TY - JOUR
T1 - Hyperemesis gravidarum in the primary care setting
T2 - cross-sectional study of GPs Melanie Nana1
AU - Morgan, Holly
AU - Ahmed, Haroon
AU - Williamson, Catherine
N1 - Funding Information:
This project is funded by the National Institute for Health Research (NIHR) Senior Investigator Award (NIHR200254). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.
Publisher Copyright:
© 2022 The Authors;. All Rights Reserved.
PY - 2022/3
Y1 - 2022/3
N2 - Background: Hyperemesis gravidarum (HG), if untreated, can lead to malnutrition, dehydration, and Wernicke's encephalopathy. Foetal complications include low birth weight and neurodevelopmental delay. Recent evidence supports increased rates of termination of pregnancy and suicidal ideation. Drivers included difficulty in accessing medications, which thus contributed to poor perception of care. Aim: To identify factors that may influence prescribers' confidence and knowledge regarding pharmacological therapy for HG. Design & setting: Cross-sectional study of qualified GPs and GP trainees in Wales. Method: Distribution of a 22-item online survey. Statistical analysis was carried out using SPSS. Results: In total, 241 responses were received, with 216 included in the analysis (59% qualified GPs, 41% GP trainees). In total, 93% of responders correctly identified cyclizine as being safe in pregnancy, but no other drug recommended in the Royal College of Obstetrics and Gynaecology guidance was considered safe by more than 58%. Those reporting higher confidence levels in managing HG were more likely to correctly report guideline-recommended drugs as safe in pregnancy (P = 0.04). Additional qualifications related to obstetrics and gynaecology (O&G) and/or prior clinical experience increased confidence levels (P = 0.0001 and P = 0.0002, respectively). Only 19% of participants routinely screened for signs of mental health complications, and prior experience or education did not increase likelihood of this happening. The majority of participants (87%) would like additional education and/or access to evidence-based resources. Conclusion: This study demonstrates a demand for improved dissemination of evidence-based education on HG to support those working in primary care. The extent to which HG is covered in preexisting educational programmes should also be revisited.
AB - Background: Hyperemesis gravidarum (HG), if untreated, can lead to malnutrition, dehydration, and Wernicke's encephalopathy. Foetal complications include low birth weight and neurodevelopmental delay. Recent evidence supports increased rates of termination of pregnancy and suicidal ideation. Drivers included difficulty in accessing medications, which thus contributed to poor perception of care. Aim: To identify factors that may influence prescribers' confidence and knowledge regarding pharmacological therapy for HG. Design & setting: Cross-sectional study of qualified GPs and GP trainees in Wales. Method: Distribution of a 22-item online survey. Statistical analysis was carried out using SPSS. Results: In total, 241 responses were received, with 216 included in the analysis (59% qualified GPs, 41% GP trainees). In total, 93% of responders correctly identified cyclizine as being safe in pregnancy, but no other drug recommended in the Royal College of Obstetrics and Gynaecology guidance was considered safe by more than 58%. Those reporting higher confidence levels in managing HG were more likely to correctly report guideline-recommended drugs as safe in pregnancy (P = 0.04). Additional qualifications related to obstetrics and gynaecology (O&G) and/or prior clinical experience increased confidence levels (P = 0.0001 and P = 0.0002, respectively). Only 19% of participants routinely screened for signs of mental health complications, and prior experience or education did not increase likelihood of this happening. The majority of participants (87%) would like additional education and/or access to evidence-based resources. Conclusion: This study demonstrates a demand for improved dissemination of evidence-based education on HG to support those working in primary care. The extent to which HG is covered in preexisting educational programmes should also be revisited.
KW - antiemetics
KW - education
KW - general practice
KW - hyperemesis gravidarum
KW - pregnancy
KW - primary health care
UR - http://www.scopus.com/inward/record.url?scp=85128805292&partnerID=8YFLogxK
U2 - 10.3399/BJGPO.2021.0119
DO - 10.3399/BJGPO.2021.0119
M3 - Article
AN - SCOPUS:85128805292
SN - 2398-3795
VL - 6
SP - 1
EP - 10
JO - BJGP Open
JF - BJGP Open
IS - 1
ER -
