Asthma

Why respiratory physicians may have to get involved in antenatal care


Respiratory physicians may be needed to step in and support pregnant women with asthma management because others involved in their care lack confidence to do so, researchers are arguing.

The message follows a survey of health workers involved in antenatal care, which found the specialists were significantly more likely to believe they were capable of treating expectant mothers for respiratory issues than others such as obstetricians or midwives.

Respiratory specialists were also more likely to use clinical guidelines and scored significantly higher in evidence-based knowledge of antenatal asthma management than practitioners more usually involved in maternity care, according to a report in the Australian and New Zealand Journal of Obstetrics and Gynaecology.

The online, cross-sectional survey was answered by 346 maternity carers (obstetricians and midwives), 25 GPs and general practice nurses, 31 respiratory physicians and 14 respiratory nurses.

They were asked to report their confidence and use of clinical guidelines ranging from ‘not at all confident’ to ‘very confident’, while evidence-based knowledge was assessed via 13 questions relating to various clinical scenarios.

Confidence was highest among respiratory specialists and nurses, 71% of whom reported being ‘confident’ or ‘very confident’ in providing antenatal asthma care.

Only 36% of GPs and practice nurses reported the same level of confidence, however, while just 15% of the obstetricians and midwives had faith in their ability to treat the condition.

When it came to the evidence-based knowledge quiz, the authors stressed there was no significant difference in results for respiratory specialists vs GPs and practice nurses, although slightly more of the former received a perfect score (33% vs 28%).

There was also no significant difference in evidence-based knowledge among healthcare professionals from metropolitan, regional and rural backgrounds.

However, respondents who reported confidence in clinical guidelines scored significantly higher than those who did not, said the researchers from the University of Newcastle and Liverpool Hospital in Sydney.

With evidence showing asthma affected almost 13% of pregnant women in Australia, they said there was a need for improved treatment pathways to ensure these patients had access to doctors and nurses with respiratory training.

“The development of multidisciplinary antenatal clinics, staffed by respiratory nurses and/or physicians, could improve outcomes for pregnant women with asthma who are not undertaking shared care,” they wrote.

Guidelines for antenatal asthma management also ought to be simplified and should be promoted more broadly via the Royal Australian College of Obstetricians and Gynaecologists, they added.

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