Aims
To identify the barriers to implementing the Diabetes Contraception and Pre-pregnancy Program (DCAPP) for women with Type 1 and Type 2 diabetes among General Practitioners (GPs) and Practice Nurses (PNs) within South-West Sydney (SWS).
Methods
All general practices in SWS were contacted and the responding GP or PN was invited to complete a semi-structured questionnaire. Questionnaires were completed in an interview over the phone or via a written or online survey distributed via fax and email. The questionnaire included multiple choice, short answer and matrix questions. Quantitative data was summarised descriptively. Chi-square test was used to compare GPs and PNs knowledge. Themes from open ended questions were identified.
Results
34/335 (10%) General Practices responded with 12 GPs and 22 PNs responding. DCAPP leaflets, posters, contraception sheets and HealthPathways material were considered useful in the primary care setting. The most common barrier was a reportedly poor knowledge base of affected women about contraception and pre-pregnancy care (PPC), particularly among younger women and women from culturally and linguistically diverse populations. PNs suggested GPs are busy and focus on the presenting problem during consultation. When PPC is practiced it competes with large numbers of preventative priorities. Women do not visit the practice before becoming pregnant or to discuss pregnancy plans unless visiting to stop their contraception. PNs felt there was little training and opportunity to deliver PPC. Compared with GPs, PNs had poorer knowledge about pregnancy safe medications (77.8% vs 24.8% p=0.04, respectively) and that 5mg was the correct dose of folic acid for a woman with pre-existing diabetes who is pregnant or planning pregnancy (92% vs 15% p<0.001).
Conclusion
Several barriers exist to implementing DCAPP in primary care including a poor knowledge base among women, language and cultural barriers, pragmatic barriers and patchy knowledge among GPs and PNs.