Perinatal Telehealth: Meeting Patients Where They Are

Abstract

IntroductionPrior to the coronavirus disease 2019 (COVID‐19) pandemic, studies of innovative telehealth perinatal care models showed similar clinical outcomes and perceived quality of care between groups receiving a combination of virtual video and in‐person visits. However, these studies included primarily White, English‐speaking participants, excluding those who were economically disenfranchised or did not speak English. The purpose of this qualitative study was to describe perinatal patients’ and providers’ experiences with telehealth during and after the acute phase of the COVID‐19 pandemic to inform future utilization of telehealth to drive the delivery of high‐quality, accessible, and equitable perinatal care to diverse communities.MethodsThis descriptive qualitative study included a purposive sample of 14 patients and 17 providers who received or provided perinatal care via telehealth in either a certified nurse‐midwifery practice or the nurse‐family partnership care model between March 2020 and April 2022. Maximum variation sampling offered a diverse population based on race, ethnicity, and rurality. Researchers conducted 2 rounds of semistructured interviews with a focus on understanding social and geographic context.ResultsSix themes were identified through inductive analysis: (1) unexpected advantages of telehealth, (2) patient empowerment, (3) providers’ fear of adverse outcomes, (4) concern for equitable care, (5) strategies to enhance the telehealth experience, and (6) strategies to address access to perinatal telehealth. Patients appreciated the increased ease and reduced cost of accessing visits, which led to fewer missed appointments. Health care providers saw great opportunity in telehealth but expressed concerns about accessibility for patients with language barriers or limited resources.DiscussionThis study provides insight into priorities for continued telehealth utilization focused on providing equitable access to perinatal care. Rather than returning to practices from before the COVID‐19 pandemic formed from longstanding routines and perceived limitations, providers are encouraged to capitalize on the rapid innovations in telehealth to build a more effective, equitable, and patient‐centered approach to perinatal care.

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

“…Again, these results elaborate on the reasons for patients’ preference for telehealth visits or vice versa. 59 – 63 For example, Lui et al found that the study participants preferred in-person prenatal care over telehealth. Our study elaborates on these findings by identifying reasons for this preference, such as the desire of patients to detect fetal heartbeat, particularly first-time mothers, that may be limited during a telehealth visit.…”

“…Kissler et al found that pregnant women using telehealth found care accessible and reduced care costs. 61 Another study by Mehl et al found that patients who had to travel longer distances and had childcare needs preferred telehealth over in-person visits. 62 These factors can help health systems understand the reasons for variable uptake of maternal telehealth services in their context and devise targeted strategies to demonstrate the effectiveness and quality of maternal telehealth services to their patient population.…”

“…Our study also extends the literature on the potential opportunities for maternal telehealth services in the future. 61 , 80 For example, Olenski et al reported the need for a hybrid delivery model consisting of telephone consultations with some face-to-face consultations for pregnant individuals with diabetes in the future. 80 We further these results by identifying the scope of clinical care that would advance the quality of clinical care, such as provider-provider consultations and antenatal testing when access can be difficult otherwise.…”

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

“…Telehealth technology has the capability to provide a diverse range of services pertaining to pregnancy [46][47][48][49][50]. Continued telehealth application aims to provide equitable access to perinatal care [51]. Telehealth has the potential to enhance standard prenatal care by facilitating consultations with specialists, providing genetic counseling, interpreting ultrasound images, remotely monitoring patients, and offering other specialized services.…”

Best Practices for Telehealth in Nurse-Led Care Settings—A Qualitative Study

“…As the nursing discipline continues to evolve and adapt to technology, nursing practice is called to find innovative ways to deliver care and to adapt to urgent health challenges during a pandemic and beyond. Nurses, nurse leaders, and healthcare policy advocates should design telehealth services that incorporate lessons learned and best practices from the evidence (Kissler et al, 2023). Implications for policy and practice include: addressing access disparities by supporting legislative actions that promote a robust and equitable technological infrastructure which remains reimbursable; policies and protocols to ensure safe, appropriate engagement with telehealth care; policies, protocols, and education around the types of visits most suited to telehealth; and inclusion of nurse-led practices as reimbursable telehealth models of care.…”