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Factors influencing referral to maternity models of care in Australian general practice

Resource type
Authors/contributors
Title
Factors influencing referral to maternity models of care in Australian general practice
Abstract
Background In the Australian maternity system, general practitioners play a vital role in advising and directing prospective parents to maternity models of care. Optimising model of care discussions and the decision-making process avoids misaligning women with over or under specialised care, reduces the potential for disruptive care transitions and unnecessary healthcare costs, and is critical in ensuring consumer satisfaction. Current literature overwhelmingly focusses on women’s decision-making around model of care discussions and neglects the gatekeeping role of the General Practitioner (GP). This study aimed to explore and describe the factors influencing Australian GPs decision-making when referring pregnant women to maternity models of care. Methods This study used a qualitative descriptive approach. General practitioners (N = 12) with experience referring women to maternity models of care in Australia participated in a semi-structured interview. Interviews occurred between October and November 2021 by telephone or videoconference. Reflexive thematic analysis was facilitated by NVivo-12 data management software to codify and interpret themes from the data. Findings Two broad themes were interpreted from the data. The first theme entitled ‘GP Factors’, incorporated three associated sub-themes including ‘1) GPs Previous Model of Care Experience’, ‘2) Gaps in GP Knowledge’ and ‘3) GP Perception of Models of Care’. The second theme, entitled ‘Woman’s Factors’, encapsulated two associated sub-themes including the ‘4) Woman’s Preferences’ and ‘5) Access to Models’. Conclusions This study provides novel evidence regarding general practitioner perspectives of the factors influencing model of care decision-making and referral. Predominant findings suggest that gaps in GP knowledge regarding the available models of care are present and are largely informed by prior personal and professional experience. Most GPs described referring to models of care they perceive positively and centring their model of care discussions on the woman’s preferences and accessibility. The exploration and description of factors influencing model of care decisions provide unique insight into the ways that all stakeholders can experience access to a broader range of models of care including midwifery-led continuity of care models aligned with consumer-demand. In addition, the role of national primary health networks is outlined as a means to achieving this.
Publication
PLOS ONE
Date
2024-5-21
Volume
19
Issue
5
Pages
e0296537
Journal Abbr
PLoS ONE
Accessed
7/7/25, 1:24 AM
ISSN
1932-6203
Language
en
Library Catalog
DOI.org (Crossref)
Notes

Study topic:
Exploration of the factors that influence general practitioners’ referral decisions to maternity models of care in Australia.

Study type:

Qualitative descriptive study using semi-structured interviews and reflexive thematic analysis.

Key findings:

  • GPs’ referral decisions are shaped by personal and professional experience, knowledge gaps, perceptions of care models, and patient preferences.
  • Limited awareness of midwifery-led continuity of care models may restrict access to evidence-based, consumer-preferred options.
  • HealthPathways was cited by participants as a useful tool for navigating maternity referral options and understanding eligibility criteria, where available.
  • Improving GP education, integrating midwives into primary care, and enhancing digital referral tools could broaden access to diverse models of care.
Citation
Thomas, J., Kuliukas, L., Frayne, J., & Bradfield, Z. (2024). Factors influencing referral to maternity models of care in Australian general practice. PLOS ONE, 19(5), e0296537. https://doi.org/10.1371/journal.pone.0296537