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Singhal M, Oyston C. Telehealth and Technology for Diabetes in Pregnancy Clinics: Staff Perspectives from South Auckland, New Zealand. Int J Telemed Appl 2024; 2024:6429519. [PMID: 38516417 PMCID: PMC10957257 DOI: 10.1155/2024/6429519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 09/19/2023] [Accepted: 02/08/2024] [Indexed: 03/23/2024] Open
Abstract
Providing care for patients with diabetes in pregnancy (DiP) provides unique challenges beyond those faced in standard antenatal care or diabetes outside of pregnancy. Teleclinics (use of telephone, email, or other technologies) as an alternative to in-person clinic appointments have become more widely used for care since the start of the COVID-19 pandemic. To understand how teleclinics might be improved for ongoing use, it is important to understand the experiences and perceptions of the clinicians involved in DiP care. Aim. To understand staff experiences of DiP teleclinics and gain their perspectives on if and how teleclinics and other technologies might be best used in the future. Methods. A qualitative study using semistructured interviews of healthcare providers in a large DiP service. Twenty staff members (midwifery, obstetrics, physician, dietician, and administration) were approached to participate. Fifteen staff across 5 specialties consented to be interviewed. Template analysis of interview transcripts was performed, with a focus on 3 themes: collaboration and working together are important for providing care for DiP, a need for flexibility in scheduling and the ability to individualise the way care is provided, and challenges to adapting to new technology. Results. Potential benefits of teleclinics were acknowledged, but respondents also viewed teleclinics as not suitable for all DiP patients due to different needs and risks. Challenges to using teleclinics include establishing good rapport and the current limited infrastructure and patient resources. Conclusion. Healthcare providers viewed teleclinics as a way of supporting rather than replacing current care. Maintaining flexibility in clinic scheduling to allow incorporation of teleclinics into patient's current schedule of visits ad hoc and providing extra technical and administrative support are important considerations for developing a teleclinic service.
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Affiliation(s)
- Megan Singhal
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Charlotte Oyston
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Obstetrics and Gynaecology, Middlemore Hospital, Te Whatu Ora Counties Manukau Health, South Auckland, New Zealand
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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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Oelmeier K, Schmitz R, Möllers M, Willy D, Sourouni M, Sondern K, Köster HA, Apsite G, Eveslage M, Fischhuber K, Storck M, Wohlmann J, Juhra C. Creating a Telemedicine Network of Specialists in Maternal-Fetal Medicine: A Prospective Cohort Study. Telemed J E Health 2023; 29:1723-1729. [PMID: 36939842 DOI: 10.1089/tmj.2022.0402] [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: 03/21/2023] Open
Abstract
Background: Even before coronavirus disease 2019, integrating telemedicine into routine health care has become increasingly attractive. Evidence regarding the benefits of telemedicine in prenatal care is still inconclusive. As one of the largest sectors of preventive medicine with a relative paucity of specialists in maternal-fetal medicine (MFM), the implementation of telemedicine solutions into prenatal care is promising. Our objective aimed at establishing a telemedicine network of specialists in MFM for interprofessional exchange regarding high-risk pregnancies. Furthermore, the aims were to evaluate the providers' attitude toward the telemedicine solutions and to quantify the number of inpatient appointments that were avoided through interprofessional video consultations. Methods: This prospective trial was part of a larger telemedicine project funded by the European Regional Development Fund. MFM experts were brought together using the ELVI software. A questionnaire was designed for the evaluation of video consultations. The responses were analyzed by the exact McNemar-Bowker test to compare planned procedures before and after video consultation. Results: An interprofessional network of specialists in prenatal ultrasound was established with a total of 140 evaluations for statistical analysis. Interprofessional video communication was viewed favorably by providers. Overall, 47% (33/70) of the scheduled visits were avoided after video consultation. The providers' tendency to refrain from sending their patients to the University Hospital Münster was statistically noticeable (p = 0.048). Conclusions: Interprofessional exchange through video consultation holds great potential in the context of prenatal care. More prospective research is needed to clearly establish the most beneficial standard of care for both patients and providers. Clinical trial registration number: 2019-683-f-S.
