Hypertensive Disorders of Pregnancy Counselling Practices of Antenatal and Postpartum Health Care Providers in Ontario, Canada.

OBJECTIVES

Hypertensive disorders of pregnancy (HDPs) affect 7% of pregnancies in Canada. Women with HDPs are at higher risk for postpartum development of traditional cardiovascular risk factors, cardiovascular disease, and increased cardiovascular mortality in the short and long term. We sought to understand whether obstetrical care providers were aware of this link and how they communicate this to patients.

METHODS

In this qualitative study, we interviewed registered midwives (RMs), family physicians (FPs), and obstetricians (OBs) using a semi-structured interview guide. Interviews were transcribed verbatim and thematic analyses was performed.

RESULTS

We interviewed 7 FPs, 6 RMs, and 6 OBs and saturation was reached. Four themes were identified explaining barriers and facilitators to counselling about HDP, caring for patients with HDP, and the role health care providers play when caring for these patients. These included the following: (1) health care professional counselling, (2) transitions of care, (3) HDP care, and (4) role of the OB versus RM versus FP.

CONCLUSIONS

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 a barrier and facilitator. Therefore, attention should be given to the creation of high-quality, integrated continuing medical education 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 templates.