Prenatal telemedicine during COVID-19: patterns of use and barriers to access

Abstract

Lay Summary To protect pregnant patients from infection during the COVID pandemic, maternity care providers turned to video and phone visits (“telemedicine”) to provide as much prenatal care as possible. To evaluate this change in our prenatal care program, we surveyed 164 pregnant people who had participated in a virtual prenatal visit about their care. Participants reported both positive and negative experiences, ranging from appreciation for having a safer option than in-person visits during the pandemic, to problems due to poor internet connection, lack of privacy, and lack of access to necessary equipment. Although 77.4% of respondents indicated they would recommend telemedicine to a friend, our program evaluation highlights the fact that the ability to participate in virtual care is not equally distributed. Unless steps are taken to address this problem, relying on telemedicine for a significant portion of prenatal care could result in widening disparities in prenatal care and outcomes. Policymakers and healthcare systems which provide telemedicine must address issues of access to technology and connectivity to avoid adding to maternal health disparities. Objective To evaluate patient experience with a prenatal telemedicine visit and identify barriers to accessing telemedicine among rural pregnant people in northern New England during the beginning of the COVID-19 pandemic. Materials and Methods We conducted a post-visit electronic survey of pregnant people who successfully participated in a prenatal telemedicine visit at a rural academic medical center in Northern New England. Nineteen questions were included in five domains; 1) engagement with prenatal care; 2) barriers to telemedicine and in person healthcare; 3) experience of prenatal care; 4) remote pregnancy surveillance tools; 5) sources of COVID-19 information. Results Responses were obtained from 164 pregnant people. Forty percent of participants had participated in an audio-only telemedicine visit, and 60% in a video telemedicine visit. The visit was easy or somewhat easy for 79% of respondents and somewhat difficult or difficult for 6.8%. The most common barrier to accessing telemedicine was poor internet or phone connectivity, followed by childcare responsibilities, lack of equipment and lack of privacy. Participants also engaged in additional remote prenatal care including phone calls with registered nurses (7.6%), communication with the obstetrics team through a secure health messaging portal (21.1%) and home health monitoring (76.3%). Discussion and Conclusions In this survey evaluating the experience of pregnant people participating in a prenatal telemedicine visit during the COVID-19 pandemic, respondents had a positive experience with telemedicine overall, but also identified significant barriers to participation including issues with connectivity and lack of equipment for the visit. Most participants used telemedicine in combination with other tools for remote self-care.

Lessons from digital technology-enabled health interventions implemented during the coronavirus pandemic to improve maternal and birth outcomes: a global scoping review

“…Previous studies conducted prior to the pandemic as well as during the pandemic has demonstrated the significance of telemedicine prenatal care [ 121 , 122 ]. However, others have raised concerns regarding equity in access to care, particularly in resource-limited settings [ 123 ]. The 6-telehealth technology-enable interventions identified in this scoping review focused on exercise, selfcare, prenatal counseling and behavioral health.…”

Women’s Satisfaction With Telehealth Services During The COVID-19 Pandemic: Cross-sectional Survey Study

“…Perhaps, women of color are satisfied with telehealth when they have access to it, but securing that access may be a greater challenge. For example, a recent survey of pregnant women living in rural areas found that although women reported a positive experience with prenatal telehealth visits overall, common barriers included poor internet and phone connectivity, childcare responsibilities, and lack of equipment [ 21 ], factors that may disproportionately impact minority groups. Although it is important to understand women’s experiences using telehealth, ensuring equitable access to these services is paramount and public health programs or policies are needed to reduce barriers to telehealth access.…”

Promoção Da Saúde Da Mulher

“…A respeito dos resultados da teleassistência, a maioria dos artigos relatou que os pacientes sentiram-se satisfeitos; incluindo gestantes de alto risco (JENAGATHAN et al, 2020). Essa satisfação foi relacionada à facilidade da consulta, segurança e diminuição de barreiras como o transporte e o risco de infecção para poder ter acesso ao cuidado (JENAGATHAN et al, 2020, MORGAN et al, 2022, FARRELL et al, 2022, CHEN et al, 2020. Também foi descrita a eficácia da telessaúde na prevenção de desfechos materno-fetais negativos, como restrição do crescimento fetal, diabetes gestacional e pré-eclâmpsia (PALMER et al, 2021), depressão perinatal (LATENDRESSE et al, 2021); GAO et al, (2022) inclusive revelaram que os resultados obstétricos não tiveram diferenças significativas entre os pré-natais realizados de forma presencial e remota.…”

“…Também foi descrita a eficácia da telessaúde na prevenção de desfechos materno-fetais negativos, como restrição do crescimento fetal, diabetes gestacional e pré-eclâmpsia (PALMER et al, 2021), depressão perinatal (LATENDRESSE et al, 2021); GAO et al, (2022) inclusive revelaram que os resultados obstétricos não tiveram diferenças significativas entre os pré-natais realizados de forma presencial e remota. As dificuldades relatadas foram principalmente devidas a dificuldades de acesso (MADDEN et al, 2020;FARRELL et al, 2022) e a uma relativa insegurança entre as gestantes comparado ao modelo presencial (MORGAN et al, 2022).…”

“…Os estudos apresentam que esse recurso foi importante, no sentido de reduzir o contato de gestantes com locais e pessoas -hospitais e profissionais da saúde -mais vulneráveis ao contágio da COVID-19, reduzindo também possíveis implicações para a saúde materno e fetal, uma grande preocupação desde o início da pandemia (FRYER et al, 2020, REALE et al, 2020. Percebe-se que pandemia mobilizou novas formas de cuidado, com o suporte dos profissionais de saúde, como soluções alternativas, incluindo a expansão da telemedicina, com plataformas eficazes e práticas (WATCH, 2020) e a utilização de aparelhos usualmente hospitalares em casa: como manguito para medição da pressão e ultrassonografia, como utilizados nos estudos de (JEGANATHAN et al, 2020, MORGAN et al, 2022.…”