TY - JOUR
T1 - Postnatal care following hypertensive disorders of pregnancy
T2 - A qualitative study of views and experiences of primary and secondary care clinicians
AU - Bick, Debra
AU - Silverio, Sergio A.
AU - Bye, Amanda
AU - Chang, Yan-Shing
PY - 2020/1/19
Y1 - 2020/1/19
N2 - Objectives To explore clinicians' views and experiences of caring for postnatal women who had hypertensive disorders of pregnancy (HDP), awareness of relevant National Institute for Health and Care Excellence (NICE) guidance to inform their postnatal management, the extent to which NICE guidance was implemented, barriers and facilitators to implementation and how care could be enhanced to support women's future health. Design A qualitative study using semistructured interviews. Thematic analysis was used for coding and theme generation. Setting Four National Health Service maternity units and three general practice clinics in South-East and South-West London. Participants A maximum variation, purposive sample of 20 clinicians with experience of providing postnatal care to women following HDP. Results Four main themes were generated: variation in knowledge and clinical practice; communication and education; provision of care; locus of responsibility for care. Perceived barriers to implementation of NICE guidance included lack of postnatal care plans and pathways, poor continuity of care, poor antihypertensive medication management, uncertainty around responsibility for postnatal care and women's lack of awareness of the importance of postnatal follow-up for their future health. Some clinicians considered that women were discharged from inpatient care too soon, as primary care clinicians did not have specialist knowledge of HDP management. Most clinicians acknowledged the need for better planning, communication and coordination of care across health settings. Conclusions Evidence of longer term consequences for women's health following HDP is accumulating, with potential for NICE guidance to support better outcomes for women if implemented. Clinicians responsible for postnatal care following HDP should ensure that they are familiar with relevant NICE guidance, able to implement recommendations and involve women in decisions about ongoing care and why this is important. The continued low priority and resources allocated to postnatal services will continue to promote missed opportunities to improve outcomes for women, their infants and families.
AB - Objectives To explore clinicians' views and experiences of caring for postnatal women who had hypertensive disorders of pregnancy (HDP), awareness of relevant National Institute for Health and Care Excellence (NICE) guidance to inform their postnatal management, the extent to which NICE guidance was implemented, barriers and facilitators to implementation and how care could be enhanced to support women's future health. Design A qualitative study using semistructured interviews. Thematic analysis was used for coding and theme generation. Setting Four National Health Service maternity units and three general practice clinics in South-East and South-West London. Participants A maximum variation, purposive sample of 20 clinicians with experience of providing postnatal care to women following HDP. Results Four main themes were generated: variation in knowledge and clinical practice; communication and education; provision of care; locus of responsibility for care. Perceived barriers to implementation of NICE guidance included lack of postnatal care plans and pathways, poor continuity of care, poor antihypertensive medication management, uncertainty around responsibility for postnatal care and women's lack of awareness of the importance of postnatal follow-up for their future health. Some clinicians considered that women were discharged from inpatient care too soon, as primary care clinicians did not have specialist knowledge of HDP management. Most clinicians acknowledged the need for better planning, communication and coordination of care across health settings. Conclusions Evidence of longer term consequences for women's health following HDP is accumulating, with potential for NICE guidance to support better outcomes for women if implemented. Clinicians responsible for postnatal care following HDP should ensure that they are familiar with relevant NICE guidance, able to implement recommendations and involve women in decisions about ongoing care and why this is important. The continued low priority and resources allocated to postnatal services will continue to promote missed opportunities to improve outcomes for women, their infants and families.
KW - Postnatal
KW - Maternal morbidity
KW - Hypertensive disorders
KW - Clinicians
KW - Primary Care
KW - Secondary Care
KW - maternal health
KW - maternal medicine
KW - postnatal hypertension
KW - obstetrics
UR - http://www.scopus.com/inward/record.url?scp=85078465644&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2019-034382
DO - 10.1136/bmjopen-2019-034382
M3 - Article
SN - 2044-6055
VL - 10
JO - BMJ Open
JF - BMJ Open
IS - 1
M1 - 034382
ER -
