Australia: a qualitative study

Abstract

The aims of this study were to explore women’s and health professionals’ perspectives of preconception care and whether expanding the role of practice nurses (PNs) to provide preconception care is acceptable. In a descriptive qualitative approach, 23 semistructured interviews and three focus groups were conducted with women (n=14), PNs (n=8), GPs (n=10) and practice managers (n=2) in the state of Victoria, Australia, between September and December 2019. An inductive process of thematic analysis identified five themes and 12 subthemes. Women and health professionals viewed preconception to be when a woman is planning a pregnancy. Women wanted personalised preconception care, and receiving this from a PN was considered to be acceptable. If the role of PNs is expanded, PNs would require training and professional recognition of their role to provide preconception care. Funding barriers were discussed by PNs, GPs and practice managers, along with potential solutions, such as Medicare item numbers and checklists to streamline consultations. Other resources in the wider community, such as schools, were identified as important aspects of a coordinated approach. Overall, expanding the role of PNs to provide preconception care was acceptable to women and health professionals to increase women’s awareness and uptake of preconception care.

Lifestyle and Psychological Factors of Women with Pregnancy Intentions Who Become Pregnant: Analysis of a Longitudinal Cohort of Australian Women

“…This might fall within the remit of primary care. Primary care physicians (general practitioners) and practice nurses, when suitably trained and remunerated, would be well placed to provide this type of care [28]. Indeed, in the Royal Australian College of General Practitioners' Guidelines for Preventive Activities in General Practice [29], all women within the age rages of 15 to 49 are recommended to receive preconception care.…”

“…However, Australian general practitioners report barriers to accessing women planning pregnancy for the provision of preconception care [30]. Broadening the perception of the preconception period from planning an immediate pregnancy to identifying longer-term parenthood aspirations is imperative to facilitate the delivery of this early preconception care and family planning [28].…”

Setting Preconception Care Priorities in Australia Using a Delphi Technique

“…Another issue with the focus on general-practitioner led care is that there is no Medicare item number to bill for PCC consultations. 19 22 An appointment where an individual presents for PCC is likely to be billed with item number 23 (professional attendance to which no other item applies, $39.10, less than 20 minutes) 56 or item number 36 (professional attendance to which no other item applies, $75.75, longer than 20 minutes). 57 Comprehensive PCC that covers all preconception priorities is not possible in a consultation that is less than 20 minutes, particularly for those with complex histories.…”

“…61 Another example is in health service reforms. Formative work with women and health professionals confirming the acceptability of primary health care nurses providing PCC has been conducted 19 ; however, further work with key stakeholders in primary care, social care, policy and the community is required to co-design PCC that is accessible and that meets people's needs and expectations. 62…”

“…Among all people, community awareness of PCC is low 17,18 and many people only seek PCC if they experience difficulties when trying to become pregnant. 19 Regardless of whether health risks are modifiable or not, PCC may help to mitigate many of the risks related to preconception health. Importantly, PCC should be accessible to all and provided with consideration of the social and economic determinants of health, including education, access to health care and employment that impact on health and health behaviors, particularly for priority populations.…”