Intravenous iron: barriers and facilitators to its use at nine maternity hospitals in New South Wales, Australia

Abstract

Background: Anaemia in pregnancy is mostly due to iron deficiency, and the use of intravenous (IV) iron is gaining acceptance as a treatment option. Recently released obstetric transfusion guidelines recommend IV iron in maternity patients requiring iron when oral formulations are poorly tolerated, unlikely to be well absorbed, or when rapid restoration of iron stores is required. Aim: To identify barriers and facilitators to the use of IV iron in pregnancy among 9 maternity hospitals in New South Wales. Materials & Methods: A qualitative research study was undertaken using semi-structured interviews. Nine maternity units were chosen to cover a range of clinical settings and obstetric blood transfusion rates. Interviews were conducted with haematologists, obstetricians and midwives, and included questions about the use of IV iron in each institution. Interviews were transcribed, coded, and NVivo software was used to develop themes. Results: 125 interviews were conducted: 61 with doctors. The use of IV iron differed between hospitals and individual doctors. There were hospital/pharmaceutical, clinician and patient factors which acted as either barriers or facilitators to the use of IV iron. Where perceived barriers outweighed facilitators in a particular hospital, doctors were less likely to use IV iron. Conclusion: The use of IV iron, as perceived by doctors, differed across hospitals. There are some potentially modifiable barriers to the use of IV iron that may need to be addressed for IV iron to be available to obstetric patients not tolerating oral formulations or requiring rapid restoration of iron stores