TY - JOUR

T1 - Barriers to assessing vulnerability in pregnant women. A cross-sectional survey in Danish general practice

AU - Veno, Louise Brygger

AU - Jarbol, Dorte Ejg

AU - Ertmann, Ruth Kirk

AU - Søndergaard, Jens

AU - Pedersen, Line Bjørnskov

PY - 2023

Y1 - 2023

N2 - Background Undetected vulnerability in pregnancy contributes to inequality in maternal and perinatal health and is associated with negative birth outcomes and adverse child outcomes. Nationwide reports indicate important barriers to assessing vulnerability among Danish general practitioners. Objective To explore general practitioners perceived barriers to vulnerability assessment in pregnant women and whether the barriers are associated with practice organization of antenatal care, general practitioner, and practice characteristics. Methods The questionnaire was sent to all Danish general practitioners (N = 3,465). Descriptive statistics described the barriers to assessing vulnerability in pregnant women. Analytical statistics with ordered logistic regression models were used to describe the association between selected barriers to vulnerability assessment and antenatal care organization, and general practitioner and practice characteristics. Results 760 general practitioners (22%) answered. Barriers to vulnerability assessment were related to lacking routines for addressing vulnerability, lacking attention to and record-keeping on vulnerability indicators, an insufficient overview of vulnerable pregnant women, and perceived insufficient remuneration for antenatal care consultations. Not prioritizing extra time when caring for vulnerable pregnant women was associated with experiencing more barriers. Always prioritizing continuity of care was associated with experiencing fewer barriers. General practitioners of either young age, male gender, or who did not prioritize extra time to care for vulnerable pregnant women experienced more barriers. Conclusion Barriers to vulnerability assessment among pregnant women do exist in general practice and are associated with organizational characteristics such as lacking prioritization of extra time and continuity in antenatal care consultations. Also, general practitioner characteristics like male gender and relatively young age are associated with barriers to vulnerability assessment.Lay Summary Identifying vulnerability in pregnant women is essential to prevent pregnancy-related depression or problems of mother-child attachment, and these women need extra support during pregnancy. In Denmark, all pregnant women are offered pregnancy care by their general practitioner (GP). However, identifying vulnerable pregnant women is challenging for the GPs. This questionnaire study among 760 GPs explores whether the GPs perceived barriers to identifying vulnerable pregnant women are lack of attention to and overview of vulnerable women in their clinic, insufficient record-keeping of vulnerability indicators, and insufficient communicative routines in addressing vulnerability. Additionally, lack of monetary incentives, i.e. not getting paid for spending extra time to talk about vulnerability, was perceived as a barrier. These barriers to identifying vulnerable pregnant women are related to e.g. characteristics of the GP, the practice, and the antenatal care organization in general practice. Young GPs, male GPs, and GPs who did not spend as much time caring for vulnerable pregnant women experienced the most barriers. Contrary, GPs who always prioritized continuity of care experienced fewer barriers. Continuity of care and extra time is important for improving the care of vulnerable pregnant women. Health commissioners may consider supporting the GPs in mobilizing extra time and resources to enhance their care for vulnerable pregnant women.

AB - Background Undetected vulnerability in pregnancy contributes to inequality in maternal and perinatal health and is associated with negative birth outcomes and adverse child outcomes. Nationwide reports indicate important barriers to assessing vulnerability among Danish general practitioners. Objective To explore general practitioners perceived barriers to vulnerability assessment in pregnant women and whether the barriers are associated with practice organization of antenatal care, general practitioner, and practice characteristics. Methods The questionnaire was sent to all Danish general practitioners (N = 3,465). Descriptive statistics described the barriers to assessing vulnerability in pregnant women. Analytical statistics with ordered logistic regression models were used to describe the association between selected barriers to vulnerability assessment and antenatal care organization, and general practitioner and practice characteristics. Results 760 general practitioners (22%) answered. Barriers to vulnerability assessment were related to lacking routines for addressing vulnerability, lacking attention to and record-keeping on vulnerability indicators, an insufficient overview of vulnerable pregnant women, and perceived insufficient remuneration for antenatal care consultations. Not prioritizing extra time when caring for vulnerable pregnant women was associated with experiencing more barriers. Always prioritizing continuity of care was associated with experiencing fewer barriers. General practitioners of either young age, male gender, or who did not prioritize extra time to care for vulnerable pregnant women experienced more barriers. Conclusion Barriers to vulnerability assessment among pregnant women do exist in general practice and are associated with organizational characteristics such as lacking prioritization of extra time and continuity in antenatal care consultations. Also, general practitioner characteristics like male gender and relatively young age are associated with barriers to vulnerability assessment.Lay Summary Identifying vulnerability in pregnant women is essential to prevent pregnancy-related depression or problems of mother-child attachment, and these women need extra support during pregnancy. In Denmark, all pregnant women are offered pregnancy care by their general practitioner (GP). However, identifying vulnerable pregnant women is challenging for the GPs. This questionnaire study among 760 GPs explores whether the GPs perceived barriers to identifying vulnerable pregnant women are lack of attention to and overview of vulnerable women in their clinic, insufficient record-keeping of vulnerability indicators, and insufficient communicative routines in addressing vulnerability. Additionally, lack of monetary incentives, i.e. not getting paid for spending extra time to talk about vulnerability, was perceived as a barrier. These barriers to identifying vulnerable pregnant women are related to e.g. characteristics of the GP, the practice, and the antenatal care organization in general practice. Young GPs, male GPs, and GPs who did not spend as much time caring for vulnerable pregnant women experienced the most barriers. Contrary, GPs who always prioritized continuity of care experienced fewer barriers. Continuity of care and extra time is important for improving the care of vulnerable pregnant women. Health commissioners may consider supporting the GPs in mobilizing extra time and resources to enhance their care for vulnerable pregnant women.

KW - behavioural medicine

KW - continuity of care

KW - depression

KW - mood disorder

KW - doctor-patient relationship

KW - family health

KW - frailty

KW - maternity care

KW - mental health

KW - quality of care

KW - risk assessment

KW - social determinants of health

KW - POSTPARTUM DEPRESSION

KW - PERINATAL DEPRESSION

KW - META-SYNTHESIS

KW - MENTAL-HEALTH

KW - RISK-FACTORS

KW - CARE

KW - ANXIETY

KW - MANAGEMENT

KW - PATTERNS

U2 - 10.1093/fampra/cmac134

DO - 10.1093/fampra/cmac134

M3 - Journal article

C2 - 36420813

JO - Family Practice

JF - Family Practice

SN - 0263-2136

ER -