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Affiliation(s)
- Kathrin Oelmeier
- Department of Obstetrics and Gynecology, University Hospital of Münster, Münster, Germany
| | - Ralf Schmitz
- Department of Obstetrics and Gynecology, University Hospital of Münster, Münster, Germany
| | - Mareike Möllers
- Department of Obstetrics and Gynecology, University Hospital of Münster, Münster, Germany
| | - Daniela Willy
- Department of Obstetrics and Gynecology, University Hospital of Münster, Münster, Germany
| | - Marina Sourouni
- Department of Obstetrics and Gynecology, University Hospital of Münster, Münster, Germany
| | - Kathleen Sondern
- Department of Obstetrics and Gynecology, University Hospital of Münster, Münster, Germany
| | - Helen Ann Köster
- Department of Obstetrics and Gynecology, University Hospital of Münster, Münster, Germany
| | - Gunita Apsite
- Centre for Clinical Trials Münster, University of Münster, Münster, Germany
| | - Maria Eveslage
- Institute of Biostatistics and Clinical Research, and University of Münster, Münster, Germany
| | - Karen Fischhuber
- Institute of Biostatistics and Clinical Research, and University of Münster, Münster, Germany
| | - Michael Storck
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - Jan Wohlmann
- Office for eHealth, University Hospital Münster, Münster, Germany
| | - Christian Juhra
- Office for eHealth, University Hospital Münster, Münster, Germany
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Mohapatra I, Rai VK, Samantaray SR. Impact of telemedicine on antenatal care at a teaching institution in Eastern India: An insight into the future of better India. J Family Med Prim Care 2023; 12:2652-2660. [PMID: 38186769 PMCID: PMC10771158 DOI: 10.4103/jfmpc.jfmpc_995_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 08/04/2023] [Accepted: 08/09/2023] [Indexed: 01/09/2024] Open
Abstract
Objectives Telemedicine (TM) emergence has been profound in using technology to address the problems of obstetrics in remote and rural places, especially in low-risk pregnancy. Through this study, we made an effort to assess the satisfaction level and concerns of antenatal and postnatal patients who availed the telemedicine facility during the study period. We also made an effort to facilitate improved access to antenatal and postnatal care, especially the low-risk pregnancies through telemedicine for patients from remote areas of eastern India that do not have the availability of specialists. Materials and Methods Primary data were collected by means of a telephonic survey of all the antenatal patients who used telemedicine services of AIIMS, Kalyani, based on a preformed questionnaire. Results A total of 80 antenatal patients gave consent to participate in the study. Most of the patients were from the upper lower class [43.75%] followed by the lower middle class [35%]. The average gestational age of respondents was 23.95 weeks. Seventy-one out of 80 patients felt that the appointment was made within a reasonable time. Only 12 patients [15.3%] had waiting time greater than 10 min. The average waiting time was 6.93 min. 56.3% of respondents felt that the person who attended their call was very cooperative. 86.3% of respondents strongly agreed that the consultant was able to understand their health issues completely. Eighty percent of the respondents said that they would like to continue using telemedicine in the future. There is a significant difference between those preferring to use telemedicine in the future and those who do not prefer telemedicine in the future. Poor internet facility and privacy were prominent reasons for not opting for telemedicine in the future by some respondents. Conclusion From this study, it was concluded that TM certainly has great potential to make health care accessible to people residing in rural and far-off places.
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Affiliation(s)
- Ipsita Mohapatra
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Kalyani, West Bengal, India
| | - Vikash K Rai
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Kalyani, West Bengal, India
| | - Subha Ranjan Samantaray
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Kalyani, West Bengal, India
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Kulkarni A, Monu N, Ahsan MD, Orakuwue C, Ma X, McDougale A, Frey MK, Holcomb K, Cantillo E, Chapman-Davis E. Patient and provider perspectives on telemedicine use in an outpatient gynecologic clinic serving a diverse, low-income population. J Telemed Telecare 2023:1357633X231197965. [PMID: 37788366 DOI: 10.1177/1357633x231197965] [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: 10/05/2023]
Abstract
OBJECTIVE To evaluate patient and provider experiences using telemedicine for gynecologic visits among a diverse, low-income population. METHODS Patients attending telemedicine visits at a resident-run gynecology clinic completed a modified Telemedicine Usability Questionnaire and providers completed a survey addressing satisfaction and barriers for each visit. The Telemedicine Usability Questionnaire included six subscales to assess telemedicine usability with 1-5 Likert-scale responses. Statistical analyses included Chi-square, Fisher's exact, Wilcoxon rank sum, Wilcoxon signed-rank, and two-sample t-test. RESULTS Of 192 patients enrolled, 157 (82%) completed the surveys (87% video visits, 13% telephone visits). Most patients were ethnic minorities (non-Hispanic White-16%, Hispanic-32%, Black-28%, Asian-10%), median age was 40 years (range 18-69), and 63% reported income under $40,000. The total mean Telemedicine Usability Questionnaire score was 4.3/5. The reliability subscale score (3.72/5) was lower compared to all other subscales (p < 0.001). Older respondents were more likely to find telemedicine unreliable (mean age >44 vs <39, p = 0.02). Without telemedicine, 54% would have traveled ≥1 h to appointments, with 46% spending over $35 on travel, and 27% missing ≥ 1 workday. Patients preferred telemedicine for follow-up rather than initial visits (81% vs 33%, p < 0.01). Among providers, residents felt less adequately trained in telemedicine compared to nurse practitioners and fellows (54% vs 46%, p = 0.039). CONCLUSION Low-income women utilizing telemedicine for outpatient gynecologic care report positive experiences with improved access to healthcare, cost, and time savings compared to in-person visits. Provider experiences were also positive; however, teaching hospitals must evaluate whether trainee providers feel adequately trained to deliver telemedicine visits.
