Aims
Long term follow up for Gestational Diabetes Mellitus (GDM) is vital. It is a chronic risk factor, unmasked in pregnancy, for the development of T2DM. Rates of follow up are universally poor. While much has been written about the perspective of patients with GDM, little is known about the experience of General Practitioners (GP) at the time of initial diagnosis and management. In a scenario increasingly managed in the tertiary hospital, the confidence of GPs and their role in ongoing care has not been examined. Our study explores GDM from the GP’s perspective.
Methods
Through purposive and snowball sampling, we conducted semi-structured interviews exploring the GP experience in diagnosis and initial management of GDM. Data collection and analysis were concurrent, to identify the point of data and thematic saturation. The Leximancer data analysis tool assisted with content analysis and suggestion of themes.
Results
Dominant themes include uncertainty / urgency and feeling under-utilised. GPs have a pragmatic approach in the face of uncertainty, and adopt one of several strategies to meet the patient’s needs. A key issue that may impact on long term follow up and high quality GP-patient relationships is the concern about the patient being ‘taken away’ by the hospital. Communication with the hospital is generally perceived as poor.
Conclusions:
The experience of GPs in the initial diagnosis and management of GDM may hold some insights into improving GDM follow up post-partum. GPs are likely an untapped resource in management pathways, particularly for diet-controlled GDM. GP uncertainty could be reduced with clear supported management protocols and patient resources. GPs feel underutilised and are open to doing more, if supported and sustainably resourced. Protection of, and respect for, the GP-patient relationship may increase patient satisfaction and improve follow up rates in GDM and therefore improve patient outcomes.