Interconception care in general practice: a qualitative exploratory study

Problem

There is increasing recognition that poor pregnancy and birth outcomes are linked to a woman's health status prior to conception. Women who experience an adverse pregnancy outcome are predisposed to a recurrence of these issues in future pregnancies. The interconception period, that is the time between pregnancies, provides an opportunity to address maternal lifestyle and behavioural risk factors, institute chronic disease management and plan timing of future pregnancies in order to optimise outcomes and reduce morbidity and mortality. Interconception care (ICC) requires systematic identification of women at high risk, communication and integration of care between tertiary hospitals and primary care practitioners and a multidisciplinary approach. General practitioners (GPs) are critical to the delivery of ICC however little is known about GP understanding and experiences of ICC. We aimed to explore GP knowledge, attitudes and practices with regards to ICC.

Approach

A qualitative study was conducted with 18 GPs working in metropolitan Melbourne, Australia. GPs were recruited using purposeful sampling. Semi-structured telephone interviews were conducted to explore GP knowledge, perspectives and experiences of ICC. Interviews were audio-recorded and transcribed verbatim. Data were analysed using thematic analysis facilitated by the Framework Method.

Findings

GPs were unfamiliar with the term 'interconception care'. GPs conceptualised ICC as routine care of childbearing age women as opposed to interventions aimed specifically at optimising a subsequent pregnancy. Participants reported key priorities in the interconception period across three domains of postpartum care, well-woman care and pre-pregnancy care. GPs reported providing ICC opportunistically beyond the six-week postpartum visit and identified well-baby checks as a key contact point with mothers. GPs perceived lack of engagement in ICC from mothers with high competing demands and questioned whether women prioritised health optimisation for a subsequent pregnancy whilst raising a young child. GPs also reported time constraints and a lack of clarity on the content and timing of ICC as provider barriers. Continuity of care and education materials for women and GPs were viewed as facilitators to ICC.

Consequences

Our exploratory study found that 'interconception care' is not a recognised concept amongst GPs. The opportunistic delivery and lack of priority given to it together with GP knowledge and patient barriers to delivery mean that ICC is currently not being delivered in a way to maximise outcomes. Our findings require confirmation in larger studies. Research to evaluate women's perspectives on ICC together with the views of hospital staff are also necessary to better understand how ICC delivery can be improved.