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Affiliation(s)
| | - Ngozi Monu
- Weill Cornell Medical College, New York, USA
| | | | | | - Xiaoyue Ma
- Weill Cornell Medical College, New York, USA
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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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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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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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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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11
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Changes in Telehealth Experienced by Advanced Practice RNs During COVID-19: US Survey Results. COMPUTERS, INFORMATICS, NURSING : CIN 2022:00024665-990000000-00072. [PMID: 36730718 DOI: 10.1097/cin.0000000000000979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The sudden, expanded need for telehealth during the COVID-19 pandemic added to the challenges advanced practice RNs face in the United States. The purposes of this article are to summarize advanced practice RNs' responses about the use of telehealth before and during the pandemic and to analyze free-text comments about how the use of telehealth changed during the pandemic. A 20-item survey was distributed using convenience sampling to advanced practice RNs from June 1 to September 23, 2020. Analyses of descriptive and open text responses related to telehealth were conducted. Most of the respondents did not use telehealth prior to the pandemic (n = 5441 [73%]), but during the pandemic, half used telehealth at least daily (n = 3682 [49%]). The most common barriers related to telehealth were about the difficulty some populations had in accessing the necessary technology. The most common favorable comments cited by respondents were related to some patients' improved access to care. Telehealth use is unlikely to return to prepandemic levels. As a result, considerations of telehealth-related recommendations provided for advanced practice RN education, policy, and practice are encouraged for the purpose of increasing healthcare access.
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Guendelman S, Krueger GN, Cruz GI, Trepman PC, Suharwardy SH. Use of Telehealth During the COVID-19 Pandemic Among Practicing Maternal-Fetal Medicine Clinicians. Telemed J E Health 2022; 29:696-707. [PMID: 36251953 DOI: 10.1089/tmj.2022.0346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Limited knowledge exists about the drivers of telehealth use among obstetricians during COVID-19 in the United States. We investigated the use of live video visits by Maternal-Fetal Medicine (MFM) clinicians, the factors associated with use and interest in future use. Methods: We drew survey data from 373 clinicians on two outcomes: (1) use of any (vs. no) live video visits during COVID-19 and (2) among users, the extent of live video use. Bivariate and multivariate logistic regressions quantified the association between predisposing (demographic and practice setting characteristics) and enabling factors (prepandemic telehealth use, structural and perceived patient barriers) and each outcome. Results: During the pandemic, 88% reported any use, a jump from 29% prepandemic utilization. Users (vs. nonusers) were younger (p = 0.02); tended to provide comprehensive prenatal care (p = 0.01) and/or inpatient care (p = 0.02), practice in university settings (p = 0.01), engage in various telehealth modalities prepandemic (p ≤ 0.01), and to perceive challenges with technical (p < 0.01), reimbursement (p = 0.05), and patient barriers to internet or data plan access (p ≤ 0.001). After adjusting for covariates, only prepandemic communication through patient portal (adjusted odds ratio [aOR] = 3.85; 95% confidence interval [CI] = 1.33-11.12), perceived patient access barriers (aOR = 5.27; 95% CI = 1.95-14.23), and practice in multiple versus university settings (aOR = 0.18; 95% CI = 0.06-0.56) remained significantly associated with use. Approximately 44% were high users. Prepandemic ultrasound use (aOR = 1.92; 95% CI = 1.17-3.16), perceived patient access barriers (aOR = 1.85; 95% CI = 1.12-3.06) and Midwest versus North practice location (aOR = 0.46; 95% CI = 0.21-0.98) predicted high use. Among high users, 99% wanted to continue offering video visits. Conclusions: We found widespread use of live video obstetric care by MFM clinicians and continued interest in use postpandemic.
