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Tannis A, Miele K, Carlson JM, O'Callaghan KP, Woodworth KR, Anderson B, Praag A, Pulliam K, Coppola N, Willabus T, Mbotha D, Abetew D, Currenti S, Longcore ND, Akosa A, Meaney-Delman D, Tong VT, Gilboa SM, Olsen EO. Syphilis Treatment Among People Who Are Pregnant in Six U.S. States, 2018-2021. Obstet Gynecol 2024; 143:718-729. [PMID: 38626449 DOI: 10.1097/aog.0000000000005586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 03/07/2024] [Indexed: 04/18/2024]
Abstract
OBJECTIVE To describe syphilis treatment status and prenatal care among people with syphilis during pregnancy to identify missed opportunities for preventing congenital syphilis. METHODS Six jurisdictions that participated in SET-NET (Surveillance for Emerging Threats to Pregnant People and Infants Network) conducted enhanced surveillance among people with syphilis during pregnancy based on case investigations, medical records, and linkage of laboratory data with vital records. Unadjusted risk ratios (RRs) were used to compare demographic and clinical characteristics by syphilis stage (primary, secondary, or early latent vs late latent or unknown) and treatment status during pregnancy (adequate per the Centers for Disease Control and Prevention's "Sexually Transmitted Infections Treatment Guidelines, 2021" vs inadequate or not treated) and by prenatal care (timely: at least 30 days before pregnancy outcome; nontimely: less than 30 days before pregnancy outcome; and no prenatal care). RESULTS As of September 15, 2023, of 1,476 people with syphilis during pregnancy, 855 (57.9%) were adequately treated and 621 (42.1%) were inadequately treated or not treated. Eighty-two percent of the cohort received timely prenatal care. Although those with nontimely or no prenatal care were more likely to receive inadequate or no treatment (RR 2.50, 95% CI, 2.17-2.88 and RR 2.73, 95% CI, 2.47-3.02, respectively), 32.1% of those with timely prenatal care were inadequately or not treated. Those with reported substance use or a history of homelessness were nearly twice as likely to receive inadequate or no treatment (RR 2.04, 95% CI, 1.82-2.28 and RR 1.83, 95% CI, 1.58-2.13, respectively). CONCLUSION In this surveillance cohort, people without timely prenatal care had the highest risk for syphilis treatment inadequacy; however, almost a third of people who received timely prenatal care were not adequately treated. These findings underscore gaps in syphilis screening and treatment for pregnant people, especially those experiencing substance use and homelessness, and the need for systems-based interventions, such as treatment outside of traditional prenatal care settings.
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Affiliation(s)
- Ayzsa Tannis
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, and the Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, and the Georgia Department of Public Health, Atlanta, Georgia; Eagle Global Scientific, LLC, San Antonio, Texas; Lukos LLC, Tampa, Florida; the Arizona Department of Health Services and Maricopa County Public Health, Phoenix, Arizona; the New Jersey Department of Health, Trenton, New Jersey; the Washington State Department of Health, Bellevue, Washington; and the New York State Department of Health, Albany, New York
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Chapman RR, Mohamed SB, Rage H, Abdulahi A, Jimenez J, Gavin AR, Zetell J, Chatterjee KN, Valderrábano S, Sundar S, Madey H, Pfeiffer JT. Preventing Health Disparities during COVID through Perinatal Home Screening as Black Authoritative Knowledge. J Racial Ethn Health Disparities 2024; 11:1286-1300. [PMID: 37191769 PMCID: PMC10187511 DOI: 10.1007/s40615-023-01608-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 05/17/2023]
Abstract
During COVID-19 epidemic, health protocols limited face-to-face perinatal visits and increased reliance on telehealth. To prevent increased health disparities among BIPOC pregnant patients in health-underserved areas, we used a pre-post survey design to pilot a study assessing (1) feasibility of transferring technology including a blood pressure (BP) cuff (BPC) and a home screening tool, (2) providers' and patients' acceptance and use of technology, and (3) benefits and challenges of using the technology. Specific objectives included (1) increasing contact points between patients and perinatal providers; (2) decreasing barriers to reporting and treating maternal hypertension, stress/depression, and intimate partner violence (IPV)/domestic violence (DV); and (3) bundling to normalize and facilitate mental, emotional, and social health monitoring alongside BP screening. Findings confirm this model is feasible. Patients and providers used this bundling model to improve antenatal screening under COVID quarantine restrictions. More broadly, home-monitoring improved antenatal telehealth communication, provider diagnostics, referral and treatment, and bolstered patient autonomy through authoritative knowledge. Implementation challenges included provider resistance, disagreement with lower than ACOG BP values to initiate clinical contact and fear of service over-utilization, and patient and provider confusion about tool symbols due to limited training. We hypothesize that routinized pathologization and projection of crisis onto BIPOC people, bodies, and communities, especially around reproduction and continuity, may contribute to persistent racial/ethnic health disparities. Further research is needed to examine whether authoritative knowledge increases use of critical and timely perinatal services by strengthening embodied knowledge of marginalized patients and, thus, their autonomy and self-efficacy to enact self-care and self-advocacy.
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Affiliation(s)
- Rachel R Chapman
- Department of Anthropology, University of Washington, Seattle, WA, USA.
| | - Sumaya B Mohamed
- Department of Anthropology, University of Washington, Seattle, WA, USA
| | | | | | - Jan Jimenez
- College of Osteopathic Medicine, Yakima, WA, USA
| | - Amelia R Gavin
- School of Social Work, University of Washington, Seattle, WA, USA
| | - Jasmine Zetell
- Department of Anthropology, University of Washington, Seattle, WA, USA
| | | | | | | | | | - James T Pfeiffer
- Department of Global Health, University of Washington, Seattle, WA, USA
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Zhang R, Byrd T, Qiao S, Torres ME, Li X, Liu J. Maternal care utilization and provision during the COVID-19 pandemic: Voices from minoritized pregnant and postpartum women and maternal care providers in Deep South. PLoS One 2024; 19:e0300424. [PMID: 38683808 PMCID: PMC11057746 DOI: 10.1371/journal.pone.0300424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 02/27/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has significantly affected maternal care services especially for minoritized individuals, creating challenges for both service users (i.e., African American and Hispanic pregnant/postpartum women) and maternal care providers (MCPs). Guided by a socioecological framework, this study aims to investigate the experiences of African American and Hispanic pregnant and postpartum women, as well as MCPs, in accessing and providing maternal care services during the COVID-19 pandemic in the Deep South. METHODS We conducted semi-structured interviews with 19 African American women, 20 Hispanic women, and 9 MCPs between January and August 2022. Participants were recruited from Obstetrics and Gynecology clinics, pediatric clinics, and community health organizations in South Carolina, and all births took place in 2021. Interview transcripts were analyzed thematically. RESULTS Maternal care utilization and provision were influenced by various factors at different socioecological levels. At the intrapersonal level, women's personal beliefs, fears, concerns, and stress related to COVID-19 had negative impacts on their experiences. Some women resorted to substance use as a coping strategy or home remedy for pregnancy-induced symptoms. At the interpersonal level, family and social networks played a crucial role in accessing care, and the discontinuation of group-based prenatal care had negative consequences. Participants reported a desire for support groups to alleviate the pressures of pregnancy and provide a platform for shared experiences. Language barriers were identified as an obstacle for Hispanic participants. Community-level impacts, such as availability and access to doulas and community health workers, provided essential information and support, but limitations in accessing doula support and implicit bias were also identified. At the institutional level, mandatory pre-admission COVID-19 testing, visitation restrictions, and reduced patient-MCP interactions were women's common concerns. Short staffing and inadequate care due to the impact of COVID-19 on the health care workforce were reported, along with anxiety among MCPs about personal protective equipment availability. MCPs emphasized the quality of care was maintained, with changes primarily attributed to safety protocols rather than a decline in care quality. CONCLUSION The pandemic has disrupted maternal care services. To overcome these issues, health facilities should integrate community resources, adopt telehealth, and develop culturally tailored education programs for pregnant and postpartum women. Supporting MCPs with resources will enhance the quality of care and address health disparities in African American and Hispanic women.
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Affiliation(s)
- Ran Zhang
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America
| | - Tiffany Byrd
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America
| | - Shan Qiao
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America
| | - Myriam E. Torres
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America
| | - Xiaoming Li
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America
| | - Jihong Liu
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America
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Brooks KM, Charlot-Swilley D, Robertson HA, Bodrick N, Danielson AL, Genovez M, Boogaard C, Morris S, Deshmukh S, Kiker L, Green O, Le HN. "A Judgment-Free Zone": Adaptation and Pilot Study of a Virtual Wellness Group for African American Mothers with Young Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:390. [PMID: 38673302 PMCID: PMC11049826 DOI: 10.3390/ijerph21040390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/09/2024] [Accepted: 03/20/2024] [Indexed: 04/28/2024]
Abstract
The COVID-19 pandemic has been particularly challenging for the mental health of African American (AA) birthing people. The pandemic necessitated shifting mental health care to online interventions. The goals of this study were to (1) describe an adapted evidence-based group preventive intervention for AA mothers with young children within a pediatric setting and (2) evaluate the feasibility, acceptability, and preliminary effectiveness of this virtual intervention. Phase 1 describes the adaptation of the HealthySteps Mom's Virtual Wellness Group, including eight weekly sessions based on the Mothers and Babies Course. Phase 2 was a mixed-methods, pre-post intervention design. Six AA mothers with young children completed questionnaires related to depression, anxiety, and parenting competence at three time points: pre-intervention (T1), post-intervention (T2), and 3 months post-intervention (T3). The participants also completed a focus group post-T2 to gather qualitative feedback regarding the intervention. The median scores for depression were lower at T2 and increased at T3, and for anxiety, they increased at T2 and decreased at T3. The median scores for parenting competence increased across the three time points. The participants attended a mean of 7.2 sessions (SD = 0.74). The qualitative results indicate that the participants gained a sense of empowerment, enjoyed connecting with other mothers, and acquired information. This pilot study suggests that a virtual intervention is feasible, acceptable, and can increase parenting competence and support among AA mothers with young children.
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Affiliation(s)
- Kimberly M. Brooks
- Children’s National Hospital, 1 Inventa Place 5th Floor, Silver Spring, MD 20910, USA; (N.B.); (M.G.); (C.B.); (S.D.)
| | - Dominique Charlot-Swilley
- Department of Psychiatry, Medstar Georgetown University Hospital, Washington, DC 20007, USA; (D.C.-S.); (H.A.R.); (A.L.D.)
| | - Hillary A. Robertson
- Department of Psychiatry, Medstar Georgetown University Hospital, Washington, DC 20007, USA; (D.C.-S.); (H.A.R.); (A.L.D.)
| | - Nia Bodrick
- Children’s National Hospital, 1 Inventa Place 5th Floor, Silver Spring, MD 20910, USA; (N.B.); (M.G.); (C.B.); (S.D.)
| | - Aimee L. Danielson
- Department of Psychiatry, Medstar Georgetown University Hospital, Washington, DC 20007, USA; (D.C.-S.); (H.A.R.); (A.L.D.)
| | - Marta Genovez
- Children’s National Hospital, 1 Inventa Place 5th Floor, Silver Spring, MD 20910, USA; (N.B.); (M.G.); (C.B.); (S.D.)
| | - Claire Boogaard
- Children’s National Hospital, 1 Inventa Place 5th Floor, Silver Spring, MD 20910, USA; (N.B.); (M.G.); (C.B.); (S.D.)
| | - Sydney Morris
- Department of Psychology, Palo Alto University, Palo Alto, CA 94308, USA;
| | - Sanyukta Deshmukh
- Children’s National Hospital, 1 Inventa Place 5th Floor, Silver Spring, MD 20910, USA; (N.B.); (M.G.); (C.B.); (S.D.)
| | - Lauren Kiker
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC 20013, USA; (L.K.); (O.G.); (H.-N.L.)
| | - Olukemi Green
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC 20013, USA; (L.K.); (O.G.); (H.-N.L.)
| | - Huynh-Nhu Le
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC 20013, USA; (L.K.); (O.G.); (H.-N.L.)
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Zaidi M, Fantasia HC, Penders R, Koren A, Enah C. Increasing U.S. Maternal Health Equity Among Immigrant Populations Through Community Engagement. Nurs Womens Health 2024; 28:11-22. [PMID: 38072010 DOI: 10.1016/j.nwh.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/03/2023] [Accepted: 09/07/2023] [Indexed: 01/09/2024]
Abstract
Immigrant women in the United States are at an elevated risk of poor maternal health outcomes due to cultural, linguistic, or socioeconomic barriers that may lead to critical delays in obtaining adequate health care. Ensuring access to high-quality, culturally appropriate perinatal health care is crucial to improve the health and well-being of immigrant mothers and their children. Various aspects of perinatal health care for immigrant women can be improved through community engagement strategies. Barriers can be addressed by involving community members in designing and delivering culturally appropriate maternal health services. Some strategies discussed in this commentary include working with community health workers, encouraging telehealth through community health workers, providing breastfeeding and mental health support within cultural norms, and involving community-based doulas and midwives.
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Nir O, Dvir G, Galler E, Axelrod M, Farhi A, Barkai G, Weisz B, Sivan E, Mazaki Tovi S, Tsur A. Integrating technologies to provide comprehensive remote fetal surveillance: A prospective pilot study. Int J Gynaecol Obstet 2024; 164:662-667. [PMID: 37553895 DOI: 10.1002/ijgo.15018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/03/2023] [Accepted: 07/10/2023] [Indexed: 08/10/2023]
Abstract
OBJECTIVE To determine the feasibility of extending remote maternal-fetal care to include fetus well-being. METHODS The authors performed a prospective pilot study investigating low-risk pregnant participants who were recruited at the time of their first full-term in-person visit and scheduled for a follow-up telemedicine visit. Using novel self-operated fetal monitoring and ultrasound devices, fetal heart monitoring and amniotic fluid volume measurements were obtained to complete a modified biophysical profile (mBPP). Total visit length was measured for both the in-person first visit and the subsequent telemedicine encounter. A patient satisfaction survey form was obtained. RESULTS Ten women between 40 + 1 and 40 + 6 weeks of gestation participated in telemedicine encounters. Nine women (90%) were able to complete remote mBPP assessment. For one participant, fetal assessment was not completed due to technically inconclusive fetal monitoring. Another participant was referred for additional assessment in the delivery room. Satisfactory amniotic fluid volume measurements were achieved in 100% of participants. The telemedicine encounter was significantly shorter (93.1 ± 33.1 min) than the in-person visit (247.2 ± 104.7 min; P < 0.001). We observed high patient satisfaction. CONCLUSION Remote fetal well-being assessment is feasible and time-saving and results in high patient satisfaction. This novel paradigm of comprehensive remote maternal and fetal assessment is associated with important clinical, socioeconomic, and logistics advantages.
