Perinatal Telehealth: Meeting Patients Where They Are

Digital Training for Nurses and Midwives to Improve Treatment for Women with Postpartum Depression and Protect Neonates: A Dynamic Bibliometric Review Analysis

The high prevalence of postpartum depression makes it necessary for midwives and nurses to implement prenatal interventions for expectant mothers. The current study aims to investigate and highlight the importance of the digital training of nurses in order to help women mitigate the symptoms of postpartum depression and protect infants. To approach this, we conducted a bibliometric analysis to address the study's main objective. Articles were retrieved from the Scopus database for the timeframe 2000-2023. Data analysis was conducted using the statistical programming language R (version R-4.4.) and the bibliometric software VOSviewer (version 1.6.20) and Biblioshiny (version 4.1.4), focused on year, journal, and country. For this investigation, we selected a total of 31 MeSH keywords and sub-headings that exhibited significant frequencies. We consistently used six significant clusters of MeSH keywords. We obtained a total of 585 articles from the Scopus database that were major contributors to the field of PPD, as evidenced by their extensive publication of research articles and their influential role in the domain. The studies included a thorough analysis of depression research, the use of scales for diagnosing and screening PPD, psychological studies related to PPD, and the exploration of causes, mechanisms, outcomes, and genetic factors. Our study's results demonstrate a steady and significant increase in the availability of information on PPD. Importantly, the novelty of the current study lies in highlighting the need for a transition in the ways in which nurses and midwives are trained to mitigate postpartum disease by integrating emerging technologies into their practices. The knowledge provided here has the potential to serve as a foundation for future advancements in obstetric psychology, both presently and in the future.

The evolution of health system planning and implementation of maternal telehealth services during the COVID-19 Pandemic

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.

Sudden Shift to Telehealth in COVID-19: A Retrospective Cohort Study of Disparities in Use of Telehealth for Prenatal Care in a Large Midwifery Service

INTRODUCTION

The coronavirus disease 2019 (COVID-19) pandemic created disruption in health care delivery, including a sudden transition to telehealth use in mid-March 2020. The purpose of this study was to examine changes in the mode of prenatal care visits and predictors of telehealth use (provider-patient messaging, telephone visits, and video visits) during the COVID-19 pandemic among those receiving care in a large, academic nurse-midwifery service.

METHODS

We conducted a retrospective cohort study of those enrolled for prenatal care in 2 nurse-midwifery clinics between 2019 and 2021 (n = 3172). Use outcomes included number and type of encounter: in-person and telehealth (primary outcome). Comparisons were made in frequency and types of encounters before and during COVID-19. A negative binomial regression was fit on the outcome of telehealth encounter count, with race/ethnicity, age, language, parity, hypertension, diabetes, and depression as predictors.

RESULTS

When comparing pre-COVID-19 (before March 2020) with during COVID-19 (after March 2020), overall encounters increased from 15.9 to 19.5 mean number of encounters per person (P < .001). The increase was driven by telehealth encounters; there were no significant differences for in-person prenatal visit counts before and during the pandemic period. Direct patient-provider messaging was the most common type of telehealth encounter. Predictors of telehealth encounters included English as primary language and diagnoses of diabetes or depression.

DISCUSSION

No differences in the frequency of in-person prenatal care visits suggests that telehealth encounters led to more contact with midwives and did not replace in-person encounters. Spanish-speaking patients were least likely to use telehealth-delivered prenatal care during the pandemic; a small, but significant, proportion of patients had no or few telehealth encounters, and a significant proportion had high use of telehealth. Integration of telehealth in future delivery of prenatal care should consider questions of equity, patient and provider satisfaction, access, redundancies, and provider workload.