Organizing Preconception Care for Women Suffering from Chronic Diseases: Patients’ View on the Role of General Practitioners: A Qualitative Study.

Abstract

Background: Women suffering from chronic diseases should preferably receive specialized individual preconception care (PCC) by an obstetrician before becoming pregnant. For most chronic diseases it is important that the disease is in remission or under control before conception, aiming for optimal pregnancy outcome. Especially, amongst other considerations, medication use should be monitored for toxicity before starting a pregnancy. Specific case findings followed by a referral to an obstetrician for specialized individual PCC by a general practitioner (GP) could be a solution to improve the uptake of PCC. The aim of this study was to explore patients’ views on PCC organized by general practitioners (GP) for women suffering from a chronic disease.Methods: We recruited participants via a public Facebook message. We asked women suffering from a chronic medical condition, aged 18-42 years, living in the Netherlands and planning to become pregnant to contact the researcher by a personal message. Once contacted, women received additional information about the aim of the study. After reading the study information, women were asked for participation and a digital informed consent was sent. Thereafter, an appointment for a semi-structured interview by telephone, the study intervention, was made. The interviews were audio-taped, transcribed verbatim and member checked. The transcripts were coded and analysed on facilitators and barriers for preconception care by GP’s, using NVivo 10.Results: 45 women replied to the public Facebook message. All women were contacted by the researcher. Finally, 23 women consented to participate in a semi-structured interview by telephone. This resulted in a heterogeneous study population. The participants indicated a range of facilitators and barriers for organizing PCC via the GP. The GP was viewed to be trustworthy, to have knowledge about their medical history and to have a coordinating role but limited knowledge about pregnancy. Patients preferred a referral from the GP to an obstetrician to have a face-to-face preconception consultation together with their medical specialist. Conclusions: According to women suffering from a chronic disease, PCC is ideally given by an obstetrician and medical specialist in a face-to-face consultation whereby the GP has a coordinating role.Trial registration: not applicable.