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Affiliation(s)
- Sylvia Guendelman
- The Wallace Center for Maternal, Child and Adolescent Health, School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Grace N. Krueger
- The Wallace Center for Maternal, Child and Adolescent Health, School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Giovanna I. Cruz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University, Palo Alto, California, USA
| | - Paula C. Trepman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University, Palo Alto, California, USA
| | - Sanaa H. Suharwardy
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University, Palo Alto, California, USA
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Zuo Y, Luo BR, Wang LN, Cheng BC, Hu XL. Exploring lived experiences of informal caregivers for pregnant women seeking scheduled antenatal care during the COVID-19 lockdown in China: A phenomenological study. Midwifery 2022; 109:103316. [PMID: 35364369 PMCID: PMC8933869 DOI: 10.1016/j.midw.2022.103316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/20/2022] [Accepted: 03/18/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We aimed to explore the lived experiences of informal caregivers for pregnant women seeking scheduled antenatal care during the early stage of China's COVID-19 lockdown and potential measures to address the challenges. DESIGN This is a phenomenological qualitative study. SETTING The study was carried out in a leading teaching hospital in Southwest China. PARTICIPANTS We recruited 15 informal caregivers for healthy pregnant women on routine antenatal visits about six months after China launched the city-wide lockdown and other control measures for COVID-19, including 10 males and 5 females with diverse demographic backgrounds. MEASURES AND FINDINGS The research team developed a demographic form and an interview outline with key questions, conducted semi-structured interviews with the informal caregivers, and analyzed the data using the Colazzie's method. Five themes of lived experiences were revealed, i.e., increased caregiving burdens, disruption of routines in family life, lack of accurate information and knowledge, active role adjustment, and positive attitudes and coping in a difficult time. Some caregivers reacted positively to the lockdown experience and saw it as an opportunity to rethink their lives and improve family relations. KEY CONCLUSIONS The informal caregivers experienced increased physical and psychological burdens. Strategies such as adoption of a less frequent prenatal visit schedule, use of tele-medicine technologies, and provision of accurate information and knowledge may help to ease the increased informal caregiving burdens. Psychological counseling, community services and disaster response policies specially targeting pregnant women and their informal caregivers may also be valuable resources. IMPLICATIONS FOR PRACTICE Attention should be drawn to the group of informal caregivers for pregnant women during a COVID-19 lockdown, including professional assistance delivered by nursing and other related professionals. Measures are called for to minimize exposure opportunities such as adoption of a new prenatal care schedule and tele-medicine technologies. Patient education with reliable information should be provided, preferably by nursing staff and physicians. Social support efforts including professional mental counseling may added and work with other resources such as community services and policy makers.
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Affiliation(s)
- Yan Zuo
- West China School of Nursing, Sichuan University / Department of Nursing, West China Second University Hospital, Sichuan University / Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education. #20 3rd Section, Renmin Nan Road, Chengdu 610041 Sichuan Province, China
| | - Bi-ru Luo
- West China School of Nursing, Sichuan University / Department of Nursing, West China Second University Hospital, Sichuan University / Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education. #20 3rd Section, Renmin Nan Road, Chengdu 610041 Sichuan Province, China
| | - Ling-ning Wang
- West China School of Nursing, Sichuan University / Department of Nursing, West China Second University Hospital, Sichuan University / Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education. #20 3rd Section, Renmin Nan Road, Chengdu 610041 Sichuan Province, China
| | - Bo-chao Cheng
- Radiology Department, West China Second University Hospital, Sichuan University / Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education. #20 3rd Section, Renmin Nan Road, Chengdu 610041 Sichuan Province, China
| | - Xiao-lin Hu
- West China School of Nursing, Sichuan University / Department of Nursing, West China Hospital, Sichuan University. #37 Guoxue Alley, Wuhou District, Chengdu 610041, Sichuan Province, China,Corresponding author
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Affiliation(s)
- Malavika Prabhu
- Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Weill Cornell Medicine, New York, New York
| | - Line Malha
- Division of Nephrology and Hypertension, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Laura E Riley
- Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Weill Cornell Medicine, New York, New York
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15
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Farrell RM, Craighead C, Collart C, Frankel R, Rose S, Misra-Hebert AD, Tucker Edmonds B, Michie M, Chien E, Coleridge M, Goje O, Ranzini AC. The Impact of Telehealth on the Delivery of Prenatal Care During COVID-19: A Mixed Methods Study of Barriers and Opportunities to Improve Healthcare Communication in Discussions about Pregnancy and Prenatal Genetic Testing (Preprint). JMIR Form Res 2022; 6:e38821. [DOI: 10.2196/38821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 10/14/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022] Open
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16
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Walter JR, Xu S, Stringer JS, Rogers JA. The Future of Remote Monitoring for Pregnancy. BRIDGE (WASHINGTON, D.C. : 1969) 2022; 52:16-24. [PMID: 38111590 PMCID: PMC10727511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Affiliation(s)
- Jessica R Walter
- Department of Obstetrics and Gynecology, Northwestern University
| | - Shuai Xu
- Querrey Simpson Institute for Bioelectronics and Departments of Dermatology, Biomedical Engineering, and Pediatrics at Northwestern University
| | - Jeffrey S Stringer
- Department of Obstetrics and Gynecology at the University of North Carolina at Chapel Hill
- Global Women's Health Division
| | - John A Rogers
- Querrey Simpson Institute for Bioelectronics and the Departments of Biomedical Engineering, Materials Science, Computer Science, and Neurological Surgery at Northwestern University
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17
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Kern-Goldberger AR, Srinivas SK. Obstetrical Telehealth and Virtual Care Practices During the COVID-19 Pandemic. Clin Obstet Gynecol 2022; 65:148-160. [PMID: 35045037 PMCID: PMC8767919 DOI: 10.1097/grf.0000000000000671] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The coincidence of a global pandemic with 21st-century telecommunication technology has led to rapid deployment of virtual obstetric care beginning in March of 2020. Pregnancy involves uniquely time-sensitive health care that may be amenable to restructuring into a hybrid of telemedicine and traditional visits to optimize accessibility and outcomes. The coronavirus disease 2019 pandemic has provided an unprecedented natural laboratory to explore how virtual obstetric care programs can be developed, implemented, and maintained, both as a contingency model for the pandemic and potentially for the future. Here, we discuss the role of telehealth and virtual care for pregnancy management in the coronavirus disease 2019 pandemic, as well as anticipated barriers, challenges, and strategies for success for obstetric telemedicine.
