873: A randomized trial of prenatal care using telemedicine for low-risk pregnancies: patient-related cost and time savings

Barbour, Kelli; Nelson, Richard E.; Esplin, M. Sean; Varner, Michael W.; Clark, Erin

doi:10.1016/j.ajog.2016.11.782

Cited by 8 publications

(13 citation statements)

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“…30 Furthermore, a randomized trial by Barbour et al found that using telemedicine for patients with low-risk pregnancies saved time and was associated with lower costs. 31 The aim of this scoping review was to determine how health care organizations are responding rapidly to the COVID-19 pandemic by incorporating telehealth visits into their protocols for obstetric care, what types of obstetric services were converted to telehealth, the benefits that telehealth can provide for medical practices, and the barriers these organizations are facing when implementing telehealth during the COVID-19 pandemic.…”

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confidence: 99%

Models of Incorporating Telehealth into Obstetric Care During the COVID-19 Pandemic, Its Benefits And Barriers: A Scoping Review

Almuslim

AlDossary

2022

Telemedicine and e-Health

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Introduction: Coronavirus disease 2019 (COVID-19) is a highly contagious viral infection. Hospitals worldwide have decreased face-to-face visits to reduce the exposure to the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Prenatal and postpartum care are essential for the health of women and their fetuses. Therefore, many hospitals have incorporated telehealth into their protocols. Objectives: The aim of this review was to determine how health care organizations are responding to the COVID-19 pandemic by incorporating telehealth visits into their protocols for obstetrics care, what services were converted to telehealth, and its benefits and barriers. Method: A computerized literature search was performed using PubMed and Cumulative Index of Nursing and Allied Health Literature (CINAHL) databases using terms, including ''telehealth,'' ''virtual visits,'' ''obstetric,'' ''pregnancy,'' ''postpartum,'' and ''COVID-19'' for articles published before October 2020. Peer reviewed articles and guidelines were included in this review. Results: A total of 25 articles were identified. Fifteen articles reported protocols. During this pandemic, protocols developed replaced some in-person visits with telehealth visits, when no testing or vaccinations are required. The main reported benefits were minimizing exposure to SARS-CoV-2 and the continuity to provide high-quality and safe care. Lack of access to high-speed internet and hardware and inaccessibility to patients were the most reported barriers. Conclusion: Telehealth provided the opportunity for reducing in-person visits during the COVID-19 pandemic. Some prenatal services could be completely provided through telehealth and others require medical equipment to be delivered. Health care organizations recognized that using telehealth could be continued beyond this pandemic, as they provided many benefits for patients, medical staff, and the organizations themselves.

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confidence: 99%

Models of Incorporating Telehealth into Obstetric Care During the COVID-19 Pandemic, Its Benefits And Barriers: A Scoping Review

Almuslim

AlDossary

2022

Telemedicine and e-Health

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“…Overall, seven studies (in 9 publications) compared televisits (or hybrid visits) with in-person visits for routine antenatal care. [55][56][57][58][59][60][61][62][63] These included two RCTs, 55,56 four NRCSs, [57][58][59][60][61][62] and one survey. 63 The studies mostly compared groups of patients who either had a hybrid schedule, including both televisits and in-person visits, with those who had in-person visits only.…”

Section: Summary Of Findingsmentioning

confidence: 99%

“…Six studies compared hybrid antenatal visit schedules (both televisits and in-person visits) with in-person antenatal visits only. Two were RCTs (Barbour 2017, Butler Tobah 2019) 55,56 and four were NRCSs , Pflugeisen 2017). [57][58][59][60] Except for Palmer 2021 (conducted in Australia), the studies were conducted in the United States, in Salt Lake City, Minnesota, Dallas, and around Seattle.…”

Section: Hybrid Visits Versus In-person Visitsmentioning

confidence: 99%

Schedule of Visits and Televisits for Routine Antenatal Care: A Systematic Review