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Affiliation(s)
- Omer Nir
- Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Gur Dvir
- Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Esther Galler
- Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat Gan, Israel
| | - Michal Axelrod
- Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Adel Farhi
- The Gertner Institute for Epidemiology and Health Policy, Ramat Gan, Israel
| | - Galia Barkai
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
- Sheba Beyond, The Virtual Hospital, Sheba Medical Center, Ramat Gan, Israel
| | - Boaz Weisz
- Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
- The Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Sheba Medical Center, Ramat-Gan, Israel
| | - Eyal Sivan
- Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Shali Mazaki Tovi
- Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
- The Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Sheba Medical Center, Ramat-Gan, Israel
| | - Abraham Tsur
- Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
- The Gertner Institute for Epidemiology and Health Policy, Ramat Gan, Israel
- Sheba Beyond, The Virtual Hospital, Sheba Medical Center, Ramat Gan, Israel
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Mobeen S, Fogel J, Harishankar K, Jacobs AJ. The COVID-19 Pandemic and Routine Prenatal Care: Use of Online Visits. Matern Child Health J 2024:10.1007/s10995-024-03904-8. [PMID: 38270717 DOI: 10.1007/s10995-024-03904-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 01/26/2024]
Abstract
OBJECTIVE To evaluate whether prenatal visits or screening/testing were fewer or occurred later during the initial phase of the COVID-19 pandemic in 2020 (CINT) as compared to the prior year (PreCINT). METHODS A retrospective cohort study compared CINT (n = 2,195) to PreCINT (n = 2,395) at seven public hospitals in New York City. The primary outcome was total number of prenatal-care visits. Secondary outcomes were components of prenatal-care visits completion, timing of standard pregnancy screening tests, and adverse neonatal outcomes. RESULTS CINT patients had more total prenatal-care visits (B = 1.30, 95% CI:1.04, 1.56, p < 0.001), lower odds for initiation of prenatal care which was inadequate according to widely used criteria (OR:0.39, 95% CI:0.34, 0.45, p < 0.001), and lower gestational age at initial visit (B=-4.51, 95% CI:-5.10, -3.93, p < 0.001) than PreCINT patients. In-person visits did not differ between the two groups. PreCINT patients had no televisits, while CINT patients had a median of one televisit (Median = 1, p < 0.001). CINT patients had increased odds for group B Streptococcus screening (OR:1.27, 95% CI: 1.10, 1.48, p = 0.001), quadrivalent screening (OR:1.30, 95% CI:1.15, 1.48, p < 0.001), and anatomy sonogram (OR:2.30, 95% CI:2.04, 2.59, p < 0.001) but decreased odds for glucose challenge test screening (OR:0.81, 95% CI:0.72, 0.91, p < 0.001). Adverse neonatal outcome did not differ between CINT and PreCINT pregnancies. CONCLUSIONS FOR PRACTICE Despite the difficulties and perceived dangers of in-person visits during the COVID-19 pandemic, the COVID-19 pandemic had little negative impact upon the outpatient prenatal care received by patients in this hospital system.
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Affiliation(s)
- Sadia Mobeen
- Department of Obstetrics and Gynecology, South Brooklyn Health, 2601 Ocean Parkway, Brooklyn, New York, 11235, USA
| | - Joshua Fogel
- Department of Obstetrics and Gynecology, South Brooklyn Health, 2601 Ocean Parkway, Brooklyn, New York, 11235, USA
- Department of Management, Marketing, and Entrepreneurship, Brooklyn College, Brooklyn, New York, USA
| | - Krupa Harishankar
- Department of Obstetrics and Gynecology, Elmhurst Hospital Center, Queens, New York, USA
- Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Allan J Jacobs
- Department of Obstetrics and Gynecology, South Brooklyn Health, 2601 Ocean Parkway, Brooklyn, New York, 11235, USA.
- Department of Obstetrics and Gynecology, Downstate Medical Center, Brooklyn, New York, USA.
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Aijaz M, Bozkurt B, Planey AM, Cilenti D, Khairat S, Shea CM. The evolution of health system planning and implementation of maternal telehealth services during the COVID-19 Pandemic. Digit Health 2024; 10:20552076241259858. [PMID: 38832100 PMCID: PMC11146003 DOI: 10.1177/20552076241259858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 05/21/2024] [Indexed: 06/05/2024] Open
Abstract
Background Differential access to healthcare is associated with disparities in maternal outcomes. Telehealth is one approach for improving access to maternal services. However, little is known regarding how health systems leverage telehealth to close the access gap. Objective This study examines how health systems have approached decisions about using telehealth for maternal services before and during the COVID-19 public health emergency and what factors were considered. Methods We conducted semi-structured interviews with 15 health system leaders between July and October 2021 and June and August 2022. We used a rapid analysis followed by a content analysis approach. Results Five health systems did not provide maternal telehealth services before the PHE due to a lack of reimbursement. Two health systems provided limited services as research endeavors, and one had integrated telehealth into routine maternity care. During the PHE, all transitioned to telehealth, with the primary consideration being patient and staff safety. At the time of the interview, key considerations shifted to patient access, patient preferences, patient complexity, return on investment, and staff burnout. However, several barriers impacted telehealth use, including coverage of portable devices and connectivity. These issues were reported to be common among underinsured, low-income, and rural patients. Health systems with particularly advanced capabilities worked on approaches to fill access gaps for these patients. Conclusion Some health systems prioritized telehealth to improve access to high-quality maternal services for patients at the highest risk of adverse outcomes. However, policy and patient-level barriers to equitable implementation of these services persist.
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Affiliation(s)
- Monisa Aijaz
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA
| | - Burcu Bozkurt
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA
| | - Arrianna Marie Planey
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, USA
| | - Dorothy Cilenti
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA
| | - Saif Khairat
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, USA
- School of Nursing, University of North Carolina, Chapel Hill, USA
| | - Christopher M Shea
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, USA
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McCoy HC, Allison MK, Hernandez M, Ali MM, Stokes M, Bogulski CA, Eswaran H. Assessment of Pregnancy-Related Telehealth Interventions in the United States: A 10-Year Scoping Review. Telemed J E Health 2024; 30:36-46. [PMID: 37256707 DOI: 10.1089/tmj.2023.0176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
Introduction: Telehealth use in obstetrics has been demonstrated to improve efficiency, access to care, and pregnancy outcomes. Despite reported successful implementation of these programs, information regarding the program variations and its impact on health care costs and outcomes are scarce. Methods: This is a scoping review of pregnancy-related telehealth studies to understand the current landscape of pregnancy-related telehealth interventions as well as to subset those that are used in high-risk pregnancies. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework to guide this review. Results: A total of 70 articles were included in this scoping review. Of those, 53 (75.7%) studies included a pregnant population and 17 (24.3%) studies focused on a rural and/or urban population. Most studies (n = 56; 80%) included some form of synchronous interaction between provider and participant. Patient outcomes included maternal/infant health outcomes (n = 41; 44.1%), patient satisfaction (n = 9; 9.7%), and attendance/compliance (n = 5; 5.4%). Provider-level outcomes included knowledge change (n = 11; 11.8%) and self-efficacy (n = 3; 3.2%). Other outcomes included assessment of costs and patient/provider feasibility and acceptability of the intervention. Overall, there has been a growing trend in articles published on pregnancy-related telehealth studies since 2011, with 2018 having the most publications in a single year. Conclusion: This review suggests a steadily growing body of literature on pregnancy-related telehealth interventions; however, more research is needed to better understand outcomes of telehealth for pregnancy-related care, especially related to patient satisfaction, health disparities, and cost-benefit.
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Affiliation(s)
- Hannah C McCoy
- Institute for Digital Health and Innovation, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Mary Kathryn Allison
- Department of Health Behavior and Health Education, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Michelle Hernandez
- College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Mir M Ali
- Institute for Digital Health and Innovation, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Melony Stokes
- Southcentral Telehealth Resource Center, Institute for Digital Health and Innovation, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Cari A Bogulski
- Department of Biomedical Informatics and College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Hari Eswaran
- Department of Obstetrics and Gynecology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Huang H, Ceavers O, Iregui MP, Howard MM. Being Pregnant during COVID-19: Exploring the COVID-19 Related Beliefs, Behaviors, and Birth Outcome among Users of a Pregnancy App. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 21:34. [PMID: 38248499 PMCID: PMC10815880 DOI: 10.3390/ijerph21010034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 12/22/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024]
Abstract
Being pregnant during COVID-19 increases the risk of experiencing severe COVID-19 symptoms, which in turn increases the risk of complications. This study aimed to examine COVID-19-related beliefs, behaviors, and birth outcomes among users of Count the Kicks (CTK), a fetal movement tracking app. This study used the End of Pregnancy Survey data from 1037 CTK users. We used descriptive analyses to analyze COVID-19-related beliefs and behaviors and used the chi-square statistic and Z statistic to examine factors associated with vaccination and birth outcome. Nearly half of the survey respondents reported not being concerned that in-person prenatal visits might lead to COVID-19 exposure. Most respondents (65.9%) had already received the COVID-19 vaccine at the time of the survey. The vaccination rate was statistically significantly lower among African Americans than the remaining race/ethnicity groups (mostly white). The healthy birth rate is lower among respondents with high-risk pregnancies, while the stillbirth rate is highest among Hispanics. Vaccination status was not associated with the likelihood of a healthy birth. Our findings confirmed that vaccination does not compromise birth outcomes, further contributing to the existing evidence of COVID vaccine safety during pregnancy. This study also demonstrates an example of using data from a pregnancy app to facilitate research on app users in real-time.
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Affiliation(s)
- Hui Huang
- School of Social Work, University of Texas at Arlington, Arlington, TX 76010, USA
| | - Olivia Ceavers
- Department of Health Promotion & Disease Prevention, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL 33199, USA; (O.C.); (M.P.I.)
| | - Maria Pinzon Iregui
- Department of Health Promotion & Disease Prevention, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL 33199, USA; (O.C.); (M.P.I.)
| | - Melissa M. Howard
- Department of Health Promotion and Behavior, College of Public Health, University of Georgia, Athens, GA 30602, USA;
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11
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Alkawaldeh M, Alkhawaldeh A, Yeboah T. Exploring patients' experiences with telehealth in obstetrics care during the COVID-19 pandemic: A qualitative study. PLoS One 2023; 18:e0292799. [PMID: 38117846 PMCID: PMC10732431 DOI: 10.1371/journal.pone.0292799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 09/28/2023] [Indexed: 12/22/2023] Open
Abstract
AIM The aim of this study was to evaluate patients' experiences with telehealth provision of obstetrics and gynecology care during the COVID-19 pandemic qualitatively. DESIGN AND SETTING In this study, a qualitative research design, namely descriptive phenomenology, was employed. Participants were recruited from the OB department at UMass Memorial Medical center in Worcester, MA, between 6/2020 and 7/2020. METHODS Between June 2020 and July 2020, in-depth interviews were conducted with 18 women receiving care at the Obstetrics and Maternal and Fetal Medicine clinics. Data were analyzed using qualitative thematic analysis, as outlined by Braun and Clarke. RESULTS Telehealth is a feasible and safe health-care tool that is available during these unprecedented times. This study provided qualitative evidence based on patients' perspectives and experiences. Participants' meanings in relation to their experiences of using telehealth services emerged from the data in four themes: the overall experience of using modern telehealth platforms, telehealth and its perceived benefits, telehealth and its perceived challenges, and telehealth and its potential future use. CONCLUSION While this study highlights areas in telehealth implementation that require improvement, the overall positive experiences and consistent perceived benefits of most participants suggests that telehealth can be an important tool in healthcare delivery for appropriate patients and situations moving forward in a post-pandemic world. IMPACT During the global pandemic, telehealth has been recognized to have the potential to play a critical role in healthcare delivery. Establishing qualitative evidence-based practices in the emerging field of telehealth for OB services is pivotal to mitigate potential safety, feasibility, and cost issues that could be associated with the rapid adoption of telehealth. Yet, this qualitative study However highlighted several challenges that are necessary to be addressed in order for telehealth to meet maximum effectiveness and functionality in the future.
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Affiliation(s)
| | - Asma Alkhawaldeh
- Research Specialist, Jordanian Royal Medical Services, Amman, Jordan
| | - Tracy Yeboah
- Department of OBGYN, Research Coordinator, University of Massachusetts Medical School, Worcester, MA, United States of America
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12
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Simon S, John S, Lisonkova S, Razaz N, Muraca GM, Boutin A, Bedaiwy MA, Brandt JS, Ananth CV, Joseph KS. Obstetric Intervention and Perinatal Outcomes During the Coronavirus Disease 2019 (COVID-19) Pandemic. Obstet Gynecol 2023; 142:1405-1415. [PMID: 37826851 PMCID: PMC10642704 DOI: 10.1097/aog.0000000000005412] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 08/07/2023] [Accepted: 08/17/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE To quantify pandemic-related changes in obstetric intervention and perinatal outcomes in the United States. METHODS We carried out a retrospective study of all live births and fetal deaths in the United States, 2015-2021, with data obtained from the natality, fetal death, and linked live birth-infant death files of the National Center for Health Statistics. Analyses were carried out among all singletons; singletons of patients with prepregnancy diabetes, prepregnancy hypertension, and hypertensive disorders of pregnancy; and twins. Outcomes of interest included preterm birth, preterm labor induction or preterm cesarean delivery, macrosomia, postterm birth, and perinatal death. Interrupted time series analyses were used to estimate changes in the prepandemic period (January 2015-February 2020), at pandemic onset (March 2020), and in the pandemic period (March 2020-December 2021). RESULTS The study population included 26,604,392 live births and 155,214 stillbirths. The prepandemic period was characterized by temporal increases in preterm birth and preterm labor induction or cesarean delivery rates and temporal reductions in macrosomia, postterm birth, and perinatal mortality. Pandemic onset was associated with absolute decreases in preterm birth (decrease of 0.322/100 live births, 95% CI 0.506-0.139) and preterm labor induction or cesarean delivery (decrease of 0.190/100 live births, 95% CI 0.334-0.047) and absolute increases in macrosomia (increase of 0.046/100 live births), postterm birth (increase of 0.015/100 live births), and perinatal death (increase of 0.501/1,000 total births, 95% CI 0.220-0.783). These changes were larger in subpopulations at high risk (eg, among singletons of patients with prepregnancy diabetes). Among singletons of patients with prepregnancy diabetes, pandemic onset was associated with a decrease in preterm birth (decrease of 1.634/100 live births) and preterm labor induction or cesarean delivery (decrease of 1.521/100 live births) and increases in macrosomia (increase of 0.328/100 live births) and perinatal death (increase of 9.840/1,000 total births, 95% CI 3.933-15.75). Most changes were reversed in the months after pandemic onset. CONCLUSION The onset of the coronavirus disease 2019 (COVID-19) pandemic was associated with a transient decrease in obstetric intervention (especially preterm labor induction or cesarean delivery) and a transient increase in perinatal mortality.