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18
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Golbasi H, Omeroglu I, Bayraktar B, Golbasi C, Adıyaman D, Ekin A. How COVID-19 pandemic is changing the practice of prenatal screening and diagnosis? J Perinat Med 2022; 50:124-131. [PMID: 34881543 DOI: 10.1515/jpm-2021-0343] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/11/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To evaluate the impact of the COVID-19 pandemic on prenatal screening and diagnostic tests. METHODS We conducted a retrospective study with pregnant women attending to the perinatology department of a tertiary referral center. The pre-COVID-19 period between 11 March 2019 and 10 March 2020 and COVID-19 period between 11 March 2020 and 10 March 2021 were evaluated. Both periods were compared in terms of outpatient visits, ultrasound examinations, prenatal screening and diagnostic tests. The correlation of deaths related to COVID-19 pandemic on these parameters was also assessed. RESULTS A total of 38,918 patients were examined and 28,452 ultrasound examinations, 26,672 prenatal screening tests and 1,471 prenatal diagnostic tests were performed over two years. During COVID-19 pandemic, number of outpatient visits decreased by 25.2%, ultrasound examinations decreased by 44.2%, prenatal screening tests decreased by 36.2% and prenatal diagnostic tests decreased by 30.7%. Statistically significant correlation was not observed between deaths related to COVID-19 and outpatient visits (p=0.210), ultrasound examinations (p=0.265), prenatal screening (p=0.781) and diagnostic tests (p=0.158). Among indications of prenatal diagnostic tests, maternal anxiety was significantly higher in COVID-19 period (p=0.023). There was significant decrease in the detection of fetuses with trisomy 21 (p=0.047) and a significant increase in the detection of fetuses with Turner syndrome (p=0.017) during COVID-19 period. CONCLUSIONS The COVID-19 pandemic has severely impacted antenatal care. Prenatal fetal screening and diagnosis was adversely affected by the pandemic in terms of detecting genetic and structural anomalies.
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Affiliation(s)
- Hakan Golbasi
- Division of Perinatology, Department of Obstetrics and Gynecology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
| | - Ibrahim Omeroglu
- Division of Perinatology, Department of Obstetrics and Gynecology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
| | - Burak Bayraktar
- Department of Obstetrics and Gynecology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
| | - Ceren Golbasi
- Department of Obstetrics and Gynecology, Izmir Tınaztepe University Faculty of Medicine, Izmir, Turkey
| | - Duygu Adıyaman
- Division of Perinatology, Department of Obstetrics and Gynecology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
| | - Atalay Ekin
- Division of Perinatology, Department of Obstetrics and Gynecology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
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19
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Farrell R, Collart C, Craighead C, Pierce M, Chien E, Frankel R, Tucker Edmonds B, Perni U, Coleridge M, Ranzini A, Rose S. Successes and Challenges of Implementing Telehealth for Diverse Patient Populations: Attending to Prenatal Care during COVID-19. JMIR Form Res 2021; 6:e32791. [PMID: 35275833 PMCID: PMC8970157 DOI: 10.2196/32791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background Although telehealth appears to have been accepted among some obstetric populations before the COVID-19 pandemic, patients’ receptivity and experience with the rapid conversion of this mode of health care delivery are unknown. Objective In this study, we examine patients' prenatal care needs, preferences, and experiences during the COVID-19 pandemic, with the aim of supporting the development of successful models to serve the needs of pregnant patients, obstetric providers, and health care systems during this time. Methods This study involved qualitative methods to explore pregnant patients’ experiences with prenatal health care delivery at the onset of the COVID-19 pandemic. We conducted in-depth interviews with pregnant patients in the first and second trimester of pregnancy who received prenatal care in Cleveland, Ohio, from May to July 2020. An interview guide was used to probe experiences with health care delivery as it rapidly evolved at the onset of the pandemic. Results Although advantages of telehealth were noted, there were several concerns noted with the broad implementation of telehealth for prenatal care during the pandemic. This included concerns about monitoring the pregnancy at home; the need for additional reassurance for the pregnancy, given the uncertainties presented by the pandemic; and the ability to have effective patient-provider discussions via a telehealth visit. The need to tailor telehealth to prenatal health care delivery was noted. Conclusions Although previous studies have demonstrated that telehealth is a flexible and convenient alternative for some prenatal appointments, our study suggests that there may be specific needs and concerns among the diverse patient groups using this modality during the pandemic. More research is needed to understand patients' experiences with telehealth during the pandemic and develop approaches that are responsive to the needs and preferences of patients.
