Integrating preconception care for women with diabetes into primary care: a qualitative study.

BACKGROUND: National guidelines emphasise the need to deliver preconception care to women of childbearing age. However, uptake of the services among women with diabetes in the UK is low. Questions arising include how best to deliver preconception care and what the respective roles of primary versus secondary caregivers might be. AIM: To explore the perspective of GPs and secondary care health professionals on the role of GPs in delivering preconception care to women with diabetes. DESIGN OF STUDY: Qualitative, cross-sectional study. SETTING: A London teaching hospital and GP practices in the hospital catchment area. METHOD: Semi-structured interviews with GPs and members of the preconception care team in secondary care. Thematic analysis using the framework approach. RESULTS: GPs and secondary care professionals differ in their perception of the number of women with diabetes requiring preconception care and the extent to which preconception care should be integrated into GPs' roles. Health professionals agreed that GPs have a significant role to play and that delivery of preconception care is best shared between primary and secondary care. However, the lack of clear guidelines and shared protocols detailing the GP's role presents a challenge to implementing 'shared' preconception care. CONCLUSION: GPs should be more effectively involved in providing preconception care to women with diabetes. Organisational and policy developments are required to support GPs in playing a role in preconception care. This study's findings stress the importance of providing an integrated approach to ensure continuity of care and optimal pregnancy preparation for women with diabetes.