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Affiliation(s)
- Sophie Simon
- Department of Obstetrics and Gynaecology, the Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, and the School of Population and Public Health, University of British Columbia, and the Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, British Columbia, the Departments of Obstetrics and Gynecology and Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, and the Department of Pediatrics, Faculty of Medicine, Université Laval and CHU de Québec-Université Laval Research Center, Québec City, Québec, Canada; the Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, NYU Grossman School of Medicine, New York, New York; and the Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, the Cardiovascular Institute of New Jersey, and the Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, and the Department of Biostatistics and Epidemiology, Rutgers School of Public Health, and the Environmental and Occupational Health Sciences Institute, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
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13
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Riggan KA, Weaver AL, Ashby G, Huang L, Long ME, Torbenson VE, Wick MJ, Allyse MA, Rivera-Chiauzzi EY. Influence of the COVID-19 pandemic on prenatal and postpartum patient experiences and well-being. Birth 2023; 50:1034-1044. [PMID: 37555375 PMCID: PMC10843728 DOI: 10.1111/birt.12760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 12/08/2022] [Accepted: 07/25/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND It has yet to be fully elucidated how differing populations of obstetric patients adapted to the disruptions in perinatal care and postpartum support from the COVID-19 pandemic. We surveyed an enriched sample of socioeconomically advantaged patients to understand the influence of COVID-19 on their perinatal care experience, well-being, and coping. METHODS We surveyed pregnant and postpartum patients (n = 6140) at a large academic medical center in the Midwest of the United States using the Coronavirus and Perinatal Experiences instrument in Spring 2021. RESULTS The survey was sent to 6141 pregnant and postpartum patients; 1180 (17.8%) respondents completed the survey, including 256 who were pregnant and 834 postpartum. Most pregnant patients experienced no changes in their prenatal care with 16.5% indicating somewhat worsened care. In the postpartum cohort, 37.5% stated their care had somewhat worsened. In describing influences on stress and mental health, 58.1% of postpartum respondents stated it was moderately, and 17.4% significantly, worse. The pandemic had a somewhat or moderately negative influence for 72.7% of respondents, with 11.0% stating these effects were extremely negative. Both cohorts characterized a range of coping strategies, most commonly, talking with friends and family (76.3%). CONCLUSION(S) Even among this sample of socioeconomically advantaged patients, respondents indicated that the pandemic disrupted many facets of their medical care and daily life, especially social activities and postpartum support. Our findings suggest that counseling on coping and adaptation strategies for stressors and increased health systems support be part of perinatal care during public health emergencies for all demographic groups.
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Affiliation(s)
| | - Amy L. Weaver
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN
| | | | - Lily Huang
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL
| | - Margaret E. Long
- Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN
| | | | - Myra J. Wick
- Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN
| | - Megan A. Allyse
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN
- Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN
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14
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Lee J, Manalew WS. Reasons for Not Pursuing Virtual Prenatal Care in 2020 Through 2021 and Policy Implications. Telemed J E Health 2023; 29:1492-1503. [PMID: 36787485 PMCID: PMC10589501 DOI: 10.1089/tmj.2022.0492] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 02/16/2023] Open
Abstract
Aim: To investigate patterns of virtual prenatal visits and examine reasons for not pursuing virtual visits for prenatal care. Methods: A pooled cross-sectional study used Pregnancy Risk Assessment Monitoring System from October 2020 through June 2021, a nationally representative surveillance system targeted at women who recently gave live birth. Individuals (n = 11,829) who reported their prenatal care experiences were included. A modified poison regression estimated prevalence ratios for virtual prenatal visits and reasons for not using virtual services. Results: One-third of participants used virtual prenatal care. Hispanics were more likely to use virtual prenatal care than whites. Compared with college graduates, those with high school graduation (Prevalence Ratios [PR] 0.87, 95% confidence interval [CI] 0.76-0.99; p = 0.033) or some college education (PR 0.86, 95% CI 0.77-0.96; p = 0.009) were less likely to use virtual visits. A preference for in-person was the most common reason for not pursuing virtual visits (77.1%), followed by no available virtual appointments (29.5%), technology barriers (6.1%), and no private space (1.7%). Individuals with less than or with high school graduation had 4.16 times (95% CI 2.32-7.46; p ≤ 0.001) and 2.72 times (95% CI 1.67-4.43; p ≤ 0.001) greater technology barriers, and 10.03 times (95% CI 3.42-29.46; p ≤ 0.001) and 4.29 times (95% CI 1.56-11.80; p = 0.005) greater likelihood of lacking private space, respectively, while they had a lesser in-person preference. Conclusions: In a disrupted health care landscape, barriers to accessing virtual prenatal care may have further exacerbated access to care and effective management of pregnancy among those underserved. The findings provide practical implications for safe and effective prenatal care.
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Affiliation(s)
- Jusung Lee
- Department of Public Health, University of Texas at San Antonio, San Antonio, Texas, USA
| | - W. Samuel Manalew
- Department of Health Services Management and Policy, East Tennessee State University, Johnson City, Tennessee, USA
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15
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Amiel Castro RT, Schaal NK, Meyerhoff H, Preis H, Mahaffey B, Lobel M, La Marca-Ghaemmaghami P. Investigating Factors Influencing Prenatal Stress, Anxiety, and Fear of Childbirth During the COVID-19 Pandemic in Germany and Switzerland: An Online Survey. Matern Child Health J 2023; 27:1864-1875. [PMID: 37470899 DOI: 10.1007/s10995-023-03758-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVES Pregnant women are likely to experience high levels of stress during the COVID-19 pandemic. However, the factors that might influence the extent of experienced emotional distress are poorly understood. Therefore, we aimed to investigate potential correlates of prenatal emotional distress during the COVID-19 pandemic. METHODS In total, N = 1437 pregnant women from Germany and Switzerland participated in an online study during the first wave of the COVID-19 pandemic (May-August 2020). The survey assessed prenatal distress, pandemic-related pregnancy stress, general anxiety, fear of childbirth, and several socio-demographic, pregnancy- and COVID-19-related factors. Linear multivariate regression models were the main analytical strategy. RESULTS The results highlight that several factors such as full-time employment, nulliparity, high-risk pregnancy, emotional problems, cancelled prenatal appointments, and stating that COVID-19 affected the choice of birth mode were significantly associated with elevated prenatal distress, anxiety, pandemic-related pregnancy stress, and fear of childbirth. Conversely, access to an outdoor space was a protective factor for pandemic-related pregnancy stress and prenatal distress. CONCLUSIONS FOR PRACTICE Overall, the study highlights significant correlates influencing the levels of emotional distress pregnant women experienced during the COVID-19 pandemic. These findings may contribute to the improvement of maternal prenatal medical and psychological care during a public health crisis of international concern, such as the COVID-19 pandemic.
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Affiliation(s)
- Rita T Amiel Castro
- Department of Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland
| | - Nora K Schaal
- Institute of Experimental Psychology, Heinrich-Heine-University, Dusseldorf, Germany
| | - Hannah Meyerhoff
- Department of Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland
| | - Heidi Preis
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
- Department of Obstetrics, Gynecology and Reproductive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Brittain Mahaffey
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | - Marci Lobel
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
- Department of Obstetrics, Gynecology and Reproductive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Pearl La Marca-Ghaemmaghami
- Psychology Counselling and Research Institute for Sexuality, Marriage and the Family, International Academy for Human Sciences and Culture, Staadweg 3, P.O. Box 57, 8880, Walenstadt, Switzerland.
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16
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Julceus EF, Olatosi B, Hung P, Zhang J, Li X, Liu J. Racial disparities in adequacy of prenatal care during the COVID-19 pandemic in South Carolina, 2018-2021. BMC Pregnancy Childbirth 2023; 23:686. [PMID: 37741980 PMCID: PMC10517534 DOI: 10.1186/s12884-023-05983-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 09/07/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, hospitals' decision of not admitting pregnant women's partner or support person, and pregnant women's fear of contracting COVID-19 in hospitals may disrupt prenatal care. We aimed to examine whether prenatal care utilization in South Carolina varied before and during the COVID-19 pandemic, and whether the variation was different by race. METHODS We utilized 2018-2021 statewide birth certificate data using a pre-post design, including all women who delivered a live birth in South Carolina. The Kotelchuck Index - incorporating the timing of prenatal care initiation and the frequency of gestational age-adjusted visits - was employed to categorize prenatal care into inadequate versus adequate care. Self-reported race includes White, Black, and other race groups. Multiple logistic regression models were used to calculate adjusted odds ratio of inadequate prenatal care and prenatal care initiation after first trimester by maternal race before and during the pandemic. RESULTS A total of 118,925 women became pregnant before the pandemic (before March 2020) and 29,237 women during the COVID-19 pandemic (March 2020 - June 2021). Regarding race, 65.2% were White women, 32.0% were Black women and 2.8% were of other races. Lack of adequate prenatal care was more prevalent during the pandemic compared to pre-pandemic (24.1% vs. 21.6%, p < 0.001), so was the percentage of initiating prenatal care after the first trimester (27.2% vs. 25.0%, p < 0.001). The interaction of race and pandemic period on prenatal care adequacy and initiation was significant. The odds of not receiving adequate prenatal care were higher during the pandemic compared to before for Black women (OR 1.26, 95% CI 1.20-1.33) and White women (OR 1.10, 95% CI 1.06-1.15). The odds of initiating prenatal care after the first trimester were higher during the pandemic for Black women (OR 1.18, 95% CI 1.13-1.24) and White women (OR 1.09, 95% CI 1.04-1.13). CONCLUSIONS Compared to pre-pandemic, the odds of not receiving adequate prenatal care in South Carolina was increased by 10% for White women and 26% for Black women during the pandemic, highlighting the needs to develop individual tailored interventions to reverse this trend.
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Affiliation(s)
- Emmanuel Fabrice Julceus
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Bankole Olatosi
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Peiyin Hung
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Xiaoming Li
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Jihong Liu
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
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Cox V, Sharma P, Verma GS, Gill N, Diamond-Smith NG, Duggal M, Kumar V, Bagga R, Kaur J, Singh P, El Ayadi AM. User Acceptability and Perceived Impact of a Mobile Interactive Education and Support Group Intervention to Improve Postnatal Health Care in Northern India: A Qualitative Study. RESEARCH SQUARE 2023:rs.3.rs-3320095. [PMID: 37790487 PMCID: PMC10543439 DOI: 10.21203/rs.3.rs-3320095/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Background Postnatal care, crucial for preventing and assessing complications after birth, remains low in India. An interactive mHealth community-based postnatal intervention was implemented to promote healthy maternal behaviors through knowledge and social support in rural Northern India. However, there is limited information on how virtual health interventions in resource-constrained settings are perceived by the users and which elements influence their engagement and sustained participation. Objective We explored the user perceptions of acceptability and impact of a virtual interactive maternal and child health intervention pilot tested in Punjab State, India, including their perspectives on barriers and facilitators to engage with this intervention. Methods This qualitative study was embedded within extensive mixed-method research, and oriented by the Realist Evaluation approach. Sixteen participants were recruited from the parent study. They were identified by purposive sampling to cover diverse levels of attendance and engagement with the intervention. In-depth interviews were conducted by phone. Following translation, a framework analysis was completed to search for the main themes. Feedback was requested from intervention moderators during the process to prioritize local interpretation. Results Study participants reported overall satisfaction with the intervention. The mothers appreciated the educational material provided and the communication with other participants and health professionals. Across context, intervention, and actor domains, the barriers most commented on were network and connectivity challenges, lack of time due to household responsibilities, and feeling uncomfortable sharing personal experiences. Family buy-in and support were fundamental for overcoming the high domestic workload and baby care. Another facilitator mentioned was moderators' guidance on using the different intervention modalities. Regarding perceived impact, participants shared that MeSSSSage increased their capability and motivation to breastfeed, seek care as needed, and use contraception according to their preferences. Finally, participants suggested adding more topics to the educational content and adjusting the dynamics within the group calls to improve the intervention. Conclusions This study identifies the high acceptability and perceived impact of a novel postnatal care program in a rural setting, including the users' perceived barriers to engaging with the intervention and possible solutions to overcome them. These findings enable refinement of the ongoing intervention, providing a more robust framing for its scalability and long-term sustainability. On a larger scale, conclusions from this research provide new insights and encouragement to global stakeholders who aspire to improve maternal and neonatal outcomes in low-income and middle-income countries through mHealth.
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Affiliation(s)
| | | | | | - Navneet Gill
- Postgraduate Institute of Medical Education & Research
| | | | - Mona Duggal
- Postgraduate Institute of Medical Education & Research
| | | | - Rashmi Bagga
- Postgraduate Institute of Medical Education & Research
| | - Jasmeet Kaur
- Indraprastha Institute of Information Technology Delhi
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Peahl AF, Turrentine M, Srinivas S, King T, Zahn CM. Routine Prenatal Care. Obstet Gynecol Clin North Am 2023; 50:439-455. [PMID: 37500209 DOI: 10.1016/j.ogc.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
The one-size-fits-all model of prenatal care has remained largely unchanged since 1930. New models of prenatal care delivery can improve its efficacy, equity, and experience through tailoring prenatal care to meet pregnant people's medical and social needs. Key aspects of recently developed prenatal care models include visit schedules based on needed services, telemedicine, home measurement of routine pregnancy parameters, and interventions that address social and structural drivers of health. Several barriers that affect the individual, provider, health system, and policy levels must be addressed to facilitate implementation of new prenatal care delivery models.
