Healthcare Professionals’ Perspectives on the Cross-Sectoral Treatment Pathway for Women with Gestational Diabetes during and after Pregnancy—A Qualitative Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Data Collection
2.2. Participants and Study Settings
2.3. Analysis
2.4. Ethical Considerations
3. Results
3.1. Professional Identities
“We talk about the risk of birth complications; the importance of keeping normal blood sugars because that is what they especially need to take care of. I also tell them that there is already a risk related to their children becoming overweight and developing metabolic disturbances in childhood and emphasize the importance of thinking about diet and exercise for their children”.(Obstetrician, N)
“They [women diagnosed with GDM] receive a basic knowledge about what happens in the body to make them well-informed. Also, that it is important to keep an eye on their blood sugars in pregnancy and we teach them how to do blood sugar measurements”.(Diabetes Nurse, P)
“The midwives try to hold on to the pregnancy course and baby and delivery and family formation, so they try to stay away from the sick because that’s what we take care of. We deal with it [GDM] both as dietitians and as nurses. And many of the patients actually report that it is such a nice ‘refuge’ [in quote] to consult with a midwife”.(Diabetes Nurse, P)
“I always make them reflect on what makes them overweight. Also, I help and motivate them in terms of where there is something they can work with”.(Midwife, I)
“So, they [women with GDM] feel that they are in a rather pregnancy prison-like state. And when they get rid of all the controls they have during pregnancy, [they feel like] “they can live their lives completely free again”. Then they really forget what motivated them to hold on to the good habits”.(Midwife, K)
“We try to hold on to the fact that it is because of genes for the most part. And they can’t do anything about that. Not that we want to take the responsibility away from them, but it does no good that you walk around feeling guilty”.(Health visitor, A)
“No, I do not think so. […] It is the pregnant women who sets the agenda. So, sitting and giving long speeches—we don’t do that. If she is worried then we will talk about it, but there is a lot to be done in the consultation that does not necessarily relate to gestational diabetes”.(GP, Q)
3.2. Unclear Guidelines on Type 2 Diabetes Prevention after GDM
“I’m not sure it’s that prestigious to work with it [GDM]. It is when they are pregnant, but afterwards I don’t think it’s that prestigious. I just think we don’t have enough focus on it. I don’t think it’s prioritized enough”.(Obstetrician, O)
“Somehow, we cannot really in decency let them [women with GDM] go. I mean, it is a lot about the ‘treating’ healthcare system in a way. Where we are saying ‘okay now we have treated you and now there is no more, now you have to take care of yourself’. We need some more health promotion and prevention, also in the postpartum period”.(Diabetes Nurse, S)
“These women with gestational diabetes, they disappear a little alongside so many other things. There is a lot of focus during pregnancy, but after pregnancy, it disappears into the wellbeing of the baby and illness and so on”.(GP, R)
“I think a precise to-do list for gestational diabetes is missing. We should focus on how we most appropriately can follow these women.‘ This was a case of gestational diabetes, but what then?’ It becomes forgotten”.(GP, Q)
3.3. Cross-Sectoral Collaboration
“Since we’re placed in two geographically different locations, it is hard to have a close collaboration. Of course, we read each other’s notes, but I know that the pregnant women experience that we, as healthcare professionals, say different things. Since I visit the hospital regularly, I don’t think that I communicate that differently from the professionals over there [obstetricians, dieticians, endocrinologists]. […] Because I go there [to the outpatient clinic] and have the possibility to talk to them [HCPs at the outpatient clinic]”.(Midwife, K)
“Yes, I think you distance yourself from what you don’t know that much about. Then you think: ‘they [the outpatient clinic] take care of that over there,’ and I take care of mine according to what I usually do”.(Midwife, J)
“My own doctor just said I have to avoid putting sugar in the coffee’ [referring to a statement from a woman with GDM]. There is a big difference between what they are told by their GP and what we do. We find that there are many practitioners who neglect that young fertile women may develop type 2 diabetes”.(Diabetes Nurse, P)
“You have to keep the doctors in general practices on their toes. So, they [women with prior GDM] know what they have to go through. Then, the women would tell their doctors: ‘Excuse me, but I haven’t received information about a glucose tolerance test’, or something like that”.(Health visitor, C)
“I think what I need is a clearer handover of what the task is. What has been said in the diabetes or obstetric departments to these women. And then an early indication of how they should look after themselves and what is the appropriate way to follow up on that”.(GP, Q)
4. Discussion
4.1. Communicating Risk after Pregnancy
4.2. Creating Awareness around GDM
4.3. Strengths and Weaknesses of the Study
4.4. A Need to Reorganize Care for Women with Prior GDM
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Non-GDM-Affected Pregnancy | GDM-Affected Pregnancy | |||
---|---|---|---|---|
Pregnancy | After Delivery | Pregnancy | After Delivery | |
General practitioner | 3 consultations | 2 consultations | 3 consultations | 3 consultations |
Diabetes nurse | - | - | 3–5 consultations | 0–1 ** consultations |
Endocrinologist * | - | - | 0–5 consultations * | |
Obstetrician | - | 3–5 consultations | - | |
Dietician | - | - | 3 consultations | 0–1 consultation |
Midwife | 3–5 consultations | - | 4–6 consultations | - |
Health visitor | - | 5 home visits | 0–1 consultation *** | 5 home visits |
Total visits | 6–8 consultations | 7 consultations | 16–28 consultations | 8–10 consultations |
Extra GDM consultations | 10–20 consultations | 1–3 consultations |
Method | Interview Person | Occupation | Seniority | Sector |
---|---|---|---|---|
Focus group 1 | A | Health visitor | >15 years | Municipality |
B | 10–14 years | |||
C | <5 years | |||
D | <5 years | |||
Focus group 2 | E | >15 years | ||
F | 5–9 years | |||
G | <5 years | |||
H | <5 years | |||
Semi-structured interview | I | Midwife | >15 years | Obstetric department, regional |
J | 10–14 years | |||
K | >15 years | |||
L | 5–9 years | |||
N | Obstetrician | 5–9 years | ||
O | 10–14 years | |||
P | Diabetes nurse | >15 years | ||
Q | General practitioner | >15 years | General practice | |
R | >15 years |
Major Themes | Key Points |
---|---|
Professional identities |
|
Unclear guidelines on type 2 diabetes prevention after GDM |
|
Cross-sectoral collaboration |
|
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Timm, A.; Nielsen, K.K.; Christensen, U.; Maindal, H.T. Healthcare Professionals’ Perspectives on the Cross-Sectoral Treatment Pathway for Women with Gestational Diabetes during and after Pregnancy—A Qualitative Study. J. Clin. Med. 2021, 10, 843. https://doi.org/10.3390/jcm10040843
Timm A, Nielsen KK, Christensen U, Maindal HT. Healthcare Professionals’ Perspectives on the Cross-Sectoral Treatment Pathway for Women with Gestational Diabetes during and after Pregnancy—A Qualitative Study. Journal of Clinical Medicine. 2021; 10(4):843. https://doi.org/10.3390/jcm10040843
Chicago/Turabian StyleTimm, Anne, Karoline Kragelund Nielsen, Ulla Christensen, and Helle Terkildsen Maindal. 2021. "Healthcare Professionals’ Perspectives on the Cross-Sectoral Treatment Pathway for Women with Gestational Diabetes during and after Pregnancy—A Qualitative Study" Journal of Clinical Medicine 10, no. 4: 843. https://doi.org/10.3390/jcm10040843