Developing management pathways for hypertensive disorders of pregnancy (HDP) in Indonesian primary care: a study protocol

Abstract

BackgroundNational and international guidelines for the management of hypertensive disorders of pregnancy (HDP) are available in developing countries. However, more detailed clinical pathways for primary care settings are limited. This study focuses on Indonesia, where 72% of women who died from HDP and its complications had received less appropriate treatment according to international guidelines. There is an urgent need to develop primary care focused pathways that enable general practitioners (GPs), midwives and other relevant providers to manage HDP better.ObjectivesThis paper describes a study protocol for the development of HDP management pathways for Indonesian primary care settings.MethodsThis study design is informed by Implementation Science theories and consists of three phases. The exploratory phase will involve conducting semi-structured interviews with key Indonesian primary care stakeholders to explore their experiences and views on HDP management. The development phase will apply evidence from the literature review and results of the exploratory phase to develop HDP management pathways contextualised to Indonesian primary care settings. Consensus will be sought from approximately 50 experts, consist of general practitioners (GPs), midwives, obstetricians, nurses and policy makers using Delphi technique survey. The evaluation phase will involve a pilot study to evaluate the pathways’ acceptability and feasibility in a sample of Indonesian primary care practices using mixed methods.DiscussionThe implementation science frameworks inform and guide the phases in this study. Qualitative interviews in the exploratory phase are conducive to eliciting opinions from key stakeholders. Using Delphi technique at the development phase is suitable to seek participants’ consensus on HDP management in primary care. Observations, focus group discussions, interviews as well as analysis of patients’ medical records at the evaluation phase are expected to provide a comprehensive investigation of the implementation of the pathways in practice settings.

The elephant in the room: an exploratory study of hypertensive disorders of pregnancy (HDP) management in Indonesian primary care settings

“…Using the theoretical frameworks of MRC [ 21 ] and PRISM [ 22 ] regarding aims of our larger study to improve HDP management [ 20 ], results of the interviews highlight and confirm the need for focused clinical intervention for improving HDP management in Indonesian primary care. Our findings draw attention to ‘ the elephant in the room ’, which stipulates a need for HDP clinical practice improvement that is mutually agreed as essential by the participants but is inadequately discussed anywhere in the current Indonesian literature.…”

“…In this case, both of the frameworks provide guidance on stages of the intervention development and factors that may influence the implementation of the intervention in primary care [ 21 , 22 ]. The MRC framework [ 21 ] was used to inform aims of this study to better understand HDP management in Indonesian primary care before a further intervention was developed [ 20 ]. Then, the PRISM [ 22 ] model was used to guide groups of stakeholders (recipients involved in HDP management) participated in this study, such as GPs, nurses, midwives, women with an HDP history, obstetricians, cardiologist, and policymakers; and to inform the development of guiding questions used in the interviews.…”

“…This paper reports an exploratory study that is part of a larger study to improve HDP management by developing a set of HDP management pathways in Indonesian primary care [ 20 ]. The exploratory study aims to explore the way HDP has been managed in primary care, to identify implementation barriers and facilitators of any existing HDP clinical standards in Indonesia, and to determine whether primary care clinicians are ready to change their practice in HDP management.…”

Guias de assistência à mulher com síndrome hipertensiva na Atenção Primária: revisão integrativa

“…Quanto a gravidade das doenças hipertensivas, o corpo torna-se um ambiente teratogênico e que destrói as células trofoblasticas, o excesso de fatores vasculares leva ao dano tecidual com exacerbação do prognóstico clinico, essas alterações podem ser passiveis de tratamento quando corretamente acompanhadas pela atenção primária (Alonso-Remédios, Pérez-Cutiño, & Delgado, 2017). Quando há uma incorreta gestão do cuidado na APS os outros níveis de atenção tornam-se superlotados, o que reflete na baixa qualidade dos atendimentos (Ekawati, et al, 2017).…”

Hypertensive disorders of pregnancy (HDP) management pathways: results of a Delphi survey to contextualise international recommendations for Indonesian primary care settings

“…The HDP statements tested in the survey were informed by our review of international evidence-based HDP guidelines [12,17] and our exploratory interviews with Indonesian primary care stakeholders [9,18]. The 125 statements were divided into 62 statements for the first-round survey (topics included in this round: HDP definitions, risks, screening and diagnosis, prevention and long-term follow-up), and 63 statements for the second-round survey (topics included in this round: HDP management, monitoring, facilities and surveillance for women with HDP).…”