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Affiliation(s)
- Alex F Peahl
- Department of Obstetrics and Gynecology, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI 48109, USA; University of Michigan Institute for Healthcare Policy and Innovation, 2800 Plymouth Road, Ann Arbor, MI 48109, USA.
| | - Mark Turrentine
- Department of Obstetrics and Gynecology, Baylor College of Medicine, 6651 Main Street, Suite F1020, Houston, TX 77030, USA
| | - Sindhu Srinivas
- Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Tekoa King
- University of California, San Francisco School of Nursing, 2 Koret Way, San Francisco, CA 94143, USA
| | - Christopher M Zahn
- American College of Obstetricians and Gynecologists, 409 12th Street Southwest, Washington, DC 20024, USA
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Atkinson J, Hastie R, Walker S, Lindquist A, Tong S. Telehealth in antenatal care: recent insights and advances. BMC Med 2023; 21:332. [PMID: 37649028 PMCID: PMC10470141 DOI: 10.1186/s12916-023-03042-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/21/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND For decades, antenatal care in high-resource settings has involved 12-14 face-to-face visits across pregnancy. The COVID-19 pandemic forced many care providers to rapidly embrace telehealth to reduce face-to-face visits. Here we review recent advances in telehealth used to provide antenatal care. MAIN BODY We conducted a narrative review examining the impact of telehealth on obstetric care. Two broad types of telehealth are used in antenatal care. The first is real-time telehealth, where consultations are done virtually instead of face-to-face. The second is remote monitoring, where in-clinic physical examinations are replaced with at-home alternatives. These can include blood pressure monitoring, fetal heart rate monitoring, and emerging technologies such as tele-ultrasound. Large cohort studies conducted during the pandemic era have shown that telehealth appears not to have increased adverse clinical outcomes for mothers or babies. However, further studies may be required to confidently conclude rare outcomes are unchanged, such as maternal mortality, serious morbidity, or stillbirth. Health economic studies suggest telehealth has the potential to reduce the financial cost of care provision. Telehealth in antenatal care seems to be acceptable to both pregnant women and healthcare providers. CONCLUSION Adoption of telehealth technologies may improve the antenatal care experience for women and reduce healthcare expenditure without adversely impacting health outcomes for the mother or baby. More studies are warranted to confirm telehealth does not alter the risk of rare outcomes such as maternal or neonatal mortality.
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Affiliation(s)
- Jessica Atkinson
- Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, 163 Studley Road, Heidelberg, VIC, 3084, Australia
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, VIC, Australia
| | - Roxanne Hastie
- Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, 163 Studley Road, Heidelberg, VIC, 3084, Australia
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, VIC, Australia
| | - Susan Walker
- Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, 163 Studley Road, Heidelberg, VIC, 3084, Australia
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, VIC, Australia
| | - Anthea Lindquist
- Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, 163 Studley Road, Heidelberg, VIC, 3084, Australia
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, VIC, Australia
| | - Stephen Tong
- Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, 163 Studley Road, Heidelberg, VIC, 3084, Australia.
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, VIC, Australia.
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Egloff C, Roques P, Picone O. Impact of COVID-19 on pregnant women's health: Consequences in obstetrics two years after the pandemic. J Reprod Immunol 2023; 158:103981. [PMID: 37390631 PMCID: PMC10266984 DOI: 10.1016/j.jri.2023.103981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 05/23/2023] [Accepted: 06/13/2023] [Indexed: 07/02/2023]
Abstract
The pandemic linked to SARS-CoV-2 has profoundly disrupted the health systems and many studies have led to a better understanding of this virus, which is responsible for severe disease, particularly during pregnancy. Pregnancy is a risk factor for severe COVID-19. Term of pregnancy and vaccination status is the main risk factor in addition to classic comorbidities like general population. COVID-19 during pregnancy is responsible for more maternal death, stillbirth, pre-eclampsia spontaneous and induced prematurity. Vaccination is therefore strongly recommended for pregnant patients. In addition, the COVID-19 pandemic has highlighted a psychological and social dimension that should not be neglected in the management of a pregnant patient. Correlation between immunological changes and clinical impact are described in this review. Many conclusions can now be made and are summarized in this article in order to discuss possible future research.
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Affiliation(s)
- Charles Egloff
- Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, AP-HP, Université de Paris, France.
| | - Pierre Roques
- Center for Immunology of Viral, Auto-immune, Hematological and Bacterial Diseases, (IMVA-HB/IDMIT), Université Paris-Saclay, INSERM, CEA, Fontenay-aux-Roses, Le Kremlin-Bicêtre, France; Virology Unit, Institut Pasteur de Guinée, Conakry, Guinea.
| | - Olivier Picone
- Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, AP-HP, Université de Paris, France; IAME Inserm, U1137, Paris, France; Groupe de Recherche Contre Les Infections au Cours de la Grossesse(GRIG), Velizy, France.
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21
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Bhattarai S, Yadav SK, Thapaliya B, Giri S, Bhattarai B, Sapkota S, Manandhar S, Arjyal A, Saville N, Harris-Fry H, Haghparast-Bidgoli H, Copas A, Hillman S, Baral SC, Morrison J. Contextual factors affecting the implementation of an anemia focused virtual counseling intervention for pregnant women in plains Nepal: a mixed methods process evaluation. BMC Public Health 2023; 23:1301. [PMID: 37415262 PMCID: PMC10326951 DOI: 10.1186/s12889-023-16195-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 06/26/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Anemia is estimated to cause 115,000 maternal deaths each year. In Nepal, 46% of pregnant women have anemia. As part of an integrated anemia-prevention strategy, family engagement and counseling of pregnant women can increase compliance to iron folic acid tablets, but marginalized women often have lower access to these interventions. We implemented the VALID (Virtual antenatal intervention for improved diet and iron intake) randomized controlled trial to test a family-focused virtual counseling mHealth intervention designed to inclusively increase iron folic acid compliance in rural Nepal; here we report findings from our process evaluation research. METHODS We conducted semi structured interviews with 20 pregnant women who had received the intervention, eight husbands, seven mothers-in-laws and four health workers. We did four focus groups discussions with intervention implementers, 39 observations of counseling, and used routine monitoring data in our evaluation. We used inductive and deductive analysis of qualitative data, and descriptive statistics of monitoring data. RESULTS We were able to implement the intervention largely as planned and all participants liked the dialogical counseling approach and use of story-telling to trigger conversation. However, an unreliable and inaccessible mobile network impeded training families about how to use the mobile device, arrange the counseling time, and conduct the counseling. Women were not equally confident using mobile devices, and the need to frequently visit households to troubleshoot negated the virtual nature of the intervention for some. Women's lack of agency restricted both their ability to speak freely and their mobility, which meant that some women were unable to move to areas with better mobile reception. It was difficult for some women to schedule the counseling, as there were competing demands on their time. Family members were difficult to engage because they were often working outside the home; the small screen made it difficult to interact, and some women were uncomfortable speaking in front of family members. CONCLUSIONS It is important to understand gender norms, mobile access, and mobile literacy before implementing an mHealth intervention. The contextual barriers to implementation meant that we were not able to engage family members as much as we had hoped, and we were not able to minimize in-person contact with families. We recommend a flexible approach to mHealth interventions which can be responsive to local context and the situation of participants. Home visits may be more effective for those women who are most marginalized, lack confidence in using a mobile device, and where internet access is poor.
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Affiliation(s)
- Sanju Bhattarai
- HERD International, Sainbu Awas Cr-10 Marga, Bhaisepati, Lalitpur, Nepal
| | | | - Bibhu Thapaliya
- HERD International, Sainbu Awas Cr-10 Marga, Bhaisepati, Lalitpur, Nepal
| | - Santosh Giri
- HERD International, Sainbu Awas Cr-10 Marga, Bhaisepati, Lalitpur, Nepal
| | - Basudev Bhattarai
- HERD International, Sainbu Awas Cr-10 Marga, Bhaisepati, Lalitpur, Nepal
| | - Suprich Sapkota
- HERD International, Sainbu Awas Cr-10 Marga, Bhaisepati, Lalitpur, Nepal
| | - Shraddha Manandhar
- HERD International, Sainbu Awas Cr-10 Marga, Bhaisepati, Lalitpur, Nepal
| | - Abriti Arjyal
- HERD International, Sainbu Awas Cr-10 Marga, Bhaisepati, Lalitpur, Nepal
| | - Naomi Saville
- UCL Institute for Global Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Helen Harris-Fry
- London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | | | - Andrew Copas
- UCL Institute for Global Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Sara Hillman
- UCL Institute for Women's Health, Rm 237C Medical School Building, 74 Huntley Street, London, WC1E 6AU, UK
| | | | - Joanna Morrison
- UCL Institute for Global Health, 30 Guilford Street, London, WC1N 1EH, UK.
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22
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Merz-Herrala AA, Kerns JL, Logan R, Gutierrez S, Marshall C, Diamond-Smith N. Contraceptive care in the United States during the COVID-19 pandemic: A social media survey of contraceptive access, telehealth use and telehealth quality. Contraception 2023; 123:110000. [PMID: 36871620 PMCID: PMC9985539 DOI: 10.1016/j.contraception.2023.110000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 03/07/2023]
Abstract
OBJECTIVES To examine demographic, socioeconomic, and regional differences in contraceptive access, differences between telehealth and in-person contraception visits, and telehealth quality in the United States during the COVID-19 pandemic. STUDY DESIGN We surveyed reproductive-age women about contraception visits during the COVID-19 pandemic via social media in July 2020 and January 2021. We used multivariable regression to examine relationships between age, racial/ethnic identity, educational attainment, income, insurance type, region, and COVID-19 related hardship, and ability to obtain a contraceptive appointment, telehealth vs in-person visits, and telehealth quality scores. RESULTS Among 2031 respondents seeking a contraception visit, 1490 (73.4%) reported any visit, of which 530 (35.6%) were telehealth. In adjusted analyses, lower odds of any visit was associated with Hispanic/Latinx and Mixed race/Other identity (aOR 0.59 [0.37-0.94], aOR 0.36 [0.22-0.59], respectively), the South, Midwest, Northeast (aOR 0.63 [0.47-0.85], aOR 0.64 [0.46-0.90], aOR 0.52 [CI 0.36-0.75], respectively), no insurance (aOR 0.63 [0.43-0.91]), greater COVID-19 hardship (aOR 0.52 [0.31-0.87]), and earlier pandemic timing (January 2021 vs July 2020 aOR 2.14 [1.69-2.70]). Respondents from the Midwest and South had lower odds of telehealth vs in-person care (aOR 0.63 [0.44-0.88], aOR 0.54 [0.40-0.72], respectively). Hispanic/Latinx respondents and those in the Midwest had lower odds of high telehealth quality (aOR 0.37 [0.17-0.80], aOR 0.58 [0.35-0.95], respectively). CONCLUSIONS We found inequities in contraceptive care access, less telehealth use for contraception visits in the South and Midwest, and lower telehealth quality among Hispanic/Latinx people during the COVID-19 pandemic. Future research should focus on telehealth access, quality, and patients' preferences. IMPLICATIONS Historically marginalized groups have faced disproportionate barriers to contraceptive care, and telehealth for contraceptive care has not been employed equitably during the COVID-19 pandemic. Though telehealth has the potential to improve access to care, inequitable implementation could exacerbate existing disparities.
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Affiliation(s)
- Allison A Merz-Herrala
- University of California, San Francisco, Department of Obstetrics, Gynecology and Reproductive Sciences, San Francisco, CA, United States.
| | - Jennifer L Kerns
- University of California, San Francisco, Department of Obstetrics, Gynecology and Reproductive Sciences, San Francisco, CA, United States
| | - Rachel Logan
- University of California, San Francisco, Department of Family and Community Medicine, San Francisco, CA, United States
| | - Sirena Gutierrez
- University of California, San Francisco, Department of Epidemiology and Biostatistics, San Francisco, CA, United States
| | - Cassondra Marshall
- School of Public Health, University of California, Berkeley, Berkeley, CA, United States
| | - Nadia Diamond-Smith
- University of California, San Francisco, Department of Epidemiology and Biostatistics, San Francisco, CA, United States
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23
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Silverio SA, De Backer K, Brown JM, Easter A, Khazaezadeh N, Rajasingam D, Sandall J, Magee LA. Reflective, pragmatic, and reactive decision-making by maternity service providers during the SARS-CoV-2 pandemic health system shock: a qualitative, grounded theory analysis. BMC Pregnancy Childbirth 2023; 23:368. [PMID: 37210485 DOI: 10.1186/s12884-023-05641-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/24/2023] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND Pregnant and postpartum women were identified as having particular vulnerability to severe symptomatology of SARS-CoV-2 infection, so maternity services significantly reconfigured their care provision. We examined the experiences and perceptions of maternity care staff who provided care during the pandemic in South London, United Kingdom - a region of high ethnic diversity with varied levels of social complexity. METHODS We conducted a qualitative interview study, as part of a service evaluation between August and November 2020, using in-depth, semi-structured interviews with a range of staff (N = 29) working in maternity services. Data were analysed using Grounded Theory analysis appropriate to cross-disciplinary health research. ANALYSIS & FINDINGS Maternity healthcare professionals provided their views, experiences, and perceptions of delivering care during the pandemic. Analysis rendered three emergent themes regarding decision-making during reconfigured maternity service provision, organised into pathways: 1) 'Reflective decision-making'; 2) 'Pragmatic decision-making'; and 3) 'Reactive decision-making'. Whilst pragmatic decision-making was found to disrupt care, reactive-decision-making was perceived to devalue the care offered and provided. Alternatively, reflective decision-making, despite the difficult working conditions of the pandemic, was seen to benefit services, with regards to care of high-quality, sustainability of staff, and innovation within the service. CONCLUSIONS Decision-making within maternity care was found to take three forms - where at best changes to services could be innovative, at worst they could cause devaluation in care being delivered, and more often than not, these changes were disruptive. With regard to positive changes, healthcare providers identified staff empowerment, flexible working patterns (both for themselves and collectively as teams), personalised care delivery, and change-making in general, as key areas to capitalise on current and ongoing innovations borne out of the pandemic. Key learnings included a focus on care-related, meaningful listening and engagement of staff at all levels, in order to drive forward high-quality care and avoid care disruption and devaluation.
