Assessing access to obstetrical care via telehealth in the era of COVID-19

Osarhiemen, Omwanghe A; Robinson, Marc; Zhao, Zhiguo; D, Tan; Crants, Shelby; Carpenter, Heidi L; Lister, Rolanda

doi:10.1016/j.ajog.2021.09.011

Cited by 6 publications

(6 citation statements)

References 5 publications

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“…These findings align with the existing literature on less utilization of maternal telehealth services by rural, low-income, publicly insured pregnant and postpartum individuals and those whose primary language is not English. 43 , 56 , 57 Policymakers and payers could support health systems and practices by providing better access to blood pressure cuffs and other portable devices to prevent further exacerbation of disparities. Moreover, amid known geographic disparities in broadband availability and access, it is critical to consider how telehealth adoption may widen pre-existing disparities in access and outcomes—and find solutions to minimize them.…”

Section: Discussionmentioning

confidence: 99%

“…38 , 39 Studies have shown promising results in this regard. 40 – 43 For example, a randomized control trial for postpartum hypertension shows that black women in the postpartum telehealth group had more than 90% utilization of services compared to 33% in the traditional in-person group. 40 Furthermore, evidence suggests that patients value having telehealth as an option.…”

Section: Introductionmentioning

confidence: 99%

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

Aijaz,

Bozkurt,

Planey

et al. 2024

DIGITAL HEALTH

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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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Aijaz,

Bozkurt,

Planey

et al. 2024

DIGITAL HEALTH

View full text Add to dashboard Cite

show abstract

“… 7 Of note, 1 large study comparing prenatal visits before and after the pandemic demonstrated that, among identified vulnerable populations (based on demographics associated with higher prepandemic no-show rates), telehealth neither widened nor mitigated these disparities in accessing care. 16 …”

Section: Discussionmentioning

confidence: 99%

Impact of telehealth implementation on diagnosis of hypertensive disorders of pregnancy

Abelman

Svetec

Felder

et al. 2023

American Journal of Obstetrics & Gynecology MFM

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“…Studies from other settings have also reported improved access [ 48 , 72 , 92 , 93 ]. Conversely, Osarhiemen et al [ 94 ] identified that while telehealth did not mitigate inequities in access, it also did not widen existing disparities in the USA.…”

Section: Consumer Satisfactionmentioning

confidence: 99%

Telehealth in antenatal care: recent insights and advances

Atkinson,

Hastie,

Walker

et al. 2023

BMC Med

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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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Assessing access to obstetrical care via telehealth in the era of COVID-19

Cited by 6 publications

References 5 publications

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

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

Impact of telehealth implementation on diagnosis of hypertensive disorders of pregnancy

Telehealth in antenatal care: recent insights and advances

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