Integrating the primary care perspective in the implementation of a diabetes prevention program for patients with recent gestational diabetes: a qualitative descriptive study

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BACKGROUND: Women with gestational diabetes mellitus (GDM) are at high risk for the development of type 2 diabetes (T2D). Although postpartum diabetes prevention programs (DPPs) reduce the risk of diabetes after pregnancy, the transition from prenatal to postpartum diabetes care is suboptimal. As primary care providers (PCPs) are generally responsible for providing postpartum preventive care, incorporating PCPs' perspectives in the co-design of a DPP is essential to optimize the integration of prenatal and postpartum diabetes care and DPP implementation. METHODS: We used a qualitative descriptive study design to elicit PCP perspectives on implementing a new multi-centre DPP for patients with recent GDM. We purposefully sampled primary care physicians (PCPs) from Primary Care Networks connected with each DPP centre and conducted a focus group and individual one-on-one interviews. Directed conventional content analysis, based on Valentijn's integrative functions of primary care, guided the analysis of focus group and interview transcripts. RESULTS: Our analysis identified three overarching themes that align with Valentijn's micro, meso, and macro dimensions of integrated care. Micro-level integration focused on improving prenatal to postpartum care transition between providers and leveraging opportunities to integrate maternal and newborn care. Meso-level integration emphasized the need for a team-based model of care that incorporates allied health professionals and optimizes communication between these groups. Integration at the macro level included developing processes to delineate responsibility for postpartum T2D testing while reducing the burden on women through more efficient testing methods. CONCLUSIONS: The PCP perspective provides a valuable addition to the implementation strategy of a new multi-centre DPP for patients with recent GDM. To optimize the integration of prenatal and postpartum diabetes care and uptake of a DPP, PCP recommendations included leveraging newborn care, building on team-based care models, and more efficient postpartum T2D testing processes. Incorporating these themes will enable a smoother transition of care and improve the effective implementation of a postpartum DPP. TRIAL REGISTRATION: Not applicable.

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