Abstract
OBJECTIVE
Hypertensive disorders of pregnancy (HDP) affect 7% of pregnancies in Canada. Women with HDP are at higher risk for postpartum development of traditional cardiovascular risk factors, cardiovascular disease, and increased cardiovascular mortality in both the short and long-term. We sought to understand if obstetrical care providers were aware of this link and how they communicate this to patients.
METHODS
In this qualitative study, we interviewed registered midwives (RM), family physicians (FP), and obstetricians (OB) using a semi-structured interview guide. Interviews were transcribed verbatim and thematic analyses was performed.
RESULTS
We interviewed seven FP's, six RM's, and six OB's and saturation was reached. Four themes were identified explaining barriers and facilitators to counselling about HDP, caring for patients with HDP, and the role healthcare providers play when caring for these patients. These included: 1) HCP Counselling, 2) Transitions of Care, 3) HDP Care, 4) Role of the OB vs RM vs FP.
CONCLUSION
Barriers to counselling included time limitations, lack of individual specialty knowledge, ownership, competing counselling priorities, and lack of providers to transfer care to in the postpartum. Facilitators included having access to patient education tools and the globally recognized importance of preventing future cardiovascular disease. Access to easily accessible and implementable guidelines was both a barrier and facilitator. Therefore, attention should be given to the creation of high-quality integrated continuing medical education (CME) and easily accessible and implementable guidelines. Future work should focus on quality improvement initiatives, with effort paid to improving documentation via standardized forms or electronic medical record (EMR) templates.
