For a study, researchers sought to describe clinician screening practices for prior hypertensive disorders of pregnancy, knowledge of future risks associated with hypertensive disorders of pregnancy, barriers and facilitators to referrals for cardiovascular disease risk evaluation in women with prior hypertensive disorders of pregnancy, and variation by clinician- and practice-level characteristics.
They analyzed data from Fall DocStyles 2020, a cross-sectional, web-based panel survey of actively practicing doctors in the United States. The survey was completed by 67.3% (n=1,502) of the 2,231 primary care doctors, obstetrician-gynecologists (ob-gyns), nurse practitioners, and physician assistants who were asked to participate. They computed the prevalence of screening, awareness of future hazards, and obstacles and facilitators to referrals, and then used two tests to analyze differences by clinician type. Using a multivariate log-binomial model, they examined the relationships between clinician and practice-level factors and not screening.
Overall, 73.6% of physicians evaluated patients for hypertensive disorders during pregnancy; obstetricians had the greatest rate of screening (94.8%). In all, 24.8% of doctors correctly identified all of the cardiovascular risks related to hypertensive disorders of pregnancy indicated in the study. The most often mentioned barriers to referral were a lack of patient follow-through (51.5%) and patient refusal (33.6%). The most often mentioned tools needed to support referrals were more referral alternatives (42.9%), patient education materials (36.2%), and professional recommendations (34.1%). Primary care doctors, nurse practitioners, and physician assistants were more likely than ob-gyns to report not screening in the multivariable model (adjusted prevalence ratio 5.54, 95% CI 3.24–9.50, and adjusted prevalence ratio 7.42, 95% CI 4.27–12.88, respectively). Clinicians who saw less than 80 patients per week (adjusted prevalence ratio 1.81, 95% CI 1.43–2.28) were more likely not to screen than those who saw 110 or more patients per week.
Although three-quarters of physicians reported screening for a history of hypertension disorders during pregnancy, only one in four clinicians correctly recognized all of the cardiovascular risks associated with hypertensive disorders of pregnancy indicated in the study.
