Deepti Divya Gopisetty’s research while affiliated with Stanford Medicine and other places

Background Pain with gynaecological clinic-based procedures is common and undertreated. Prior research has focused on interventions for reducing pain and anxiety with analgesics, yet there remain gaps in understanding the myriad of facilitators and barriers to a person’s positive experience. We aimed to start to address these gaps by exploring factors that influence a person’s experience during gynaecological procedures beyond quantitative measures of pain. Methods A qualitative thematic analysis approach was used for this exploratory study. Through convenience sampling, we recruited 15 participants with gynaecological procedural experience with intrauterine device (IUD) insertions, surgical abortions, colposcopies and/or endometrial biopsies. We conducted in-depth, semi-structured 1:1 interviews that explored participants' experience of the procedure. We then used a mixed inductive and deductive approach for development of a codebook and thematic analysis based on the Person-Centered Care Framework for Reproductive Health Equity (PCFRHE). Results Four themes fundamental to understanding how patients process procedural experiences were identified: (1) Balancing preparation and anxiety, (2) Variable rapport with clinicians, (3) Self-advocacy and autonomy and (4) Clinician responsiveness to pain. Conclusions Person-centred care in an inclusive, trauma-responsive environment is essential for improving gynaecological procedural experience. Ensuring patient access to pre- and post-visit information and offering multiple options to increase comfort are tangible actions clinicians can take to improve patient experience. This study underscores the importance of person-centred care in gynaecological procedures, emphasising better preprocedural education and support.

Introduction A growing number of veterans are having children, and pregnancy is an opportunity to engage with health care. Within the Veterans Health Administration (VA), the VA maternity care coordination program supports veterans before, during, and after pregnancy, which are periods that inherently involve transitions between clinicians and risk care fragmentation. Postpartum transitions in care are known to be especially tenuous, with low rates of primary care reengagement. The objective of this study is to better understand this transition from the perspectives of the VA care teams. Materials and Methods Eight semi-structured qualitative interviews with VA team members who work in maternity care were conducted at a single VA center’s regional network. Interviews explored the transition from maternity care to primary care to understand the care team’s perspective at three levels: patient, clinician, and systems. Rapid qualitative analysis was used to identify emergent themes. Results Participants identified facilitators and opportunities for improvement in the postpartum transition of care. Patient–clinician trust is a key facilitator in the transition from maternity to primary care for veterans, and the breadth of VA services emerged as a key system-level facilitator to success. Interviewees also highlighted opportunities for improvement, including more trauma-informed practices for nonbinary veterans, increased care coordination between VA and community staff, and the need for training in postpartum health with an emphasis on health equity for primary care clinicians. Conclusions The Department of Veterans Affairs Healthcare System care team perspectives may inform practice changes to support the transition from maternity to primary care for veterans. To move toward health equity, a system-level approach to policy and programming is necessary to reduce barriers to primary care reengagement. This study was limited in terms of sample size, and future research should explore veteran perspectives on VA postpartum care transitions.