General practitioner perceptions and experiences of managing perinatal mental health: a scoping review.

BACKGROUND: General Practitioners (GPs) are involved in preconception, pregnancy, and postnatal care. Overall, mental health remains a significant contributor to disease burden affecting 1 in 4 pregnant women. Psychotropic medication prescribing occurs in almost 1 in 12 pregnancies, and appears to be increasing, along with the prevalence of mental health disorders in women of reproductive age. Perinatal mental health management is therefore not an unlikely scenario within their clinical practice. This scoping review aims to map current research related to GPs perceptions and experiences of managing perinatal mental health. METHOD: A comprehensive search strategy using nine electronic databases, and grey literature was undertaken between December 2021 and February 2023. Relevant studies were sourced from peer review databases using key terms related to perinatal mental health and general practitioners. Search results were screened on title, abstract and full text to assess those meeting inclusion criteria and relevance to the research question. RESULTS: After screening, 16 articles were included in the scoping review. The majority focused on perinatal depression. Findings support that GPs express confidence with diagnosing perinatal depression but report issues of stigma navigating a diagnosis. Over the last two decades, prescribing confidence in perinatal mental health remains variable with concerns for the safety profile of medication, low level of confidence in providing information and a strong reliance on personal experience. Despite the establishment of perinatal guidelines by countries, the utilisation of these and other existing resources by GPs appears from current literature to be infrequent. Many challenges exist for GPs around time pressures, a lack of information and resources, and difficulty accessing referral to services. CONCLUSION: Recommendations following this scoping review include targeted perinatal education programs specific for GPs and embedded within training programs and the development of practice guidelines and resources specific to general practice that recognises time, services, and funding limitations. To achieve this future research is first needed on how guidelines and resources can be developed and best delivered to optimise GP engagement to improve knowledge and enhance patient care.

Acceptability of using the Raising Awareness Tool for Endometriosis (RATE) in general practice: a mixed methods pilot study.

AIMS: The Raising Awareness Tool for Endometriosis (RATE) was developed to facilitate discussions with health providers regarding endometriosis-associated symptoms. We aim to evaluate the acceptability of the RATE by general practitioners (GP), including determining the prevalence of symptoms of women presenting to general practice and immediate management of symptoms. METHODS: A mixed-methods study was undertaken using a combination of quantitative and qualitative data in Western Australian General Practices from 2021 to 2022. A purposive sample of 12 GPs were included, who recruited women (18-50 years) on attendance for consultation over a one- to two-week period, followed by qualitative interviews exploring GPs' experiences with the tool. The quantitative and qualitative components were integrated during analysis of results. RESULTS: A total of 111 women completed the RATE (mean: 33, standard deviation: 8.6 years) prior to routine consultation. The tool was considered to be acceptable for use in general practice and aided discussions on symptoms and management. Overall, 68.5% of patients experienced pelvic pain or discomfort, with 22.4% rating that this interfered with quality of life. Of those with pelvic pain, 75% had associated chronic pain conditions, and 42.1% reported allodynia. The chronic pain questions provoked GP uncertainty. After symptoms were identified, GPs arranged individualised investigations and follow-up. CONCLUSIONS: The RATE was considered to be acceptable for use in the general practice setting. It identified symptoms and initiated discussions on possible diagnosis as well as management of endometriosis. Further GP education on identifying those women at most risk of developing chronic pain syndromes is needed.

Challenges in diagnosing and managing endometriosis in general practice: A Western Australian qualitative study.

BACKGROUND AND OBJECTIVES: To reduce diagnostic delay for women with endometriosis-related symptoms, we need to understand general practitioners' (GPs) perspectives on the challenges they face in diagnosing and managing endometriosis. METHOD: Qualitative interviews were conducted with nine Western Australian GPs to explore their knowledge, experiences and challenges with the diagnosis and management of endometriosis. RESULTS: Three themes were identified as challenges: eliciting symptoms, with subthemes of multiple and complex symptoms, clinician experience and awareness, time constraints and screening opportunities; delivering patient-centred care, with subthemes of cultural factors and health literary, perceived gender biases and women's choices and priorities; and system and service, which included learning on the job, clearer diagnostic pathways, access to services and collaborative care models. DISCUSSION: GPs can be better supported in dealing with endometriosis through raising awareness and education; recognition of endometriosis as a complex chronic condition; and the development of pragmatic guidelines, with increased access to local centres for excellent and collaborative care.

Supervisor conversations: Influencing attitudes through decolonisation in general practice education.

BACKGROUND: Embedded attitudes within the medical workforce mean supervisors have a key role in the practice and promotion of decolonised and antiracist approaches to their engagement with Aboriginal and Torres Strait Islander health medical education. OBJECTIVE: The aim of this paper is to provide an understanding of the practical application of decolonised and antiracist approaches for the general practitioner (GP) supervisor. DISCUSSION: Decolonised and antiracist approaches can elevate supervisor engagement with their GP trainees and assist understanding of the health of Aboriginal and Torres Strait Islander peoples.

Impact of pelvic floor dysfunction in Aboriginal and Torres Strait Islander women attending an urban Aboriginal medical service.

BACKGROUND: Pelvic floor dysfunction causes high-level disease burden, with Aboriginal and Torres Strait Islander women less likely to have access to best management for these issues due to multiple sociocultural barriers. There is limited data on the impact of pelvic floor dysfunction in this specific population. AIMS: To explore the impact of pelvic floor dysfunction on Aboriginal and Torres Strait Islander women attending an urban Aboriginal medical service, considering barriers and facilitators for care, and the services that are desired to address these conditions. METHODS: This is a mixed methods project utilising the validated Pelvic Floor Impact Questionnaire 7 in combination with qualitative data from semi-structured interviews. Quantitative data were analysed using SPSS Version 24 and analysis included the use of means, SD and Fisher's exact test for comparison. Interview transcriptions were coded into initial themes using thematic analysis and a theoretical approach was used to capture common patterned responses. RESULTS: The majority of women reported urinary incontinence. Higher scores on the urinary impact questions were significantly associated with comorbid risk factors of chronic cough and obesity. Salient themes from interviews included help-seeking behaviours, embarrassment and normalisation of the condition. Women desired access to a pelvic floor physiotherapist, and preferred a female doctor and a consistent care provider. CONCLUSION: Pelvic floor disorders cause high disease burden for Aboriginal women across a broad age range with associated comorbid risk factors frequently occurring. This study suggests service improvement and care delivery strategies that may improve long-term outcomes for Aboriginal women with pelvic floor conditions.

Postnatal care: The general practitioner visit.

BACKGROUND: The postnatal period is a rapidly changing and challenging time for new parents. General practitioners are well placed to provide support, advice, clinical care and intervention for common psychosocial and physical concerns in this critical period. OBJECTIVE: The aim of this article is to outline a consistent approach to the content and structure of the postnatal visit in the general practice setting, along with key management strategies for common postnatal conditions and comorbidities. DISCUSSION: Common physical and mental health postpartum concerns, follow-up management of antenatal comorbidities and contraceptive choices are outlined, along with management of early parenting issues.