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Affiliation(s)
- Sergio A Silverio
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, 6th Floor Addison House, Great Maze Pond, Southwark, London, SE1 1UL, UK.
| | - Kaat De Backer
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, 10th Floor North Wing, St. Thomas' Hospital, Westminster Bridge Road, Lambeth, London, SE1 7EH, UK
| | - Jeremy M Brown
- Health Research Institute, Medical School, Faculty of Health, Social Care & Medicine, Edge Hill University, St. Helen's Road, Ormskirk, L39 4QP, Lancashire, UK
| | - Abigail Easter
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, 10th Floor North Wing, St. Thomas' Hospital, Westminster Bridge Road, Lambeth, London, SE1 7EH, UK
| | - Nina Khazaezadeh
- Chief Midwifery Office, NHS England and Improvement, Wellington House, 133-155 Waterloo Road, Southwark, London, SE1 8UG, UK
| | - Daghni Rajasingam
- Maternity Services, St. Thomas' Hospital, Guy's and St. Thomas's NHS Foundation Trust, Westminster Bridge Road, Lambeth, London, SE1 7EH, UK
| | - Jane Sandall
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, 10th Floor North Wing, St. Thomas' Hospital, Westminster Bridge Road, Lambeth, London, SE1 7EH, UK
| | - Laura A Magee
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, 6th Floor Addison House, Great Maze Pond, Southwark, London, SE1 1UL, UK
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24
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Rayford MA, Morris JM, Phinehas R, Schneider E, Lund A, Baxley S, Wan JY, Goedecke PJ, Levi-D'Ancona R. Telehealth Utilization in High-Risk Pregnancies During COVID-19. TELEMEDICINE REPORTS 2023; 4:61-66. [PMID: 37283855 PMCID: PMC10240327 DOI: 10.1089/tmr.2023.0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 06/08/2023]
Abstract
Purpose To determine how telehealth has influenced outcomes in high-risk obstetrics patients during the Coronavirus disease 2019 (COVID-19) pandemic. Methods A retrospective chart review was conducted to identify patterns in both telehealth and in-person clinic visits among patients of a Maternal Fetal Medicine (MFM) department from the onset of the COVID-19 pandemic from March 2020 until October 2021. For the descriptive analysis, p-values were calculated using Wilcoxon rank sum for continuous variables and chi-square or Fisher exact (where cell n < 5) for categorical variables. Variables of interest were then tested for their univariate association with telehealth utilization using logistic regression. Variables found to meet the criterion of p < 0.2 in the univariate case were introduced into a multivariable logistic model with a backward elimination for determining variable retention. We aimed to analyze whether telehealth visits significantly impacted pregnancy outcomes. Results Four hundred nineteen high-risk patients visited the clinic via in-person and/or telehealth appointments during the study period: 320 patients without telehealth visits and 99 patients with telehealth visits. Care provided by telehealth visits was not found to be related to self-reported race (p = 0.81), maternal body mass index (p = 1.0), or maternal age (p = 0.53). Patients with private insurance were more likely to have telehealth visits than patients with public insurance (79.9% vs. 65.5%, p < 0.01). In univariate logistic analyses, patients with diagnoses of anxiety (p < 0.01), asthma (p = 0.03), and depression (p < 0.01), at the time care was established, were more likely to have telehealth visits. Those patients with telehealth visits did not have any statistical differences in mode of delivery (p = 0.2) or pregnancy outcomes (p = 0.12), including fetal demise, preterm delivery, or delivery at term as compared with patients with all in-office visits. In multivariable analysis, patient conditions of anxiety (p < 0.01), maternal obesity (p < 0.01), and twin pregnancy (p = 0.04) were associated with higher rates of telehealth visits. Conclusion Patients with certain pregnancy complications elected to have more telehealth visits. Patients with private insurance were more likely to have telehealth visits than patients with public insurance. There are benefits for patients with certain pregnancy complications to incorporate telehealth visits in addition to regularly scheduled in-person clinic visits and may be suitable in a post-pandemic setting as well. Further research in this field is needed to better understand the impact of implementing telehealth in high-risk obstetrics patients.
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Affiliation(s)
- Margie A. Rayford
- Department of Obstetrics and Gynecology, and University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Joshua M. Morris
- Department of Obstetrics and Gynecology, and University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Ramona Phinehas
- Department of Obstetrics and Gynecology, and University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Elizabeth Schneider
- Department of Obstetrics and Gynecology, and University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Amanda Lund
- Department of Obstetrics and Gynecology, and University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Sarah Baxley
- Department of Obstetrics and Gynecology, and University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Jim Y. Wan
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Patricia J. Goedecke
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Roberto Levi-D'Ancona
- Department of Obstetrics and Gynecology, and University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Department of Obstetrics and Gynecology, Southern Illinois University, Springfield, Illinois, USA
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25
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Ah-Kye L, Butt A, Gupta A, Timlin H, Daniel C, Uddin J, Thomas PBM, Sim DA, Ezra DG, Kang S. Introducing the 'Benign Eyelid Lesion Pathway': 1 year experience of synchronous tele-oculoplastics in a tertiary hospital. Eye (Lond) 2023; 37:1458-1463. [PMID: 35788698 PMCID: PMC10169839 DOI: 10.1038/s41433-022-02166-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/09/2022] [Accepted: 06/21/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Patients with benign eyelid lesions make up a large proportion of referrals to the oculoplastic service and lend themselves well to telemedicine with assessments heavily reliant on history, observation-based examination and photographs to enable management decision-making. Our tertiary unit set up tele-oculoplastics clinics for all new patients referred for benign eyelid lesions comprising tele-consultation with antecedent patient photograph: Benign Eyelid Lesion Pathway (BELP). One year on, we describe a retrospective analysis of 974 patients looking at distinct parameters of effectiveness. METHODS We retrospectively collected data from electronic patient records (EPR) for BELP patients from July 2020 to August 2021 (n = 974). We analysed time efficiency (referral time to treatment plan, consultation duration in minutes, average waiting times, number of patients seen per clinician and DNA rate), accessibility, safety (via video surveillance clinic) and theatre utilisation. RESULTS 57.3% (n = 558) were listed for a surgical procedure direct from tele-consultation with 94.9% (n = 513) of these proceeding to surgery; 22.8% (n = 222) were discharged, 10.7% (n = 104) had further video follow-up and 6.7% (n = 65) required face-to-face follow-up. Our results showed efficient referral-to-treatment times, waiting times, consultation times and non-attendance rate. There was only a 2.57% non-attendance rate. There was no missed diagnosis of a malignancy of a presumed benign lesion. CONCLUSION Tele-oculoplastics provides a streamlined, safe, effective, and logistically convenient way to review benign eyelid lesions. With the increased waiting times for referral to biopsy of eyelid lesions, this clinic shows it is imperative to provide digital accessibility for patient assessment and booking to operating theatre.
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Affiliation(s)
- Laura Ah-Kye
- Adnexal Department, Moorfields Eye Hospital NHS Foundation Trust, 162 City Rd, London, EC1V 2PD, UK.
| | - Anum Butt
- Adnexal Department, Moorfields Eye Hospital NHS Foundation Trust, 162 City Rd, London, EC1V 2PD, UK
| | - Ankur Gupta
- Adnexal Department, Moorfields Eye Hospital NHS Foundation Trust, 162 City Rd, London, EC1V 2PD, UK
| | - Hannah Timlin
- Adnexal Department, Moorfields Eye Hospital NHS Foundation Trust, 162 City Rd, London, EC1V 2PD, UK
| | - Claire Daniel
- Adnexal Department, Moorfields Eye Hospital NHS Foundation Trust, 162 City Rd, London, EC1V 2PD, UK
| | - Jimmy Uddin
- Adnexal Department, Moorfields Eye Hospital NHS Foundation Trust, 162 City Rd, London, EC1V 2PD, UK
| | - Peter B M Thomas
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Dawn A Sim
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Daniel G Ezra
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Swan Kang
- Adnexal Department, Moorfields Eye Hospital NHS Foundation Trust, 162 City Rd, London, EC1V 2PD, UK
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26
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Bruno B, Mercer MB, Hizlan S, Peskin J, Ford PJ, Farrell RM, Rose SL. Virtual prenatal visits associated with high measures of patient experience and satisfaction among average-risk patients: a prospective cohort study. BMC Pregnancy Childbirth 2023; 23:234. [PMID: 37024808 PMCID: PMC10077310 DOI: 10.1186/s12884-023-05421-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 02/02/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Virtual visits have the potential to decrease barriers to prenatal care stemming from transportation, work, and childcare concerns. However, data regarding patient experience and satisfaction with virtual visits remain limited in obstetrics. To address this gap, we explore average-risk pregnant women's experiences with virtual visits and compare satisfaction with virtual vs. in-person visits as a secondary aim. METHODS In this IRB-approved, prospective cohort study, we surveyed pregnant women after their first virtual visit between October 7, 2019 and March 20, 2020. Using heterogeneous purposive sampling, we identified a subset of respondents with diverse experiences and opinions for interviews. For comparison, Consumer Assessment of Healthcare Providers and Systems (CAHPS) satisfaction data were collected after in-person visits during the study timeframe from a control cohort with the same prenatal providers. Logistic regression controlling for age, previous pregnancies, and prior live births compared satisfaction data between virtual and in-person visits. Other quantitative survey data were analyzed through descriptive statistics. Free text survey responses and interview data were analyzed using content analysis. RESULTS Ninety five percent (n = 165/174) of surveys and 90% (n = 18/20) of interviews were completed. Most participants were Caucasian, married, and of middle to high income. 69% (114/165) agreed that their virtual appointment was as good as in-person; only 13% (21/165) disagreed. Almost all (148/165, 90%) would make another virtual appointment. Qualitative data highlighted ease of access, comparable provider-patient communication, confidence in care quality, and positive remote monitoring experiences. Recognizing these advantages but also inherent limitations, interviews emphasized interspersing telemedicine with in-person prenatal encounters. CAHPS responses after in-person visits were available for 60 patients. Logistic regression revealed no significant difference in three measures of satisfaction (p = 0.16, 0.09, 0.13) between virtual and in-person visits. CONCLUSIONS In an average-risk population, virtual prenatal visits provide a patient-centered alternative to traditional in-person encounters with high measures of patient experience and no significant difference in satisfaction. Obstetric providers should explore telemedicine to improve access - and, during the ongoing pandemic, to minimize exposures - using patients' experiences for guidance. More research is needed regarding virtual visits' medical quality, integration into prenatal schedules, and provision of equitable care for diverse populations.
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Affiliation(s)
- Bethany Bruno
- Department of Obstetrics & Gynecology, Medical University of South Carolina, Charleston, SC, 29425, USA.
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, 44195, USA.
| | - Mary Beth Mercer
- Office of Patient Experience, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Sabahat Hizlan
- Office of Patient Experience, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Julian Peskin
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, 44195, USA
- OB/GYN and Women's Health Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Paul J Ford
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, 44195, USA
- Center for Bioethics, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Ruth M Farrell
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, 44195, USA
- OB/GYN and Women's Health Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
- Center for Bioethics, Cleveland Clinic, Cleveland, OH, 44195, USA
- Genomic Medicine Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Susannah L Rose
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, 44195, USA
- Office of Patient Experience, Cleveland Clinic, Cleveland, OH, 44195, USA
- Center for Bioethics, Cleveland Clinic, Cleveland, OH, 44195, USA
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Novoa RH, Meza-Santibañez L, Rodríguez-Hilario N, Torres-Osorio J, Jáuregui-Canchari V, Huang-Yang X, Melgarejo WE, Bazo-Alvarez JC, Ventura W. Development of a Mobile Health Application Based on a Mixed Prenatal Care in the Context of COVID-19 Pandemic. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:179-185. [PMID: 37224839 PMCID: PMC10208727 DOI: 10.1055/s-0043-1768998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
OBJECTIVE We describe the development and structure of a novel mobile application in a mixed model of prenatal care, in the context of the COVID-19 pandemic. Furthermore, we assess the acceptability of this mobile app in a cohort of patients. METHODS First, we introduced a mixed model of prenatal care; second, we developed a comprehensive, computer-based clinical record to support our system. Lastly, we built a novel mobile app as a tool for prenatal care. We used Flutter Software version 2.2 to build the app for Android and iOS smartphones. A cross-sectional study was carried out to assess the acceptability of the app. RESULTS A mobile app was also built with the main attribute of being connected in real-time with the computer-based clinical records. The app screens detail information about activities programmed and developed in the prenatal care according to gestational age. A downloadable maternity book is available and some screens show warning signs and symptoms of pregnancy. The acceptability assessment was mostly rated positively regarding the characteristics of the mobile app, by 50 patients. CONCLUSION This novel mobile app was developed as a tool among pregnant patients to increase the information available about their pregnancies in the provision of a mixed model of prenatal care in the context of the COVID-19 pandemic. It was fully customized to the needs of our users following the local protocols. The introduction of this novel mobile app was highly accepted by the patients.
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28
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Abstract
The American College of Obstetrics and Gynecology recommends influenza vaccine annually, Tdap with each pregnancy, and COVID-19 vaccine for those not previously vaccinated or who are due for boosters. The influenza and COVID-19 vaccines are safe during pregnancy and are effective in reducing morbidity in both the pregnant person and infant. The Tdap vaccine is given primarily to protect the newborn from pertussis through transplacental antibody transfer. Methods to enhance vaccination rates include stocking and giving vaccines in the obstetric office, recommending eligible vaccines at each visit, and focusing on the health of the infant in conversations with patients.
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Affiliation(s)
- Cynthia M Rand
- Department of Pediatrics, University of Rochester Medical Center, 601 Elmwood Avenue, Box 777, Rochester, NY 14642, USA.
| | - Courtney Olson-Chen
- Department of Obstetrics & Gynecology, University of Rochester Medical Center, 601 Elmwood Avenue, Box 668, Rochester, NY 14642, USA
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29
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Chaput KH, Freeman M, McMorris C, Metcalfe A, Cameron EE, Jung J, Tough S, Hicks LM, Dimidjian S, Tomfohr-Madsen LM. Effect of Remote Peer-Counsellor- delivered Behavioral Activation and Peer-support for Antenatal Depression on Gestational Age at Delivery: a single-blind, randomized control trial. Trials 2023; 24:240. [PMID: 36997966 PMCID: PMC10061403 DOI: 10.1186/s13063-023-07077-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/05/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Antenatal depression (AD) is the most common complication of pregnancy in developed countries and increases the risk of preterm birth (PTB). Many pregnant individuals with AD do not obtain treatment due in part to risks associated with antidepressant medications, the expense and wait times for psychological services, and perceived stigma. Accessible and timely treatment of antenatal depression is crucial to minimize foetal impacts and associated long-term child health outcomes. Previous studies show that behavioural activation and peer support are promising avenues of treatment for perinatal depression. Additionally, remote and paraprofessional counselling interventions show promise as more accessible, sustainable, and cost-effective treatment avenues than traditional psychological services. The primary aim of this trial is to test the effectiveness of a remote, behavioural activation and peer support intervention, administered by trained peer para-professionals, for increasing gestational age at delivery among those with antenatal depression. The secondary aims are to evaluate the effectiveness for treating AD prior to delivery, with persistence into the postpartum; improving anxiety symptoms; and improving parenting self-efficacy compared to controls. METHODS A two-arm, single-blinded, parallel groups randomized controlled trial (RCT) with repeated measures will be conducted. Participants scoring >10 on the Edinburgh Postnatal Depression Scale will be recruited from the larger P3 cohort and invited to enroll. Assessments will be conducted prior to 27 weeks' gestation at trial intake (T1), post-intervention, prior to delivery (T2), 5-6 months postpartum (T3), and 11-12 months postpartum (T4) and will include self-report questionnaires and linked medical records. DISCUSSION Our remote, peer paraprofessional-delivered behavioural activation plus peer support intervention has the potential to successfully reduce symptoms of AD, which may in turn decrease the risk of PTB and subsequent health impacts. The current trial builds on previous findings and uses a patient-oriented approach to address priorities for patient care and to provide a cost-effective, accessible, and evidence-based treatment to pregnant individuals with AD. TRIAL REGISTRATION International Standard Randomised Controlled Trial Number (ISRCTN) registry (ISRCTN51098220) ISRCTN51098220. Registered on April 7, 2022.