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Affiliation(s)
- Ruth Farrell
- OB/GYN and Women's Health Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, US.,Genomic Medicine Institute, Cleveland Clinic, Cleveland, US.,Center for Bioethics, Cleveland Clinic, Cleveland, US
| | - Christina Collart
- OB/GYN and Women's Health Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, US
| | - Caitlin Craighead
- OB/GYN and Women's Health Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, US
| | - Madelyn Pierce
- OB/GYN and Women's Health Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, US
| | - Edward Chien
- OB/GYN and Women's Health Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, US
| | | | | | - Uma Perni
- OB/GYN and Women's Health Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, US
| | - Marissa Coleridge
- OB/GYN and Women's Health Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, US.,Genomic Medicine Institute, Cleveland Clinic, Cleveland, US
| | - Angela Ranzini
- Department of OB/GYN, MetroHealth Medical Center, Cleveland, US
| | - Susannah Rose
- Center for Patience Experience, Cleveland Clinic, Cleveland, US
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20
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Jordan E, Shin DE, Leekha S, Azarm S. Optimization in the Context of COVID-19 Prediction and Control: A Literature Review. IEEE ACCESS : PRACTICAL INNOVATIONS, OPEN SOLUTIONS 2021; 9:130072-130093. [PMID: 35781925 PMCID: PMC8768956 DOI: 10.1109/access.2021.3113812] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 09/10/2021] [Indexed: 05/08/2023]
Abstract
This paper presents an overview of some key results from a body of optimization studies that are specifically related to COVID-19, as reported in the literature during 2020-2021. As shown in this paper, optimization studies in the context of COVID-19 have been used for many aspects of the pandemic. From these studies, it is observed that since COVID-19 is a multifaceted problem, it cannot be studied from a single perspective or framework, and neither can the related optimization models. Four new and different frameworks are proposed that capture the essence of analyzing COVID-19 (or any pandemic for that matter) and the relevant optimization models. These are: (i) microscale vs. macroscale perspective; (ii) early stages vs. later stages perspective; (iii) aspects with direct vs. indirect relationship to COVID-19; and (iv) compartmentalized perspective. To limit the scope of the review, only optimization studies related to the prediction and control of COVID-19 are considered (public health focused), and which utilize formal optimization techniques or machine learning approaches. In this context and to the best of our knowledge, this survey paper is the first in the literature with a focus on the prediction and control related optimization studies. These studies include optimization of screening testing strategies, prediction, prevention and control, resource management, vaccination prioritization, and decision support tools. Upon reviewing the literature, this paper identifies current gaps and major challenges that hinder the closure of these gaps and provides some insights into future research directions.
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Affiliation(s)
- Elizabeth Jordan
- Department of Mechanical EngineeringUniversity of MarylandCollege ParkMD20742USA
| | - Delia E. Shin
- Department of Mechanical EngineeringUniversity of MarylandCollege ParkMD20742USA
| | - Surbhi Leekha
- Department of Epidemiology and Public HealthUniversity of Maryland School of MedicineBaltimoreMD21201USA
| | - Shapour Azarm
- Department of Mechanical EngineeringUniversity of MarylandCollege ParkMD20742USA
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21
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Liu CH, Goyal D, Mittal L, Erdei C. Patient Satisfaction with Virtual-Based Prenatal Care: Implications after the COVID-19 Pandemic. Matern Child Health J 2021; 25:1735-1743. [PMID: 34410565 PMCID: PMC8374111 DOI: 10.1007/s10995-021-03211-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2021] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The objective of this study was to identify factors related to satisfaction with virtual visits during pregnancy in an effort to prioritize intervention targets for pregnant women during the COVID-19 pandemic. METHODS The study relied on data obtained from pregnant women (N = 416) who participated in the Perinatal Experiences and COVID-19 Effects (PEACE) Study from May 21 to November 22, 2020. Using a cross-sectional design, this study examined factors including COVID-19 related experiences and prenatal care changes in association with patient satisfaction of virtual prenatal care. RESULTS Overall, women reported being very or extremely satisfied (27.9%) or moderately satisfied (43.5%) with their virtual prenatal experiences, however, 89.9% indicated a preference for in-person care under non-pandemic conditions. Those who completed the survey further into the pandemic were less satisfied with virtual prenatal care (β = - 0.127, p < 0.01). After accounting for this and other sociodemographic characteristics, COVID-19 pregnancy worries (β = - 0.226, p < 0.001) and the number of prenatal care changes due to the pandemic (β = - 0.137, p < 0.01) were associated with lower satisfaction. CONCLUSION Our findings demonstrate general satisfaction with virtual visits among pregnant women in this study although in general women would prefer in-person care if it weren't for a pandemic. Women worried about the impact of pandemic on their pregnancy, as well as those experiencing transitions in their prenatal care may need more information and reassurance. Additional studies are needed to understand the unmet needs through virtual care compared to in-person care.
