Hypertensive disorders of pregnancy (HDP) management pathways: results of a Delphi survey to contextualise international recommendations for Indonesian primary care settings

Ekawati F.M., Licqurish S., Gunn J., Brennecke S., Lau P.

Department of Family and Community Medicine, Universitas Gadjah Mada, Sleman, Yogyakarta, Indonesia; Department of General Practice, University of Melbourne, Level 2, 780 Elizabeth Street, Melbourne, VIC 3000, Australia; School of Nursing and Midwifery, Monash University, Clayton, VIC, Australia; University of Melbourne Department of Obstetrics and Gynaecology, Royal Women’s Hospital, Parkville, VIC, Australia; Pregnancy Research Centre, Department of Maternal-Fetal Medicine, Royal Women’s Hospital, Parkville, VIC, Australia


Abstract

Background: Hypertensive disorders of pregnancy (HDP) are a significant contributor to the high maternal mortality rate in Indonesia. At the moment, limited guidelines are available to assist primary care providers in managing HDP cases. A previous review of 16 international HDP guidelines has identified opportunities for improving HDP management in Indonesian primary care, but it has not determined the suitability of the recommendations in practice. This study aims to achieve consensus among the experts regarding the recommendations suitability and to develop HDP pathways in Indonesian primary care. Methods: Maternal health experts, including GPs, midwives, nurses, medical specialists and health policy researchers from Indonesia and overseas were recruited for the study. They participated in a consensus development process that applied a mix of quantitative and qualitative questions in three Delphi survey rounds. At the first and second-round survey, the participants were asked to rate their agreement on whether each of 125 statements about HDP and HDP management is appropriate for use in Indonesian primary care settings. The third-round survey presented the drafts of HDP pathways and sought participants’ agreement and further suggestions. The participants’ agreement scores were calculated with a statement needing a minimum of 70% agreement to be included in the HDP pathways. The participants’ responses and suggestions to the free text questions were analysed thematically. Results: A total of 52 participants were included, with 48, 45 and 37 of them completing the first, second and third round of the survey respectively. Consensus was reached for 115 of the 125 statements on HDP definition, screening, management and long-term follow-up. Agreement scores for the statements ranged from 70.8–100.0%, and potential implementation barriers of the pathways were identified. Drafts of HDP management pathways were also agreed upon and received suggestions from the participants. Conclusions: Most evidence-based management recommendations achieved consensus and were included in the developed HDP management pathways, which can potentially be implemented in Indonesian settings. Further investigations are needed to explore the acceptability and feasibility of the developed HDP pathways in primary care practice. © 2021, The Author(s).

Delphi survey; Hypertensive disorders of pregnancy; Indonesia; Management; Pathways; Preeclampsia; Primary care


Journal

BMC Pregnancy and Childbirth

Publisher: BioMed Central Ltd

Volume 21, Issue 1, Art No 269, Page – , Page Count


Journal Link: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85103808044&doi=10.1186%2fs12884-021-03735-3&partnerID=40&md5=b1069b47e564ccf076ba020627315458

doi: 10.1186/s12884-021-03735-3

Issn: 14712393

Type: All Open Access, Gold, Green


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