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Affiliation(s)
- Kathleen H Chaput
- Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, 2500 University Drive, NW, Calgary, AB, T2N 1N4, Canada.
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Bowman M, Jalink M, Sharpe I, Srivastava S, Wijeratne DT. Videoconferencing interventions and COPD patient outcomes: A systematic review. J Telemed Telecare 2023:1357633X231158140. [PMID: 36883234 DOI: 10.1177/1357633x231158140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
INTRODUCTION Videoconferencing circumvents various physical and financial barriers associated with in-person care. Given this technology's potential benefits and timely nature, we conducted a systematic review to understand how videoconferencing for chronic obstructive pulmonary disease (COPD) follow-up care affects patient-related outcomes. METHODS We included primary research evaluating the use of bidirectional videoconferencing for COPD patient follow-up. The outcomes of interest were resource utilization, mortality, lifestyle factors, patient satisfaction, barriers, and feasibility. We searched MEDLINE, EMBASE, EBM Reviews, and CINAHL databases for articles published from January 1, 2010, to August 2, 2021. Relevant information was extracted and presented descriptively and common themes and patterns were identified. The risk of bias for each study was assessed using design-specific validated tools. RESULTS We included 39 studies of 18,194 patients (22 quantitative, 12 qualitative, and 5 mixed methods). The included studies were grouped by type of intervention; 18 studies explored videoconferencing for exercise, 19 explored videoconferencing for clinical assessment/monitoring, and 2 examined videoconferencing for education. Generally, videoconferencing was associated with high levels of patient satisfaction. There were mixed results in terms of its effects on resource utilization and lifestyle-related factors. Additionally, 12 studies were at high risk of bias, indicating that these results should be interpreted with caution. CONCLUSIONS The videoconferencing interventions resulted in high levels of patient satisfaction, despite facing technological issues. Overall, more research is needed to better understand the effects of videoconferencing interventions on resource utilization and other patient outcomes, quantifying their advantages over in-person care.
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Affiliation(s)
- Meghan Bowman
- Department of Public Health Sciences, 4257Queen's University, Kingston, Ontario, Canada
| | - Matthew Jalink
- Department of Public Health Sciences, 4257Queen's University, Kingston, Ontario, Canada
- Department of Medicine, 4257Queen's University, Kingston, Ontario, Canada
| | - Isobel Sharpe
- Department of Public Health Sciences, 4257Queen's University, Kingston, Ontario, Canada
| | | | - Don Thiwanka Wijeratne
- Department of Public Health Sciences, 4257Queen's University, Kingston, Ontario, Canada
- Department of Medicine, 4257Queen's University, Kingston, Ontario, Canada
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Bernstein HH, Slora EJ, Mathias-Prabhu T, Park HS, Spino C. Association of Severe Acute Respiratory Syndrome Coronavirus 2 Infection With Early Breastfeeding. Acad Pediatr 2023; 23:343-350. [PMID: 36240984 PMCID: PMC9554206 DOI: 10.1016/j.acap.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 09/07/2022] [Accepted: 10/04/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVE The association of maternal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) status before delivery with breastfeeding is unknown. This study compares breastfeeding initiation, exclusivity, and duration between SARS-CoV-2-positive (+) and SARS-CoV-2-negative (-) mothers during the first 2 months of their newborns' lives. METHODS A single center, retrospective cohort study of pediatric contacts during the first 2 months in a diverse mother-infant population (n = 285) compared breastfeeding outcomes by maternal SARS-CoV-2 status during a pandemic surge. Infants of SARS-CoV-2 positive mothers were also tested before discharge. Comparison of maternal demographics (age, race, ethnicity), maternal/infant characteristics (parity, insurance, delivery mode, infant sex, hospital length of stay), and pediatric contacts by maternal SARS-CoV-2 status included Fisher's exact and Wilcoxon tests and Poisson regression for count outcomes. Logistic regression compared breastfeeding outcomes between the 2 groups, adjusting for potential confounders and effect modifiers. RESULTS Maternal demographics and maternal/infant characteristics were similar. While 19% of mothers tested positive for SARS-CoV-2 (n = 54), their infants were all negative. SARS-CoV-2 positive mothers had fewer in-person, but more virtual pediatric contacts. After controlling for the above variables, SARS-CoV-2 positive mothers had lower odds of breastfeeding initiation within 1 to 7 days of life (78% vs 88%; adjusted odds ratio [aOR] = 0.40, 95% confidence interval [CI]: 0.17, 0.96) and of any breastfeeding during month 2 (54% vs 76%; aOR = 0.37, 95% CI: 0.16, 0.86) compared with SARS-CoV-2 negative mothers. CONCLUSIONS Maternal SARS-CoV-2 positivity at delivery was independently associated with less initiation and shorter duration of any breastfeeding during month 2. SARS-CoV-2 positive women would likely benefit from additional breastfeeding support during pandemic surges.
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Affiliation(s)
- Henry H Bernstein
- Cohen Children's Medical Center (HH Bernstein, EJ Slora, T Mathias-Prabhu, and HS Park), New Hyde Park, NY; Zucker School of Medicine at Hofstra/Northwell (HH Bernstein), Hempstead, NY.
| | - Eric J Slora
- Cohen Children's Medical Center (HH Bernstein, EJ Slora, T Mathias-Prabhu, and HS Park), New Hyde Park, NY
| | - Tara Mathias-Prabhu
- Cohen Children's Medical Center (HH Bernstein, EJ Slora, T Mathias-Prabhu, and HS Park), New Hyde Park, NY
| | - Hee Su Park
- Cohen Children's Medical Center (HH Bernstein, EJ Slora, T Mathias-Prabhu, and HS Park), New Hyde Park, NY
| | - Cathie Spino
- University of Michigan (C Spino), Ann Arbor, Mich
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Holman C, Glover A, McKay K, Gerard C. Telehealth Adoption During COVID-19: Lessons Learned from Obstetric Providers in the Rocky Mountain West. TELEMEDICINE REPORTS 2023; 4:1-9. [PMID: 36875737 PMCID: PMC9983124 DOI: 10.1089/tmr.2023.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Obstetric providers have used telemedicine to manage gestational diabetes, mental health, and prenatal care. However, the uptake of telemedicine in this field has not been universal. The COVID-19 pandemic catalyzed the adoption of telehealth in obstetric care, which will have lasting effects, especially for rural communities. We sought to understand the experience of adapting to telehealth among obstetric providers in the Rocky Mountain West to identify implications for policy and practice. METHODS This study included 20 semi-structured interviews with obstetric providers in Montana, Idaho, and Wyoming. The interviews followed a moderator's guide based on the Aday & Andersen Framework for the Study of Access to Medical Care, exploring domains of health policy, the health system, the utilization of health services, and the population at risk. All the interviews were recorded, transcribed, and analyzed using thematic analysis. RESULTS Findings indicate that participants view telehealth as a useful tool during prenatal and postpartum care; many participants intend to continue telehealth practices after the pandemic. Participants shared that their patients reported benefits to telehealth beyond COVID-19 safety, including limiting travel time, reducing time off work, and alleviating childcare needs. Participants expressed concern that expanding telehealth will not equally benefit all patients and could widen existing health inequities. DISCUSSION Success moving forward will require a telehealth infrastructure, adaptive telehealth models, and provider and patient training. As obstetric telehealth expands, efforts must prioritize equitable access for rural and low-income communities, so all patients can benefit from the technological advancements to support health.
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Affiliation(s)
- Carly Holman
- Rural Institute for Inclusive Communities, University of Montana, Missoula, Montana, USA
| | - Annie Glover
- Rural Institute for Inclusive Communities, University of Montana, Missoula, Montana, USA
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana, USA
| | - Kimber McKay
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana, USA
| | - Courtney Gerard
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana, USA
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Fernandes BA, Alves B, Matosinhos AC, Calácio e Silva BL, Dias R, Hasparyk UG, Damásio J, Bastos FM, Simões e Silva AC. The use and role of telemedicine in maternal fetal medicine around the world: an up-to-date. HEALTH AND TECHNOLOGY 2023; 13:365-372. [PMID: 36846740 PMCID: PMC9942621 DOI: 10.1007/s12553-023-00742-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 02/16/2023] [Indexed: 02/23/2023]
Abstract
Purpose The aim of this narrative review is to sumarize data about the use and role of telemedicine in maternal fetal medicine (MFM). Methods We searched pubmed and scopus to find articles about telemedicine in MFM by using the terms telmedicine or telehealth and maternal fetal medicine. Results Telehealth has been widely used for several medical specialties. During the coronavirus disease 2019 (COVID-19) pandemic, telehealth has gained investment and further research. Even though telemedicine in MFM has not been frequently applied, from 2020 onwards it has increased in both implementation and acceptance worldwide. The need to screen the patients in overloaded centers in a pandemic scenario required telemedicine in MFM, which has exhibited consistently good results concerning health and budget. The aim of this study was to review the telehealth programs and research focused on MFM around the world. Few studies have been applied to MFM and even fewer in developing and undeveloped countries. The majority of studies were concentrated in the USA and in Europe. Conclusion Further research is needed, especially in non-developed countries, to comprehend the potential role of telemedicine in MFM for improving the life quality of the patients, health professionals, and to be cost-efficient.
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Affiliation(s)
- Bruna Achtschin Fernandes
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG Brazil
| | - Bernardo Alves
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG Brazil
| | - Ana Carolina Matosinhos
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG Brazil
| | - Bárbara Linhares Calácio e Silva
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG Brazil
| | - Raphael Dias
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG Brazil
| | - Ursula Gramiscelli Hasparyk
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG Brazil
| | - Júlia Damásio
- Department of Gynecology and Obstetrics, Service of Fetal Medicine, Faculty of Medicine, UFMG, Belo Horizonte, MG Brazil
| | - Fernando Macedo Bastos
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG Brazil
- Department of Gynecology and Obstetrics, Service of Fetal Medicine, Faculty of Medicine, UFMG, Belo Horizonte, MG Brazil
| | - Ana Cristina Simões e Silva
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG Brazil
- Department of Pediatrcs, Faculty of Medicine, UFMG. Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, UFMG, Avenida Alfredo Balena, 190, 2nd floor, room #281, 30130-100 Belo Horizonte, MG Brazil
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Cai F, McCabe M, Srinivas SK. A randomized trial assessing the impact of educational podcasts on personal control and satisfaction during childbirth. Am J Obstet Gynecol 2023; 228:592.e1-592.e10. [PMID: 36791987 DOI: 10.1016/j.ajog.2023.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/19/2023] [Accepted: 01/19/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Childbirth education can help pregnant individuals feel in control, relieve anxiety and fear, and decrease pain perception. However, many barriers exist that impede patients from obtaining adequate childbirth education, especially in the era of the COVID-19 pandemic. Advances in technology, such as podcasts, can allow for asynchronous patient education. OBJECTIVE This study aimed to assess the effect of a labor education podcast on personal perception of control and patient satisfaction during childbirth. STUDY DESIGN This was a randomized controlled trial that included nulliparous, low-risk women with singleton gestations who reached 36 weeks' gestation at 2 academic hospitals in Philadelphia, Pennsylvania. Participants were randomized at 28 weeks and 0 days of gestation to usual education (control) or podcast education (intervention), which included links to 7 labor-related podcast episodes on patient-suggested topics that were available on widely-used podcatchers. Primary outcomes were assessed with a 3-question birth satisfaction survey and the Labour Agentry Scale to evaluate personal perception of control during childbirth. Secondary outcomes included the Edinburgh Postnatal Depression Scale score. Analyses were performed as intention-to-treat. Parametric and nonparametric data were compared using the Student t-test or Wilcoxon rank-sum test, as appropriate. RESULTS A total of 201 women were randomized, and 153 were included in the final analysis (78 in podcast and 75 in control group). There were no significant differences in maternal demographics. Patients in the podcast group had higher median birth satisfaction scores compared with the control group (20 [18-21] vs 18 [16-21]; P=.002), without a significant difference in median Labour Agentry Scale scores (57 [50-63] vs 54 [47-62]; P=.12). When restricting analysis to patients who underwent induction, Labour Agentry Scale scores were significantly higher in the podcast group (58 [53-64] vs 54 [47-61]; P=.045), representing an increased perception of control. However, birth satisfaction score was not different between the groups (P=.06). The most downloaded podcasts were on induction and labor anesthesia. More than 95% of participants would recommend the podcasts to family and friends. CONCLUSION An educational podcast on labor topics was well-received, increased patient satisfaction overall, and increased labor agentry among those who were induced. Podcasts are a promising educational modality to improve patient experience during childbirth, and warrant further exploration.
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Affiliation(s)
- Fei Cai
- Division of Maternal Fetal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Meaghan McCabe
- Division of Maternal Fetal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sindhu K Srinivas
- Division of Maternal Fetal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Henke RM. Knowing Well, Being Well: well-being born of understanding: The COVID-19 Pandemic and Children: Implications for Future Health. Am J Health Promot 2023; 37:263-288. [PMID: 36646664 DOI: 10.1177/08901171221140641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Ghimire S, Martinez S, Hartvigsen G, Gerdes M. Virtual prenatal care: A systematic review of pregnant women's and healthcare professionals' experiences, needs, and preferences for quality care. Int J Med Inform 2023; 170:104964. [PMID: 36565547 DOI: 10.1016/j.ijmedinf.2022.104964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 11/10/2022] [Accepted: 12/02/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Exploitation of telehealth in prenatal care has the potential to reduce the access barrier to care and empower women to participate in their own care. This review aims to assess the practical implications of virtual prenatal care and identify the needs and experiences associated with it. METHODS A systematic literature review was conducted in four electronic databases: PubMed, Web of Science, Scopus, and Cochrane. The keywords used were "pregnancy", "virtual visit", "prenatal", and others. The search included all relevant studies published from 2011 to 2021 written in English. Articles mentioning virtual prenatal care incorporating synchronous communication between pregnant women and health care professionals were included. Those unrelated to prenatal care or employing asynchronous means of virtual care were excluded. The review was structured following the PRISMA guidelines. Different quality appraisal methods such as JBI, CASP, NOS, and Cochrane were used to assess the methodological quality of the literature. The data were then analyzed based on the categorization of the studies. RESULTS Overall, 2863 articles were identified, of which 19 met the inclusion criteria after removing duplicates, screening of abstracts, and full text-four articles identified from hand-searching were incorporated, making a total of 23 eligible articles for the review. The studies' findings revealed the preference for implementing cost-effective virtual care based on the resource set, technological literacy, and consistent accessibility. Further, no significant differences in clinical outcomes were observed between two modes of care, virtual and in-person. The higher satisfaction by pregnant women and healthcare professionals indicated the continuity of the care. In addition, the hybrid model of virtual prenatal care integrated with traditional in-person care was acceptable to both low-risk and high-risk pregnant women. Virtual prenatal care substantially reduced travel time and absences from work, drops in clinic wait time and no-show rate, limited the risk of exposure during a pandemic, and increased self-accountability. CONCLUSION Virtual prenatal care offers predominant advantages over in-person when it is carefully designed with the inclusion of pregnant women and healthcare professionals' needs. Evidence showed that providing adequate technology training, proper instruction, and guidelines for initial setup and assurance of a reliable and accessible system is vital in increasing access to care.
