Sudden Shift to Telehealth in COVID-19: A Retrospective Cohort Study of Disparities in Use of Telehealth for Prenatal Care in a Large Midwifery Service.
COVID-19
delivery of health care
midwifery
prenatal care
telemedicine
Journal
Journal of midwifery & women's health
ISSN: 1542-2011
Titre abrégé: J Midwifery Womens Health
Pays: United States
ID NLM: 100909407
Informations de publication
Date de publication:
18 Dec 2023
18 Dec 2023
Historique:
revised:
26
10
2023
medline:
19
12
2023
pubmed:
19
12
2023
entrez:
19
12
2023
Statut:
aheadofprint
Résumé
The coronavirus disease 2019 (COVID-19) pandemic created disruption in health care delivery, including a sudden transition to telehealth use in mid-March 2020. The purpose of this study was to examine changes in the mode of prenatal care visits and predictors of telehealth use (provider-patient messaging, telephone visits, and video visits) during the COVID-19 pandemic among those receiving care in a large, academic nurse-midwifery service. We conducted a retrospective cohort study of those enrolled for prenatal care in 2 nurse-midwifery clinics between 2019 and 2021 (n = 3172). Use outcomes included number and type of encounter: in-person and telehealth (primary outcome). Comparisons were made in frequency and types of encounters before and during COVID-19. A negative binomial regression was fit on the outcome of telehealth encounter count, with race/ethnicity, age, language, parity, hypertension, diabetes, and depression as predictors. When comparing pre-COVID-19 (before March 2020) with during COVID-19 (after March 2020), overall encounters increased from 15.9 to 19.5 mean number of encounters per person (P < .001). The increase was driven by telehealth encounters; there were no significant differences for in-person prenatal visit counts before and during the pandemic period. Direct patient-provider messaging was the most common type of telehealth encounter. Predictors of telehealth encounters included English as primary language and diagnoses of diabetes or depression. No differences in the frequency of in-person prenatal care visits suggests that telehealth encounters led to more contact with midwives and did not replace in-person encounters. Spanish-speaking patients were least likely to use telehealth-delivered prenatal care during the pandemic; a small, but significant, proportion of patients had no or few telehealth encounters, and a significant proportion had high use of telehealth. Integration of telehealth in future delivery of prenatal care should consider questions of equity, patient and provider satisfaction, access, redundancies, and provider workload.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : NCATS NIH HHS
ID : UL1 TR2535
Pays : United States
Informations de copyright
© 2023 by the American College of Nurse-Midwives.
Références
LeRouge C, Garfield MJ. Crossing the telemedicine chasm: have the U.S. barriers to widespread adoption of telemedicine been significantly reduced? Int J Environ Res Public Health. 2013;10(12):6472-6484. doi:10.3390/ijerph10126472
Hong YR, Lawrence J, Williams D Jr, Mainous A III. Population-level interest and telehealth capacity of US hospitals in response to COVID-19: cross-sectional analysis of Google search and national hospital survey data. JMIR Public Health Surveill. 2020;6(2):e18961. doi:10.2196/18961
Ukoha EP, Davis K, Yinger M, et al. Ensuring equitable implementation of telemedicine in perinatal care. Obstet Gynecol. 2021;137(3):487-492. doi:10.1097/aog.0000000000004276
Smith DC, Anderson JL, Carrington S, Nacht A, Nodine PM, Barton AJ. Contemporary nurse-midwifery care in Colorado: a survey of certified nurse-midwife practices in hospital and community settings. Policy Polit Nurs Pract. 2023;24(2):102-109. doi:10.1177/15271544221147301
Tuckson RV, Edmunds M, Hodgkins ML. Telehealth. N Engl J Med. 2017;377(16):1585-1592. doi:10.1056/NEJMsr1503323
Telehealth: defining 21st century care. American Telehealth Association website. Accessed August 15, 2023. https://www.americantelemed.org/resource/why-telemedicine/
World Health Organization. WHO recommendations on antenatal care for a positive pregnancy experience. World Health Organization; 2016. Accessed August 15, 2023. https://www.who.int/publications/i/item/9789241549912
Friedman Peahl A, Heisler M, Essenmacher LK, et al. A comparison of international prenatal care guidelines for low-risk women to inform high-value care. Am J Obstet Gynecol. 2020;222(5):505-507. doi:10.1016/j.ajog.2020.01.021
Kilpatrick SJ. Guidelines for perinatal care. American Academy of Pediatrics; 2017.
