Bridging the care gap between diagnosis of hypertensive disorders of pregnancy and prevention of future cardiovascular disease

Abstract

Background:Hypertensive disorders of pregnancy (HDP), including preeclampsia and gestational hypertension, affect up to 10% of pregnancies. Hemodynamic changes associated HDP can persist post-pregnancy and predispose patients to future cardiovascular disease (CVD). Lack of patient and provider awareness of the long-term implications of HDP on cardiovascular health have hindered progress in preventative care. Poor system integration between obstetric and primary care services and lack of documentation of pregnancy complications in electronic medical records further adds to this care gap. Black and Southeast and South Asian populations are at a higher risk for HDP and CVD. Socioeconomic disparities, inequities in access to care, systemic racism and healthcare provider bias contribute to this increased risk. Interprofessional healthcare providers (IHPs) are well-positioned to provide patient education that takes into account social determinants of health, cultural differences, gender transformative principles, and mental health challenges.   Approach: Our team, which includes IHPs and people with lived experience, has created a patient-directed educational workshop for people with a recent HDP diagnosis to acquire skills and tools to increase self-efficacy in implementing healthy behaviour change. The workshop is led by a nurse-educator, a dietician, a social worker and a family physician and incorporates CVD education, nutrition, physical activity, sleep, and mental health recommendations. Iterative workshop and outreach refinements are guided by participant feedback and team discussion. Research participants are asked to fill out a demographic questionnaire, a pre-workshop survey that includes questions about interests and expectations, and a post-workshop evaluation survey. We are also exploring ways in which to improve obstetric care provider (family physician, midwife, obstetrician) handover to primary care, through standardized discharge referrals to primary care, changes to order sets, and referrals to the workshop.   Results: Three workshops have been held to date. Attendance has been lower than anticipated with a total of 7 participants. Feedback from participants was primarily positive. Quantitative analysis revealed a significant increase in knowledge, with participants' scores improving by an average of 1.6 points on a 5-point Likert scale. Participants reported a high level of confidence in making dietary and lifestyle changes and a high likelihood of initiating a conversation with a primary healthcare provider as a result of insights gained from the workshop, with scores of 4.3 and 4.6 out of 5, respectively. Respondents appreciated the opportunity to engage with the team, particularly valuing the explanations of disease pathology and practical advice on diet, exercise, and mental health. Several topics were identified for further exploration, including strategies for improving sleep, the relationship between hormonal changes and nutrition, breastfeeding in the context of cardiovascular disease, methods for communicating health changes to partners, and guidance on advocating for testing and preventative care.   Implications: The post-pregnancy period is a crucial window of opportunity for cardiovascular risk assessment and preventative care. An interprofessional workshop delivered by primary care teams provides one such opportunity, and enhances accessibility and equity. Future directions include the creation of an implementation guide for primary care teams that can be spread and scaled to local communities.