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Hypertensive Disorders of Pregnancy
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5 01 2022
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Source: Obstet Gynecol. 139(5):898-906
[PDF-549.57 KB]
Details:
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Alternative Title:Obstet Gynecol
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Personal Author:
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Description:Objective:
To describe clinician screening practices for prior hypertensive disorders of pregnancy (HDP), knowledge of future risks associated with HDP, barriers and facilitators to referrals for cardiovascular disease risk evaluation in women with prior HDP, and variation by clinician- and practice-level characteristics.
Methods:
We used data from Fall DocStyles 2020, a cross-sectional, web-based panel survey of currently practicing US clinicians. Of 2,231 primary care physicians, obstetrician–gynecologists, nurse practitioners, and physician assistants invited to participate, 67.3% (n=1,502) completed the survey. We calculated the prevalence of screening, knowledge of future risks, and barriers and facilitators to referrals, and assessed differences by clinician type using Chi-square tests. We evaluated associations between clinician- and practice-level characteristics and not screening using a multivariable log-binomial model.
Results:
Overall, 73.6% of clinicians screened patients for a history of HDP; obstetrician–gynecologists reported the highest rate of screening (94.8%). Overall, 24.8% of clinicians correctly identified all cardiovascular risks associated with HDP listed in the survey. Lack of patient follow-through (51.5%) and patient refusal (33.6%) were the most frequently cited barriers to referral. More referral options (42.9%), patient education materials (36.2%), and professional guidelines (34.1%) were the most frequently cited resources needed to facilitate referrals. In the multivariable model, primary care physicians and nurse practitioners and physician assistant were more likely than obstetrician–gynecologists to report not screening (adjusted prevalence ratio [aPR] 5.54, 95% Confidence Interval [CI]: 3.24, 9.50 and aPR 7.42, 95% CI: 4.27, 12.88, respectively). Clinicians seeing <80 patients per week (aPR 1.81, 95%CI: 1.43, 2.28) were more likely to not screen relative to those seeing ≥110 patients per week.
Conclusion:
Three-quarters of clinicians reported screening for a history of hypertensive disorders of pregnancy; however, only 1 out of 4 clinicians correctly identified all of the cardiovascular risks associated with HDP listed in the survey.
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Pubmed ID:35576348
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Pubmed Central ID:PMC9141470
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