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Affiliation(s)
- Sarala Ghimire
- Department of Information and Communication Technologies, Centre for e-Health, University of Agder, Grimstad, Norway.
| | - Santiago Martinez
- Department of Health and Nursing Sciences, Centre for e-Health, University of Agder, Grimstad, Norway
| | - Gunnar Hartvigsen
- Department of Health and Nursing Sciences, Centre for e-Health, University of Agder, Grimstad, Norway
| | - Martin Gerdes
- Department of Information and Communication Technologies, Centre for e-Health, University of Agder, Grimstad, Norway
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Changes to Prenatal Care Visit Frequency and Telehealth: A Systematic Review of Qualitative Evidence. Obstet Gynecol 2023; 141:299-323. [PMID: 36649343 DOI: 10.1097/aog.0000000000005046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/20/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To systematically review patient, partner or family, and clinician perspectives, preferences, and experiences related to prenatal care visit schedules and televisits for routine prenatal care. DATA SOURCES PubMed, the Cochrane databases, EMBASE, CINAHL, ClinicalTrials.gov , PsycINFO, and SocINDEX from inception through February 12, 2022. METHODS OF STUDY SELECTION This review of qualitative research is a subset of a larger review on both the qualitative experiences and quantitative benefits and harms of reduced prenatal care visit schedules and televisits for routine prenatal care that was produced by the Brown Evidence-based Practice Center for the Agency for Healthcare Research and Quality. For the qualitative review, we included qualitative research studies that examined perspectives, preferences, and experiences about the number of scheduled visits and about televisits for routine prenatal care. TABULATION, INTEGRATION, AND RESULTS We synthesized barriers and facilitators to the implementation of reduced care visits or of televisits into 1 of 14 domains defined by the Theoretical Domains Framework (TDF) and a Best Fit Framework approach. We summarized themes within TDF domains. We assessed our confidence in the summary statements using the GRADE-CERQual (Grading of Recommendations Assessment, Development and Evaluation-Confidence in Evidence from Reviews of Qualitative research) tool. Four studies addressed the number of scheduled routine prenatal visits, and five studies addressed televisits. Across studies, health care professionals believed fewer routine visits may be more convenient for patients and may increase clinic capacity to provide additional care for patients with high-risk pregnancies. However, both patients and clinicians had concerns about potential lesser care with fewer visits, including concerns about quality of care and challenges with implementing new delivery-of-care models. CONCLUSION Although health care professionals and patients had some concerns about reduced visit schedules and use of televisits, several potential benefits were also noted. Our synthesis of qualitative evidence provides helpful insights into the perspectives, preferences, and experiences of important stakeholders with respect to implementing changes to prenatal care delivery that may complement findings of traditional quantitative evidence syntheses. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42021272287.
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Witt WP, Harlaar N, Palmer A. The Impact of COVID-19 on Pregnant Women and Children: Recommendations for Health Promotion. Am J Health Promot 2023; 37:282-288. [PMID: 36646662 DOI: 10.1177/08901171221140641e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
COVID-19 continues to have severe repercussions on children and pregnant women. The repercussions include not only the direct impact of COVID-19 (ie, children getting infected by COVID-19) but also indirect impacts (eg, safeguarding from child maltreatment, obesogenic behaviors, language and socioemotional development, educational consequences [eg, interrupted learning]; social isolation; mental health; behavioral health [eg, increased substance use in adolescence]; health and economic impact of COVID-19 on caregivers and family relationships. It has also shed light on long-standing structural and socioeconomic issues, including equity in nutrition and food security, housing, childcare, and internet access. Using a socioecological, life course, and population health approach, we discuss the implications for pregnant women and children's health and well-being and give recommendations for mitigating the short and long-term deleterious impact COVID- 19 on women, children, and their families.
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Sullivan C, Cazin M, Higa C, Zalud I, Lee MJ. Maternal telehealth: innovations and Hawai'i perspectives. J Perinat Med 2023; 51:69-82. [PMID: 36367993 DOI: 10.1515/jpm-2022-0394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/27/2022] [Indexed: 11/13/2022]
Abstract
Access to maternal-fetal medicine (MFM) subspecialty services is a critical part of a healthcare system that optimizes pregnancy outcomes for women with complex medical and obstetrical disorders. Healthcare services in the State of Hawai'i consist of a complicated patchwork of independently run community health clinics and hospital systems which are difficult for many pregnant patients to navigate. Maternal telehealth services have been identified as a solution to increase access to subspecialty prenatal services for women in rural communities or neighboring islands, especially during the COVID-19 pandemic. Telehealth innovations have been rapidly developing in the areas of remote ultrasound, hypertension management, diabetes management, and fetal monitoring. This report describes how telehealth innovations are being introduced by MFM specialists to optimize care for a unique population of high-risk patients in a remote area of the world such as Hawai'i, as well as review currently available telemedicine technologies and future innovations.
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Affiliation(s)
- Cathlyn Sullivan
- Department of OB/GYN and Women's Health, Division of Maternal Fetal Medicine, University of Hawai'i, John A. Burns School of Medicine, Honolulu, HI, USA
| | | | - Christina Higa
- Social Science Research Institute, University of Hawai'i, College of Social Sciences, Honolulu, HI, USA
| | - Ivica Zalud
- Department of OB/GYN and Women's Health, Division of Maternal Fetal Medicine, University of Hawai'i, John A. Burns School of Medicine, Honolulu, HI, USA
| | - Men-Jean Lee
- Department of OB/GYN and Women's Health, Division of Maternal Fetal Medicine, University of Hawai'i, John A. Burns School of Medicine, Honolulu, HI, USA
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Dewi A, Safaria T, Supriyatiningsih S, Dewi DTK. Efforts and expectations of pregnant women against the impact of the COVID-19 pandemic: a phenomenological study. BMC Pregnancy Childbirth 2023; 23:53. [PMID: 36681793 PMCID: PMC9862243 DOI: 10.1186/s12884-023-05383-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 01/16/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND COVID-19 is a global threat that directly impacts people's mental health and physical well-being. This study explored the efforts and expectations of pregnant women against the impact of the COVID-19 pandemic. METHODS This study was a qualitative study that used a phenomenological approach. The informants of this study were pregnant women (n = 20). Data analysis used content analysis with software assistance (Nvivo Release 1.5). RESULTS The results of this study identified three themes which were: 1) causative factors of pregnant women's anxiety regarding the impact of COVID-19 including lack of knowledge regarding the impact of the COVID-19 virus and perceived susceptibility; 2) Efforts to reduce anxiety during the COVID-19 pandemic including a spiritual approach, the role of family and COVID-19 prevention; and 3) Expectation regarding healthcare services during COVID-19 including virtual based Antenatal Care (ANC) Services and Private ANC Services. CONCLUSION A spiritual approach, the role of family, and COVID-19 prevention will help pregnant women reduce their anxiety about being infected with the COVID-19 virus. Furthermore, virtual-based ANC Services, and private ANC services, such as home visits and dividing ANC services and general services into two different tracks as a protective mechanism from being infected with the COVID-19 virus, would assist pregnant women feel safer and secure.
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Affiliation(s)
- Arlina Dewi
- grid.444658.f0000 0004 0375 2195Department of Public Health, Master of Hospital Administration, Universitas Muhammadiyah Yogyakarta, Yogyakarta, Indonesia
| | - Triantoro Safaria
- grid.444626.60000 0000 9226 1101Department of Psychology, Faculty of Psychology, Ahmad Dahlan University, Yogyakarta, Indonesia
| | - Supriyatiningsih Supriyatiningsih
- grid.444658.f0000 0004 0375 2195Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Universitas Muhammadiyah Yogyakarta, Yogyakarta, Indonesia
| | - Dyah Tri Kusuma Dewi
- grid.444658.f0000 0004 0375 2195Department of Public Health, Master of Hospital Administration, Universitas Muhammadiyah Yogyakarta, Yogyakarta, Indonesia ,grid.412896.00000 0000 9337 0481School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
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Kern-Goldberger AR, Sheils NE, Ventura MEM, Paderanga AJA, Janer CD, Donato PRB, Asch DA, Srinivas SK. Patterns of Prenatal Care Delivery and Obstetric Outcomes before and during the COVID-19 Pandemic. Am J Perinatol 2023; 40:582-588. [PMID: 36228651 DOI: 10.1055/a-1960-2682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Health care providers and health systems confronted new challenges to deliver timely, high-quality prenatal care during the coronavirus disease 2019 (COVID-19) pandemic as the pandemic raised concerns that care would be delayed or substantively changed. This study describes trends in prenatal care delivery in 2020 compared with 2018 to 2019 in a large, commercially insured population and investigates changes in obstetric care processes and outcomes. STUDY DESIGN This retrospective cohort study uses de-identified administrative claims for commercially insured patients. Patients whose entire pregnancy took place from March 1 to December 31 in years 2018, 2019, and 2020 were included. Trends in prenatal care, including in-person, virtual, and emergency department visits, were evaluated, as were prenatal ultrasounds. The primary outcome was severe maternal morbidity (SMM). Secondary outcomes included preterm birth and stillbirth. To determine whether COVID-19 pandemic-related changes in prenatal care had an impact on maternal outcomes, we compared the outcome rates during the pandemic period in 2020 to equivalent periods in 2018 and 2019. RESULTS In total, 35,112 patients were included in the study. There was a significant increase in the prevalence of telehealth visits, from 1.1 to 1.2% prior to the pandemic to 17.2% in 2020, as well as a significant decrease in patients who had at least one emergency department visit during 2020. Overall prenatal care and ultrasound utilization were unchanged. The rate of SMM across this period was stable (2.3-2.8%) with a statistically significant decrease in the preterm birth rate in 2020 (7.4%) compared with previous years (8.2-8.6%; p < 0.05) and an unchanged stillbirth rate was observed. CONCLUSION At a time when many fields of health care were reshaped during the pandemic, these observations reveal considerable resiliency in both the processes and outcomes of obstetric care. KEY POINTS · Overall prenatal care and ultrasound were unchanged from 2018 to 2019 to 2020.. · There was a large increase in the prevalence of telehealth visits in 2020.. · There was no change in the rate of severe maternal morbidity or stillbirth in 2020 compared with 2018 to 2019..
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Affiliation(s)
- Adina R Kern-Goldberger
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | | | | | | | - David A Asch
- Department of Medicine, Penn Medicine Center for Health Care Innovation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sindhu K Srinivas
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Berniak-Woźny J, Rataj M. Towards Green and Sustainable Healthcare: A Literature Review and Research Agenda for Green Leadership in the Healthcare Sector. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:908. [PMID: 36673663 PMCID: PMC9858978 DOI: 10.3390/ijerph20020908] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
The health sector is one of the keys to sustainable development. Although it is directly related to only one Sustainable Development Goal (Goal 3, "Ensuring a healthy life and promoting well-being at all ages"), the sector itself, which aims to protect health, is paradoxically at the same time the main emitter of environmental pollutants that have a negative impact on health itself. Therefore, sustainability has become a key priority for health sector organizations, and leadership in this area is essential at all levels. Scientific research plays a particular role here, helping to more clearly define the links between environmental sustainability and the health effects of a polluted environment and climate change as well as indicating the direction of actions needed and disseminating good practices that can help accelerate the adoption of efforts towards climate neutrality and sustainable development of health sector organizations. The aim of this article is to present the current state of the art and future research scenarios in the field of green and sustainable healthcare through a literature review by using the Preferred Reporting Items for Systematic Reviews Meta-Analyses (PRISMA) method to perform a bibliometric analysis of papers published in 2012-2022. The Web of Science Core Collection (WoSCC) database is used for this purpose. A total of 144 papers are included for analysis, categorized based on eight fields: author(s), title, year of publication, country, journal, scientific category, and number of citations. Based on the results, themes for future research on green leadership in the healthcare sector are identified and recommended.
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Affiliation(s)
- Justyna Berniak-Woźny
- Department of Management, University of Information Technology and Management, 35-225 Rzeszów, Poland
| | - Małgorzata Rataj
- Department of Cognitive Science and Mathematical Modeling, University of Information Technology and Management, 35-225 Rzeszow, Poland
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Ferras M, Dye J, Ayala GX, Schmied E. An Examination of Factors That Influence Receipt of Reproductive Health Screenings Among Female Veterans. Mil Med 2023; 188:42-48. [PMID: 35253065 DOI: 10.1093/milmed/usac036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/23/2022] [Accepted: 02/02/2022] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION As the number of women veterans grows, so does the need to ensure they receive timely health care, including preventive reproductive health screenings such as cervical cancer screenings and mammograms. However, little is known about the rates of reproductive health screenings among veterans and what factors may be related to screening. The objectives of this cross-sectional study were to (1) understand healthcare treatment-seeking experiences among women veterans, (2) determine the rate of adherence to screening guidelines for cervical and breast cancers, and (3) examine potential correlates of adherence to clinical reproductive health screening guidelines. MATERIALS AND METHODS Women veterans completed an electronically administered survey, which assessed personal characteristics, psychological health symptoms, military service history, health insurance status, healthcare-seeking experiences (e.g., barriers to and satisfaction with care), and receipt of cervical and breast cancer screenings. Multivariable logistic regression identified factors associated with adherence to clinical guidelines for cervical and breast cancer screening. RESULTS Of the 90 women (mean age = 38.78; SD = 12.19) who participated, 64 (71.10%) reported meeting all age-applicable screening guidelines. The most common barriers to obtaining women's healthcare were availability of convenient appointment times, finding time in your schedule to make and go to an appointment, and long wait times for appointments. Multivariable logistic regression revealed veterans without a regular women's health provider were less likely to adhere to guidelines than those with a regular provider (OR = 0.16; 95% CI, 0.04-0.57). DISCUSSION Many women veterans are unable to receive reproductive health screenings; continued efforts are needed to determine how to increase adherence in this unique population.