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Affiliation(s)
- Cindy H Liu
- Department of Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA. .,Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
| | - Deepika Goyal
- The Valley Foundation School of Nursing, San Jose State University, San Jose, CA, USA
| | - Leena Mittal
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Carmina Erdei
- Department of Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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22
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O'Kelly AC, Scott N, DeFaria Yeh D. Delivering Coordinated Cardio-Obstetric Care from Preconception through Postpartum. Cardiol Clin 2021; 39:163-173. [PMID: 33222811 DOI: 10.1016/j.ccl.2020.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Coordinated preconception through postpartum cardio-obstetrics care is necessary to optimize both maternal and fetal health. Maternal mortality in the United States is increasing, largely driven by increasing cardiovascular (CV) disease burden during pregnancy and needs to be addressed emergently. Both for women with congenital and acquired heart disease, CV complications during pregnancy are associated with increased future risk of CV disease. Comprehensive cardio-obstetrics care is a powerful way of ensuring that women's CV risks before and during pregnancy are appropriately identified and treated and that they remain engaged in CV care long term to prevent future CV complications.
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Affiliation(s)
- Anna C O'Kelly
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Yawkey 5700, 55 Fruit Street, Boston, MA 02114, USA
| | - Nandita Scott
- Division of Cardiology, Cardiovascular Disease and Pregnancy Program, Massachusetts General Hospital and Harvard Medical School, Yawkey 5700, 55 Fruit Street, Boston, MA 02114, USA
| | - Doreen DeFaria Yeh
- Division of Cardiology, Cardiovascular Disease and Pregnancy Program, Massachusetts General Hospital and Harvard Medical School, Yawkey 5700, 55 Fruit Street, Boston, MA 02114, USA.
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23
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Almuslim H, AlDossary S. Models of Incorporating Telehealth into Obstetric Care During the COVID-19 Pandemic, Its Benefits And Barriers: A Scoping Review. Telemed J E Health 2021; 28:24-38. [PMID: 33819434 DOI: 10.1089/tmj.2020.0553] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Introduction: Coronavirus disease 2019 (COVID-19) is a highly contagious viral infection. Hospitals worldwide have decreased face-to-face visits to reduce the exposure to the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Prenatal and postpartum care are essential for the health of women and their fetuses. Therefore, many hospitals have incorporated telehealth into their protocols. Objectives: The aim of this review was to determine how health care organizations are responding to the COVID-19 pandemic by incorporating telehealth visits into their protocols for obstetrics care, what services were converted to telehealth, and its benefits and barriers. Method: A computerized literature search was performed using PubMed and Cumulative Index of Nursing and Allied Health Literature (CINAHL) databases using terms, including "telehealth," "virtual visits," "obstetric," "pregnancy," "postpartum," and "COVID-19" for articles published before October 2020. Peer reviewed articles and guidelines were included in this review. Results: A total of 25 articles were identified. Fifteen articles reported protocols. During this pandemic, protocols developed replaced some in-person visits with telehealth visits, when no testing or vaccinations are required. The main reported benefits were minimizing exposure to SARS-CoV-2 and the continuity to provide high-quality and safe care. Lack of access to high-speed internet and hardware and inaccessibility to patients were the most reported barriers. Conclusion: Telehealth provided the opportunity for reducing in-person visits during the COVID-19 pandemic. Some prenatal services could be completely provided through telehealth and others require medical equipment to be delivered. Health care organizations recognized that using telehealth could be continued beyond this pandemic, as they provided many benefits for patients, medical staff, and the organizations themselves.
