Current practice of preconception care by primary caregivers in the Netherlands

Abstract

Objectives: Over the past decade the value of preconception care (PCC) consultations has been acknowledged. Investments have been made to promote delivery and uptake of PCC consultations in the Dutch primary care setting. We assessed current activities, perceptions and prerequisites for delivery of PCC in primary care. Methods: A questionnaire was compiled and distributed by mail or e-mail among 1682 general practitioners (GPs) and 746 midwives in the Netherlands between 2013 and 2014. Results: The questionnaire was completed by 449 GPs and 250 midwives. While GPs and midwives were frequently asked about preconception risks, explicit requests by patients for a PCC consultation were less frequent. Although caregivers gave information on preconception risk factors, only a minority recommended PCC in the form of a dedicated consultation. Such consultations occurred infrequently. Risk factor assessment varied between GPs and midwives. Respondents' perceptions of PCC consultations, however, were generally positive. A small proportion believed that PCC medicalised pregnancy, and recognised barriers in actively raising the topic of patients' pregnancy wishes. More training, staff, promotion of PCC and adequate reimbursement were prerequisites for future delivery. GPs differed in their opinion of whether they or midwives were primarily responsible for PCC consultations. Midwives, however, saw themselves as responsible for providing PCC consultations. Conclusions: Primary care is underserving prospective parents with regards to PCC consultations. Targets to increase delivery of systematic PCC are: (1) promotion during routine care; (2) increased use of tools; (3) increased collaboration among primary caregivers; (4) reduction of caregivers' negative perceptions; and (5) tailoring PCC consultations to suit women's preferences. ARTICLE HISTORY

The effect of a local promotional campaign on preconceptional lifestyle changes and the use of preconception care

“…In 2007, the Dutch Health Council recommended to integrate PCC in the health care system and, subsequently, guidelines for GPs and midwives as well as risk assessment instruments were developed [24][25][26]. Yet, reimbursement of PCC in Dutch obstetric care has not been established up to now [27].…”

Barriers in the Uptake and Delivery of Preconception Care: Exploring the Views of Care Providers

“…(Health Council of the Netherlands 2007) Guidelines for general practitioners and midwives (de Jong-Potjer 2011) as well as risk assessment instruments have been developed (Landkroon et al 2010), and the Dutch government recognized the importance of introducing PCC as a standard component of perinatal care (Vos et al 2016). Despite these recommendations, no comprehensive PCC program has been introduced and only few healthcare professionals are currently delivering PCC (van Voorst et al 2016). …”

“…But even though primary care setting, hospital setting, community outreach programs and youth health centers all offer opportunities to address and offer PCC (Tuomainen et al 2013), healthcare professionals do not systematically discuss the availability and benefits of PCC in such settings (Mazza et al 2013a, b; van Voorst et al 2016). …”

Facilitators and Barriers of Preconception Care in Women With Inflammatory Bowel Disease and Rheumatic Diseases

“…General practitioners (GPs) and midwives are usually responsible for providing general PCC. Women receive advice about folic acid supplementation and optimal lifestyle (2)(3)(4). For women suffering from chronic diseases specialized PCC should be offered by a gynecologist or disease speci c specialist.…”