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Affiliation(s)
- Madisen Ferras
- School of Public Health, San Diego State University, San Diego, CA 92182, USA
| | - Judy Dye
- School of Nursing, San Diego State University, San Diego, CA 92182, USA
| | - Guadalupe X Ayala
- School of Public Health, San Diego State University, San Diego, CA 92182, USA.,Institute for Behavioral and Community Health, San Diego, California; 9245 Sky Park Court, Suite 221,San Diego, CA 92123-4311, USA
| | - Emily Schmied
- School of Public Health, San Diego State University, San Diego, CA 92182, USA.,Institute for Behavioral and Community Health, San Diego, California; 9245 Sky Park Court, Suite 221, San Diego, CA 92123-4311, USA
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Johnson TA, Jamieson DJ, Geary FH, Stanhope KK, Boulet SL. Impact of the COVID-19 Pandemic on Obstetric Interventions at a Public Hospital. Womens Health Issues 2023; 33:10-16. [PMID: 36117075 PMCID: PMC9381428 DOI: 10.1016/j.whi.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 08/02/2022] [Accepted: 08/09/2022] [Indexed: 02/01/2023]
Abstract
INTRODUCTION In response to the COVID-19 pandemic, health systems quickly implemented changes in care delivery with a goal of balancing patient-focused obstetric care with the need to protect pregnant persons and health care providers from infection. Yet, there is no consensus within the scientific community on the impact these measures have on obstetric outcomes in vulnerable populations. We aimed to assess the impact of the COVID-19 pandemic on rates of obstetric procedures and severe maternal morbidity (SMM) among births at an urban safety net institution. METHODS We used an interrupted time series design to calculate risk ratios (RRs) and 95% confidence intervals (CIs) comparing monthly rates of labor induction, cesarean births (overall and among nulliparous, term, singleton, vertex births), operative vaginal births, and SMM among births occurring at a public hospital before (March 1, 2016, to February 29, 2020) and during (March 1, 2020, to May 31, 2021) the COVID-19 pandemic. RESULTS There were 10,714 and 2,736 births in the prepandemic and postpandemic periods, respectively. Overall, the rates of obstetric interventions and SMM were constant over the two time periods. There were no significant differences in rates of labor induction (42% during prepandemic period vs. 45% during pandemic period; RR, 1.12; 95% CI, 0.93-1.34), operative vaginal births (5% vs. 6%; RR, 1.24; 95% CI, 0.88-1.76), cesarean births (28% vs. 33%; RR, 1.10; 95% CI, 0.94-1.28), or nulliparous, term, singleton, vertex cesarean births (24% vs. 31%; RR, 1.27; 95% CI, 0.92-1.74). Rates of SMM (7% vs. 8%; RR, 1.19; 95% CI, 0.86-1.65) were also unchanged. CONCLUSIONS Our findings indicate that the rapid implementation of measures to reduce viral transmission in the labor and delivery setting did not materially affect routine clinical management or rates of serious maternal complications.
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Affiliation(s)
- Tatyana A Johnson
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Denise J Jamieson
- Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, Georgia
| | - Franklyn H Geary
- Department of Obstetrics and Gynecology, Morehouse School of Medicine, Atlanta, Georgia
| | - Kaitlyn K Stanhope
- Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, Georgia
| | - Sheree L Boulet
- Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, Georgia.
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Lawry LL, Lugo-Robles R, McIver V. Overlooked sex and gender aspects of emerging infectious disease outbreaks: Lessons learned from COVID-19 to move towards health equity in pandemic response. Front Glob Womens Health 2023; 4:1141064. [PMID: 36891170 PMCID: PMC9986530 DOI: 10.3389/fgwh.2023.1141064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 02/01/2023] [Indexed: 02/22/2023] Open
Abstract
Sex and gender issues are especially important in emerging infectious diseases (EIDs) but are routinely overlooked despite data and practice. Each of these have an effect either directly, via the effects on vulnerability to infectious diseases, exposures to infectious pathogens, and responses to illness, and indirectly through effects on disease prevention and control programs. The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the viral agent of coronavirus disease 2019 (COVID-19) has underscored the importance of understanding the sex and gender impacts on pandemics. This review takes a broader looks at how sex and gender impact vulnerability, exposure risk, and treatment and response that affect incidence, duration, severity, morbidity, mortality, and disability of EIDs. And although EID epidemic and pandemic plans need to be "pro-women", they need to be broader and include all sex and gender factors. Incorporation of these factors are a priority at the local, national, and global policy levels to fulfil the gaps in scientific research, public health intervention programs and pharmaceutical service strengthening to reduce emerging disease inequities in the population during pandemics and epidemics. A failure to do so creates acceptance of the inequities and infringes on fairness and human rights norms.
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Affiliation(s)
- Lynn Lieberman Lawry
- Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD, United States
| | - Roberta Lugo-Robles
- Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD, United States.,Department of Preventive Medicine and Biostatistics, Henry M. Jackson Foundation, Bethesda, MD, United States
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de Guzman GS, Banal-Silao MJB. Antenatal care utilization during the COVID-19 pandemic: an online cross-sectional survey among Filipino women. BMC Pregnancy Childbirth 2022; 22:929. [PMID: 36510190 PMCID: PMC9742662 DOI: 10.1186/s12884-022-05234-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 11/23/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic resulted in unprecedented challenges to healthcare systems worldwide, including interruption of antenatal care services. The study aimed to determine the utilization of antenatal care services of Filipino women during the COVID-19 pandemic. METHODS A cross-sectional study was conducted among postpartum women using an online self-administered survey in the Philippines from January 1 to March 31, 2022. The questionnaire used to assess health-seeking behavior was validated before the survey proper. Women aged 18 to 45 years who delivered in 2021 were recruited. The participants answered a structured questionnaire to assess their access, perceptions, and utilization of antenatal care. Utilization of antenatal care was evaluated using standard measures, including the timing of initiation of antenatal care, number of subsequent visits, and place of consults. The factors affecting the adequacy of antenatal care were determined for each variable through simple logistic regression. RESULTS A total of 318 women were enrolled in the study. All the respondents agreed on the necessity of antenatal care. However, only 46.37% had six or more in-person antenatal visits, with the majority attended to by midwives at community health centers. Most respondents (71.38%) initiated antenatal care during the first trimester. Almost half reported deferrals of visits mainly due to lockdown restrictions, transportation problems, and financial issues. Positive predictors of adequate antenatal care were prior pregnancies (OR 1.80, 95% CI 1.11-9.20 for 2-3 prior pregnancies; OR 3.02, 95% CI 1.45-6.29 for 4 or more prior pregnancies), live births (OR 1.67, 95% CI 1.04-2.69 for 2-3 prior live births; OR 2.46, 95% CI 1.17-5.16 for 4 or more prior live births), having living children (OR 1.74, 95% CI 1.09-2.79), spousal support (OR 1.75, 95% CI 1.01-3.03 for married women; OR 1.89, 95% CI 1.09-3.28 for women with common-law partners), history of obstetric complications (OR 2.82, 95% CI 1.33-5.97), and use of private vehicles (OR 2.65, 95% CI 1.05-6.68). Negative predictors were employment (OR 0.37, 95% CI 0.22-0.63) and medical examination prior to pregnancy (OR 0.36, 95% CI 0.23-0.58). CONCLUSION Despite an overall positive perception of the necessity of antenatal care, utilization has been inadequate in more than half of the respondents. Various individual, facility, and policy-level factors affected the utilization of services during the pandemic. There is a need to augment antenatal care services in the country by mitigating barriers to access. The public health response should strengthen collaborative efforts with primary-level healthcare to increase service provision, especially to more vulnerable populations.
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Affiliation(s)
- Glaiza S. de Guzman
- grid.11159.3d0000 0000 9650 2179Department of Obstetrics and Gynecology, University of the Philippines Manila – Philippine General Hospital, Manila, Philippines
| | - Maria Jesusa B. Banal-Silao
- grid.11159.3d0000 0000 9650 2179Department of Obstetrics and Gynecology, University of the Philippines Manila – Philippine General Hospital, Manila, Philippines
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The Differential Impact of the COVID-19 Pandemic on Prenatal Care Utilization Among US Women by Medicaid Expansion and Race and Ethnicity. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 29:E137-E146. [PMID: 36729927 DOI: 10.1097/phh.0000000000001698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The 2014 Medicaid expansion improved racial and ethnic equity in insurance coverage and access to maternal care among women of reproductive age. This study examines differential effects of the COVID-19 pandemic on prenatal care utilization by Medicaid expansion and by race and ethnicity. METHODS Using the pooled 2019-2020 National Natality file (N = 7 361 190), logistic regression was used to estimate the effect of COVID-19 on prenatal care utilization among US women aged 10 to 54 years after controlling for maternal age, race, ethnicity, marital status, parity, nativity/immigrant status, education, payment type, and smoking during pregnancy. Outcome measures were having no care and delayed prenatal care (third trimester or no care). Stratified models by race/ethnicity and Medicaid expansion status yielded the differential effects of COVID-19 on prenatal care utilization. RESULTS During the COVID-19 pandemic, the adjusted odds of having no prenatal care decreased by 4% (adjusted odds ratio [AOR] = 0.96; 95% confidence interval [CI], 0.94-0.97) in expansion states but increased by 13% (AOR = 1.13; 95% CI, 1.11-1.15) in nonexpansion states. While most racial/ethnic groups in expansion states experienced a decrease in having no prenatal care, the adjusted odds of having no prenatal care increased by 15% for non-Hispanic Whites, 9% for non-Hispanic Blacks, 33% for American Indians/Alaska Natives, 25% for Asian/Pacific Islanders, and 13% for Hispanics in nonexpansion states. Women in expansion states experienced no change in delayed prenatal care during the pandemic, but women in nonexpansion states experienced an increase in delayed care. CONCLUSIONS Prenatal care utilization decreased during the pandemic among women in nonexpansion states, particularly for American Indians/Alaska Natives and Asian/Pacific Islanders, compared with expansion states.
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Prenatal Care via Telehealth. Prim Care 2022; 49:609-619. [PMCID: PMC9639859 DOI: 10.1016/j.pop.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Trinh LTT, Achat H, Chua S, Gidaszewski B, Stubbs JM, Guevarra V. Effects of the COVID-19 Pandemic on the Use of Telehealth for Antenatal Care. Telemed J E Health 2022; 28:1796-1805. [PMID: 35417264 DOI: 10.1089/tmj.2021.0631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Aims: To determine changes in the use of telehealth and face-to-face consultations for antenatal care (ANC) associated with the COVID-19 pandemic and to identify the groups of women most affected. Materials and Methods: Routine administrative data from three public hospitals in a Local Health District in New South Wales, Australia, were analyzed. Data from 19,171 women who gave birth before the pandemic started (January 2018-January 2020) were compared with data of 5,479 women who gave birth after the pandemic started (December 2020-June 2021). Results: One in eight antenatal services after the pandemic started was a telehealth consultation. The average number of telehealth consultations per woman increased by 0.6 (0.7-1.3, adjusted incidence rate ratio [IRR] = 1.71, p < 0.001), while face-to-face visits decreased by 1.4 (10.6-9.2, adjusted IRR = 0.87, p < 0.001), resulting in an overall reduction of 0.8 (11.3-10.5, p < 0.001) services (7.1%). The increase in telehealth consultations was evident in all groups, but was greatest among women attending the smallest hospital, younger women, and Indigenous women. Most groups of women experienced a reduction in the number of face-to-face and total consultations, but the greatest reductions were among women who attended the largest hospital, received shared care, were older than 35 years, or had conceived through in vitro fertilization. Conclusions: Use of telehealth accounted for a small proportion of total ANC services; its increase did not compensate for the reduction in face-to-face visits, which might have resulted from the lack of suitable equipment, access to facilities, and skills or willingness to engage in telehealth. Ultimately there was an overall reduction of service utilization, which was not uniform among different groups of women.
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Affiliation(s)
- Lieu Thi Thuy Trinh
- Epidemiology and Health Analytics, Western Sydney Local Health District, Sydney, Australia
| | - Helen Achat
- Epidemiology and Health Analytics, Western Sydney Local Health District, Sydney, Australia
| | - Seng Chua
- Department of Obstetrics and Gynaecology, Westmead Hospital, Sydney, Australia
| | - Beata Gidaszewski
- Women's Health Research, Department of Women's and Newborn Health, Westmead Hospital, New South Wales, Australia
| | - Joanne M Stubbs
- Epidemiology and Health Analytics, Western Sydney Local Health District, Sydney, Australia
| | - Veth Guevarra
- Epidemiology and Health Analytics, Western Sydney Local Health District, Sydney, Australia
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Jaffe EF, Spach NC, Sullivan KA, Lyerly AD, Goldfarb IT. Experiences Navigating the Pregnancy Care Continuum During the COVID-19 Pandemic. Womens Health Issues 2022; 33:235-241. [PMID: 36496341 PMCID: PMC9640408 DOI: 10.1016/j.whi.2022.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION The COVID-19 pandemic led to unprecedented changes in care delivery across the pregnancy care continuum. Our primary objective with this research was to characterize the range of ways that the early months of the COVID-19 pandemic affected pregnancy, childbirth, and postpartum care experiences. METHODS Pregnant and recently pregnant patients (n = 20) from obstetrics and gynecology clinical sites associated with Massachusetts General Hospital were interviewed about their experiences with prenatal care, childbirth, and postpartum care during the first wave of the COVID-19 pandemic. Interview transcripts were analyzed for emergent themes. RESULTS This sample included 20 pregnant and postpartum people, including 11 individuals who tested positive for COVID-19 during pregnancy or postpartum and nine with suspected infection. The ways in which COVID-19 or suspected COVID-19 affected experiences of prenatal care, childbirth, and postpartum care were complex and varied. Three themes were identified across narratives of pregnancy, birth, and postpartum care: patient perceptions of diminished access to care, stigma due to COVID-19 infection, and limited capacity of providers to honor patient preferences. CONCLUSIONS A better understanding of pregnant and recently pregnant people's experiences during the early months of the COVID-19 pandemic can inform infection control policies and clinical care delivery practices that are more congruent with the needs and values of pregnant, birthing, and postpartum people as institutions craft responses to future pandemics. Approaches that maximize meaningful access across the pregnancy care continuum, center patients' priorities within adapted care models, and honor patient preferences as much as possible are important aspects of an appropriate response to future waves of COVID-19 and other pandemics.
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Affiliation(s)
- Elana F. Jaffe
- University of North Carolina School of Medicine, Chapel Hill, North Carolina,University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Natalie C. Spach
- University of North Carolina School of Medicine, Chapel Hill, North Carolina,University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Kristen A. Sullivan
- University of North Carolina School of Medicine, Chapel Hill, North Carolina,Center for Bioethics, Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Anne D. Lyerly
- University of North Carolina School of Medicine, Chapel Hill, North Carolina,Center for Bioethics, Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ilona T. Goldfarb
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts,Correspondence to: Ilona T. Goldfarb, MD, MPH, Department of Obstetrics and Gynecology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114. Tel.: (617) 724-2229
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