World Health Organization. Pregnancy, childbirth, postpartum, and newborn care: A guide for essential practice. 3rd ed. World Health Organization; 2015. Accessed August 15, 2023. https://www.who.int/publications/i/item/9789241549356
Nelson DB, Moniz MH, Davis MM. Population-level factors associated with maternal mortality in the United States, 1997-2012. BMC Public Health. 2018;18(1):1007. doi:10.1186/s12889-018-5935-2
Mbuagbaw L, Medley N, Darzi AJ, Richardson M, Habiba Garga K, Ongolo-Zogo P. Health system and community level interventions for improving antenatal care coverage and health outcomes. Cochrane Database Syst Rev. 2015;2015(12):CD010994. doi:10.1002/14651858.CD010994.pub2
Peahl AF, Gourevitch RA, Luo EM, et al. Right-sizing prenatal care to meet patients' needs and improve maternity care value. Obstet Gynecol. 2020;135(5):1027-1037.
Balk EM, Konnyu KJ, Cao W, et al. Schedule of Visits and Televisits for Routine Antenatal Care: A Systematic Review. Agency for Healthcare Research and Quality; 2022.
Butler Tobah YS, LeBlanc A, Branda M, Inselman J, Gostout B, Famuyide A. OB Nest-a novel approach to prenatal care [21]. Obstet Gynecol. 2016;127(Suppl 1):7S-8S.
Butler Tobah YS, LeBlanc A, Branda ME, et al. Randomized comparison of a reduced-visit prenatal care model enhanced with remote monitoring. Am J Obstet Gynecol. 2019;221(6):638.e1-638.e8. doi:10.1016/j.ajog.2019.06.034
Wu KK, Lopez C, Nichols M. Virtual visits in prenatal care: an integrative review. J Midwifery Womens Health. 2022;67(1):39-52. doi:10.1111/jmwh.13284
Cantor AG, Jungbauer RM, Totten AM, et al. Telehealth strategies for the delivery of maternal health care : a rapid review. Ann Intern Med. 2022;175(9):1285-1297. doi:10.7326/m22-0737
Frederiksen BR, Ranji U. Telemedicine and pregnancy care. Women's Health Policy website. February 26, 2020. Accessed August 15, 2023. https://www.kff.org/womens-health-policy/issue-brief/telemedicine-and-pregnancy-care/
Palmer KR, Tanner M, Davies-Tuck M, et al. Widespread implementation of a low-cost telehealth service in the delivery of antenatal care during the COVID-19 pandemic: an interrupted time-series analysis. Lancet. 2021;398(10294):41-52. doi:10.1016/s0140-6736(21)00668-1
Duryea EL, Adhikari EH, Ambia A, Spong C, McIntire D, Nelson DB. Comparison between in-person and audio-only virtual prenatal visits and perinatal outcomes. JAMA Netw Open. 2021;4(4):e215854-e215854. doi:10.1001/jamanetworkopen.2021.5854
Jeganathan S, Prasannan L, Blitz MJ, Vohra N, Rochelson B, Meirowitz N. Adherence and acceptability of telehealth appointments for high-risk obstetrical patients during the coronavirus disease 2019 pandemic. Am J Obstet Gynecol MFM. 2020;2(4):100233. doi:10.1016/j.ajogmf.2020.100233
Futterman I, Rosenfeld E, Toaff M, et al. Addressing disparities in prenatal care via telehealth during COVID-19: prenatal satisfaction survey in East Harlem. Am J Perinatol. 2021;38(1):088-092. doi:10.1055/s-0040-1718695
Ukoha EP, Feinglass J, Yee LM. Disparities in electronic patient portal use in prenatal care: retrospective cohort study. J Med Internet Res. 2019;21(9):e14445. doi:10.2196/14445
