Telemedicine may increase visit completion rates in postpartum patients with preeclampsia

Abstract

Postpartum cardiovascular (CV) evaluation of women with preeclampsia is recommended to screen for and treat modifiable risk factors to reduce lifetime CV risk. However, attendance at in-person postpartum obstetric and cardiology clinic visits is low. The aim of this study was to compare the completion rate of new patient telemedicine visits to in-person office visits for patients with preeclampsia referred for postpartum hypertension management and CV risk assessment at a single center. There were 236 unique new patient visits scheduled during the study period. The average age was 30.3 years, 73.7% patients were Black, and 56.7% had Medicaid insurance. The completion rate was 32% for in-person clinic visits and 70% for telemedicine visits. Women who did not complete an office visit were more likely to be Black (87% vs. 56%, p < 0.01) and younger (29.1 vs. 31.4 years, p = 0.04) compared to those who completed a visit. Notably, this difference was not seen with telemedicine visits. Telemedicine may provide a novel opportunity to improve the care for blood pressure management and CV risk reduction in a vulnerable population at risk of premature CV disease.

Hypertensive Disorders of Pregnancy

“…A single center study in a U.S. urban minority community indicated women who did not attend an in-person office visit were more often Black (87% vs 56%), P < 0.01) and younger (29.1 vs 31.4 years, P = 0.04), but no disparity by race or ethnicity was seen for telehealth visits. 51 Attendance for a telehealth visit was high, 70% vs 32% for an in-person visit. 51 Telephone, text message, and video conference-based communication were well received by patients and providers in several studies.…”

“… 51 Attendance for a telehealth visit was high, 70% vs 32% for an in-person visit. 51 Telephone, text message, and video conference-based communication were well received by patients and providers in several studies. 52 , 53 However, a University of Arkansas study of self-monitoring in a rural cohort using mobile health (mHealth) wireless transmitting equipment found several challenges with this strategy.…”

“…Use of telehealth may also reduce racial disparities. 51 , 56 , 57 In a study at the University of Pennsylvania, Hirshberg et al 56 found decreased racial disparity when using a text-messaging-based platform. Their study found that over 90% of Black participants provided a BP measurement compared to the 33% who presented for an in-person BP visit as per routine care.…”