Balk¹,

Konnyu²,

Cao³

et al. 2022

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Background. The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine plan a new evidence-based joint consensus statement to address the preferred visit schedule and the use of televisits for routine antenatal care. This systematic review will support the consensus statement. Methods. We searched PubMed®, Cochrane databases, Embase®, CINAHL®, ClinicalTrials.gov, PsycINFO®, and SocINDEX from inception through February 12, 2022. We included comparative studies from high-income countries that evaluated the frequency of scheduled routine antenatal visits or the inclusion of routine televisits, and qualitative studies addressing these two topics. We evaluated strength of evidence for 15 outcomes prioritized by stakeholders. Results. Ten studies evaluated scheduled number of routine visits and seven studies evaluated televisits. Nine qualitative studies also addressed these topics. Studies evaluated a wide range of reduced and traditional visit schedules and approaches to incorporating televisits. In comparisons of fewer to standard number of scheduled antenatal visits, moderate strength evidence did not find differences for gestational age at birth (4 studies), being small for gestational age (3 studies), Apgar score (5 studies), or neonatal intensive care unit (NICU) admissions (5 studies). Low strength evidence did not find differences in maternal anxiety (3 studies), preterm births (3 studies), and low birth weight (4 studies). Qualitative studies suggest that providers believe fewer routine visits may be more convenient for patients and may free up clinic time to provide additional care for patients with high-risk pregnancies, but both patients and providers had concerns about potential lesser care with fewer visits. In comparisons of hybrid (televisits and in-person) versus in-person only visits, low strength evidence did not find differences in preterm births (4 studies) or NICU admissions (3 studies), but did suggest greater satisfaction with hybrid visits (2 studies). Qualitative studies suggested patients and providers were open to reduced schedules and televisits for routine antenatal care, but importantly, patients and providers had concerns about quality of care, and providers and clinic leadership had suggestions on how to best implement practice changes. Conclusion. The evidence base is relatively sparse, with insufficient evidence for numerous prioritized outcomes. Studies were heterogeneous in the care models employed. Where there was sufficient evidence to make conclusions, studies did not find significant differences in harms to mother or baby between alternative models, but evidence suggested greater satisfaction with care with hybrid visits. Qualitative evidence suggests diverse barriers and facilitators to uptake of reduced visit schedules or televisits for routine antenatal care. Given the shortcomings of the evidence base, considerations other than proof of differences in outcomes may need to be considered regarding implications for clinical practice. New studies are needed to evaluate prioritized outcomes and potential differential effects among different populations or settings.

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“…Women who are physically limited from coming to the clinic will gain improved accessibility to obstetrical services; and better clinical outcomes are expected, such as identifying and preventing preterm labors and other conditions that require early diagnosis and treatments ( DeNicola et al, 2020 ; Lanssens et al, 2017 ; Xie et al, 2020 ). Additional potential benefits of remote monitoring include cost reduction through decreased antepartum hospitalization time and improved neonatal outcomes ( Buysee et al, 2008 ; Barbour et al, 2017 ; Lanssens et al, 2018 ; Butler Tobah et al, 2019 ). Specifically, the ability to perform remote non-stress tests (NSTs) could be of great benefit to women and providers seeking telehealth solutions for pregnancy care.…”

Section: Introductionmentioning

confidence: 99%

A Novel, Cardiac-Derived Algorithm for Uterine Activity Monitoring in a Wearable Remote Device

Mhajna

Sadeh²,

Sohn³

et al. 2022

Front. Bioeng. Biotechnol.

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Background: Uterine activity (UA) monitoring is an essential element of pregnancy management. The gold-standard intrauterine pressure catheter (IUPC) is invasive and requires ruptured membranes, while the standard-of-care, external tocodynamometry (TOCO)’s accuracy is hampered by obesity, maternal movements, and belt positioning. There is an urgent need to develop telehealth tools enabling patients to remotely access care. Here, we describe and demonstrate a novel algorithm enabling remote, non-invasive detection and monitoring of UA by analyzing the modulation of the maternal electrocardiographic and phonocardiographic signals. The algorithm was designed and implemented as part of a wireless, FDA-cleared device designed for remote pregnancy monitoring. Two separate prospective, comparative, open-label, multi-center studies were conducted to test this algorithm.Methods: In the intrapartum study, 41 laboring women were simultaneously monitored with IUPC and the remote pregnancy monitoring device. Ten patients were also monitored with TOCO. In the antepartum study, 147 pregnant women were simultaneously monitored with TOCO and the remote pregnancy monitoring device.Results: In the intrapartum study, the remote pregnancy monitoring device and TOCO had sensitivities of 89.8 and 38.5%, respectively, and false discovery rates (FDRs) of 8.6 and 1.9%, respectively. In the antepartum study, a direct comparison of the remote pregnancy monitoring device to TOCO yielded a sensitivity of 94% and FDR of 31.1%. This high FDR is likely related to the low sensitivity of TOCO.Conclusion: UA monitoring via the new algorithm embedded in the remote pregnancy monitoring device is accurate and reliable and more precise than TOCO standard of care. Together with the previously reported remote fetal heart rate monitoring capabilities, this novel method for UA detection expands the remote pregnancy monitoring device’s capabilities to include surveillance, such as non-stress tests, greatly benefiting women and providers seeking telehealth solutions for pregnancy care.

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873: A randomized trial of prenatal care using telemedicine for low-risk pregnancies: patient-related cost and time savings

Cited by 8 publications

References 0 publications

Models of Incorporating Telehealth into Obstetric Care During the COVID-19 Pandemic, Its Benefits And Barriers: A Scoping Review

Models of Incorporating Telehealth into Obstetric Care During the COVID-19 Pandemic, Its Benefits And Barriers: A Scoping Review

Schedule of Visits and Televisits for Routine Antenatal Care: A Systematic Review

A Novel, Cardiac-Derived Algorithm for Uterine Activity Monitoring in a Wearable Remote Device

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