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Affiliation(s)
- Hameeda Almuslim
- Department of Health Informatics, College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Sharifah AlDossary
- Department of Health Informatics, College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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24
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Farrell RM, Pierce M, Collart C, Craighead C, Coleridge M, Chien EK, Perni U, Frankel R, Ranzini A, Edmonds BT, Rose SS. The impact of the emergence of COVID-19 on women's prenatal genetic testing decisions. Prenat Diagn 2021; 41:1009-1017. [PMID: 33569794 PMCID: PMC8014673 DOI: 10.1002/pd.5902] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/28/2020] [Accepted: 01/10/2021] [Indexed: 11/13/2022]
Abstract
Objective We conducted a study to examine the impact of COVID on patients' access and utilization of prenatal genetic screens and diagnostic tests at the onset of the COVID‐19 pandemic in the United States. Methods We conducted telephone interviews with 40 patients to examine how the pandemic affected prenatal genetic screening and diagnostic testing decisions during the initial months of the pandemic in the United States. An interview guide queried experiences with the ability to access information about prenatal genetic testing options and to utilize the tests when desired. Audio recordings were transcribed and coded using NVivo 12. Analysis was conducted using Grounded Theory. Results The pandemic did not alter most participants' decisions to undergo prenatal genetic testing. Yet, it did impact how participants viewed the risks and benefits of testing and timing of testing. There was heightened anxiety among those who underwent testing, stemming from the risk of viral exposure and the fear of being alone if pregnancy loss or fetal abnormality was identified at the time of an ultrasound‐based procedure. Conclusion The pandemic may impact patients' access and utilization of prenatal genetic tests. More research is needed to determine how best to meet pregnant patients' decision‐making needs during this time.
What is already known about this topic?
Prenatal genetic screens and diagnostic tests are a core component to the delivery of high‐quality, evidence‐based prenatal care. It is critical that pregnant patients have the information and resources to make an informed decision about a growing array of prenatal genetic screening and diagnostic testing options. In the decision‐making process, pregnant patients commonly weigh the risks and benefits of gaining genetic information about the fetus with the risks and benefits of the available screens and diagnostic tests.
What does this study add?
The pandemic has led to significant changes in healthcare delivery and insurance benefits for prenatal genetic testing, raising key questions about how pregnant patient are weighing the risks and benefits of the available prenatal genetic screening and diagnostic testing options against the risks of COVID exposure by presenting to a healthcare facility for testing. COVID‐19 appears to impact how women view the utility of prenatal genetic testing, including how they weigh the risk and benefits of prenatal genetic screening and diagnostic testing in addition to when in the pregnancy they may elect to undergo testing. The COVID‐19 pandemic has resulted in increased levels of concern and anxiety that may be encountered by pregnant women in the testing process, raising awareness of the need for additional resources to support patients' decision‐making during the pandemic.
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Affiliation(s)
- Ruth M. Farrell
- OB/GYN and Women's Health InstituteCleveland ClinicClevelandOhioUSA
- Genomic Medicine InstituteCleveland ClinicClevelandOhioUSA
- Center for BioethicsCleveland ClinicClevelandOhioUSA
| | - Madelyn Pierce
- OB/GYN and Women's Health InstituteCleveland ClinicClevelandOhioUSA
| | | | | | - Marissa Coleridge
- OB/GYN and Women's Health InstituteCleveland ClinicClevelandOhioUSA
- Genomic Medicine InstituteCleveland ClinicClevelandOhioUSA
| | - Edward K. Chien
- OB/GYN and Women's Health InstituteCleveland ClinicClevelandOhioUSA
| | - Uma Perni
- OB/GYN and Women's Health InstituteCleveland ClinicClevelandOhioUSA
| | | | - Angela Ranzini
- Department of OB/GYNMetroHealth Medical CenterClevelandOhioUSA
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25
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Cena L, Biban P, Janos J, Lavelli M, Langfus J, Tsai A, Youngstrom EA, Stefana A. The Collateral Impact of COVID-19 Emergency on Neonatal Intensive Care Units and Family-Centered Care: Challenges and Opportunities. Front Psychol 2021; 12:630594. [PMID: 33716895 PMCID: PMC7943863 DOI: 10.3389/fpsyg.2021.630594] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/25/2021] [Indexed: 12/28/2022] Open
Abstract
The ongoing Coronavirus disease 2019 (COVID-19) pandemic is disrupting most specialized healthcare services worldwide, including those for high-risk newborns and their families. Due to the risk of contagion, critically ill infants, relatives and professionals attending neonatal intensive care units (NICUs) are undergoing a profound remodeling of the organization and quality of care. In particular, mitigation strategies adopted to combat the COVID-19 pandemic may hinder the implementation of family-centered care within the NICU. This may put newborns at risk for several adverse effects, e.g., less weight gain, more nosocomial infections, increased length of NICU stay as well as long-term worse cognitive, emotional, and social development. This article aims to contribute to deepening the knowledge on the psychological impact of COVID-19 on parents and NICU staff members based on empirical data from the literature. We also provided evidence-based indications on how to safely empower families and support NICU staff facing such a threatening emergency, while preserving the crucial role of family-centered developmental care practices.
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Affiliation(s)
- Loredana Cena
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Paolo Biban
- Department of Neonatal and Pediatric Critical Care, Verona University Hospital, Verona, Italy
| | - Jessica Janos
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Manuela Lavelli
- Department of Human Sciences, University of Verona, Verona, Italy
| | - Joshua Langfus
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Angelina Tsai
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Eric A. Youngstrom
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Alberto Stefana
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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