Adherence and acceptability of telehealth appointments for high-risk obstetrical patients during the coronavirus disease 2019 pandemic

Abstract

Background Telehealth has been successfully implemented for the delivery of obstetrical care. However, little is known regarding the attitudes and acceptability of patients and providers in high risk obstetrics and if implementation improves access to care in non-rural settings. Objective The study aims to: 1) Describe patient and provider attitudes toward telehealth for delivery of high risk obstetrical care in a large health care system with both urban and suburban settings. 2) Determine if implementation of a telehealth model improves patient adherence to scheduled appointments in this patient population. Study DesignTwo self-administered surveys were designed. The first survey was sent to all high-risk obstetrical patients who received a telehealth visit between March 1, 2020 and May 30, 2020. The second survey was designed for providers who participated in these visits. We also compared the attended, cancelled and no show visit rates before (March 1-May 30, 2019) and after (March 1-May 30, 2020) telehealth implementation, as well as telehealth versus in person visits in 2020. We reviewed scheduled high-risk prenatal care appointments, diabetes education sessions, and genetic counseling and Maternal- Fetal Medicine consultations. Results A total of 91 patient surveys and 33 provider surveys were analyzed. Overall, 86.9% of patients were satisfied with the care they received and 78.3% would recommend telehealth visits to others. 87.8% of providers reported having a positive experience using telehealth, and 90.9% believed that telehealth improved patients’ access to care. When comparing patient and provider preference regarding future obstetrical care after experiencing telehealth, 73.8% of patients desired a combination of in person and telehealth visits during their pregnancy. However, a significantly higher rate of providers preferred in-person visits (56% vs 23% respectively). When comparing visits between 2019 and 2020, there was a significantly lower rate of no-show appointments, patient-cancelled appointments, and patient same-day cancellations with the implementation of telehealth. There was also a significantly lower rate of patient-cancelled appointments, and patient same-day cancellations with those receiving telehealth visits compared to in person visits in 2020. Conclusion Implementation of telehealth in high risk obstetrics has the potential to improve access to high risk obstetrical care, by reducing the rate of missed appointments. Both patients and providers surveyed expressed a high rate of satisfaction with telehealth visits and a desire to integrate telehealth into the traditional model of high risk obstetrical care.

Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysis

“…One proposed explanation for the increase in adverse pregnancy outcomes is that such outcomes could be linked to reduced access to care. Although maternal anxiety was consistently shown to be increased during the pandemic, health-care providers around the world have reported reduced attendance for routine 6 , 13 , 15 , 52 , 53 , 54 , 55 and unscheduled pregnancy care. 6 , 12 , 13 , 15 , 19 , 56 This reduction could be driven by concern about the risk of acquiring COVID-19 in health-care settings, governmental advice to stay at home, or reduced public transport and childcare access during lockdowns.…”

Global changes in maternity care provision during the COVID-19 pandemic: A systematic review and meta-analysis

“…Twenty-five studies [ 13 , 26 , 28 , 29 , 33 , [35] , [36] , [37] , 40 , 42 , [44] , [45] , [46] , [47] , 50 , [56] , [57] , [58] , 60 , [65] , [66] , [67] , [68] , [69] , [70] ] reported on antenatal clinic attendance during the pandemic using a variety of metrics. In several settings, no alteration was made to the standard antenatal care protocol, but decreased antenatal clinic attendance was reported in the majority of studies; in high income settings a decline in face to face contacts was offset by an increase in remote or virtual clinic appointments and the nature but not the number of the appointments varied [ 26 , 29 , 35 , 40 , [42] , [43] , [44] , [45] , 47 , 66 , 70 ]. Reports from low resource settings noted a particularly profound reduction in antenatal care contacts.…”

Prehabilitation during a pandemic: preoperative exercise to improve fitness in patients undergoing complex surgery for cancer of the lung or oesophagus, the PRE-HIIT trial: an updated study protocol

“…Patients will be asked to complete a self-administered survey to evaluate the acceptability of the PRE-HIIT programme delivered via telehealth 7 .…”

“…At the pre-surgery assessment (T1) a sub-cohort of the study's participants will take part in a semi-structured interview 7 . This interview will collect feedback on how the PRE-HIIT study has impacted on their preparation for surgery and participant satisfaction with the delivery of PRE-HIIT via telehealth.…”