Ukoha EP, Yee LM. Use of electronic patient portals in pregnancy: an overview. J Midwifery Womens Health. 2018;63(3):335-339. doi:10.1111/jmwh.12761
Tai-Seale M, Dillon EC, Yang Y, et al. Physicians’ well-being linked to in-basket messages generated by algorithms in electronic health records. Health Aff (Millwood). 2019;38(7):1073-1078. doi:10.1377/hlthaff.2018.05509
Vandenbroucke JP, von Elm E, Altman DG, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. PLoS Med. 2007;4(10):e297. doi:10.1371/journal.pmed.0040297
de Mooij MJM, Hodny RL, O'Neil DA, et al. OB Nest: reimagining low-risk prenatal care. Mayo Clin Proc. 2018;93(4):458-466. doi:10.1016/j.mayocp.2018.01.022
Kahn MG, Raebel MA, Glanz JM, Riedlinger K, Steiner JF. A pragmatic framework for single-site and multisite data quality assessment in electronic health record-based clinical research. Med Care. 2012;50:S21-S29. doi:10.1097/MLR.0b013e318257dd67
Peahl AF, Howell JD. The evolution of prenatal care delivery guidelines in the United States. Am J Obstet Gynecol. 2021;224(4):339-347. doi:10.1016/j.ajog.2020.12.016
Peahl AF, Zahn CM, Turrentine M, et al. The Michigan plan for appropriate tailored healthcare in pregnancy prenatal care recommendations. Obstet Gynecol. 2021;138(4):593-602.
Kissler K, Thumm EB, Smith DC, et al. Perinatal telehealth: Meeting patients where they are. J Midwifery Womens Health. https://doi.org/10.1111/jmwh.13560
Singh P, Jonnalagadda P, Morgan E, Fareed N. Outpatient portal use in prenatal care: differential use by race, risk, and area social determinants of health. J Am Med Inform Assoc. 2021;29(2):364-371. doi:10.1093/jamia/ocab242
Brownson RC, Kumanyika SK, Kreuter MW, Haire-Joshu D. Implementation science should give higher priority to health equity. Implement Sci. 2021;16(1):1-16.
Yao R, Zhang W, Evans R, Cao G, Rui T, Shen L. Inequities in health care services caused by the adoption of digital health technologies: scoping review. J Med Internet Res. 2022;24(3):e34144. doi:10.2196/34144
North F, Crane SJ, Chaudhry R, et al. Impact of Patient Portal Secure Messages and Electronic Visits on Adult Primary Care Office Visits. Telemed J E Health. 2013;20(3):192-198. doi:10.1089/tmj.2013.0097
Krans EE, Davis MM, Palladino CL. Disparate patterns of prenatal care utilization stratified by medical and psychosocial risk. Matern Child Health J. 2013;17(4):639-645. doi:10.1007/s10995-012-1040-9
Cronin RM, Davis SE, Shenson JA, Chen Q, Rosenbloom ST, Jackson GP. Growth of secure messaging through a patient portal as a form of outpatient interaction across clinical specialties. Appl Clin Inform. 2015;06(02):288-304. doi:10.4338/ACI-2014-12-RA-0117
DiAngi YT, Stevens LA, Halpern-Felsher B, Pageler NM, Lee TC. Electronic health record (EHR) training program identifies a new tool to quantify the EHR time burden and improves providers’ perceived control over their workload in the EHR. JAMIA Open. 2019;2(2):222-230. doi:10.1093/jamiaopen/ooz003
Murthy VH. Confronting health worker burnout and well-being. N Engl J Med. 2022;387(7):577-579. doi:10.1056/NEJMp2207252
Bashshur RL. Guest editorial: compelling issues in telemedicine. Telemed J E Health. 2013;19(5):330-332. doi:10.1089/tmj.2013.9998