Patient and provider perspectives of a new prenatal care model introduced in response to the coronavirus disease 2019 pandemic

Abstract

Objective Randomized controlled trials document the safety and efficacy of reduced frequency prenatal visit schedules and virtual visits, but real-world data are lacking. Our institution created a prenatal care delivery model incorporating these alternative approaches to continue safely providing prenatal care during the COVID-19 pandemic. Our objective was to evaluate institutional-level adoption and patient and provider experiences with the COVID-19 prenatal care model. Study Design We conducted a single-site evaluation of a COVID-19 prenatal care model incorporating a reduced frequency visit schedule and virtual visits deployed at a suburban academic institution on March 20, 2020. We used Electronic Health Record data to evaluate institution-level model adoption, defined as changes in overall visit frequency and proportion of virtual visits in the three months before and after implementation. To evaluate the patient and provider experience with the COVID-19 model, we conducted an online survey of all pregnant patients (>20 weeks gestation) and providers in May 2020. Three domains of care experience were evaluated: 1) access, 2) quality and safety, and 3) satisfaction. Quantitative data were analyzed with basic descriptive statistics. Free-text responses coded by the three survey domains elucidated drivers of positive and negative care experiences. Results Following COVID-19 model adoption, average weekly prenatal visit volume fell by 16.1%, from 898 to 761 weekly visits, the average weekly proportion of prenatal visits conducted virtually increased from 10.8% (97/898) to 43.3% (330/761), and the average visit no-show rate remained stable (4.3% pre-implementation; 4.2%, post-implementation). Of those eligible, 74.8% (77/103) of providers and 15.0% (253/1690) of patients participated in the surveys. Patient respondents were largely white (180/253, 71.1%) and privately insured (199/253, 78.7%), reflecting the study site population. Rates of chronic conditions and pregnancy complications also differed from national prevalence. Provider respondents were predominantly white (44/66, 66.7%) and female (50/66, 75.8%). Most patients and almost all providers reported that virtual visits improved access to care (patients: 68.8%, 174/253; providers: 74/77, 96.1%). Over half of respondents (patients: 124/253, 53.3%; providers: 41/77, 62.1%) believed virtual visits were safe. Nearly all believed home blood pressure cuffs were important for virtual visits (patients: 213/231, 92.2%; providers: 63/66, 95.5%). Most reported satisfaction with the COVID-19 model (patients: 196/253, 77.5%; providers: 64/77, 83.1%). In free-text responses, drivers of positive care experiences were similar for patients and providers, and included perceived improved access to care through decreased barriers (e.g. transportation, childcare); perceived high quality of virtual visits for low-risk patients and increased ...

Knowledge and perceptions of theCOVID‐19 pandemic among patients with myasthenia gravis

“…The main limitation of this survey is the overall low participation. Although the participation was not as high as we hoped for, the survey response rate at other another American academic institution, using a similar approach to cold contact patients, during a similar point in the pandemic, and in a younger patient population was also low 31 . Other limitations include the very low participation from minorities who are more significantly impacted by the pandemic and have less access to computer and Internet resources, 32,33 and that our clinic population is generally wealthy and has very few uninsured patients.…”

Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysis

“…One proposed explanation for the increase in adverse pregnancy outcomes is that such outcomes could be linked to reduced access to care. Although maternal anxiety was consistently shown to be increased during the pandemic, health-care providers around the world have reported reduced attendance for routine 6 , 13 , 15 , 52 , 53 , 54 , 55 and unscheduled pregnancy care. 6 , 12 , 13 , 15 , 19 , 56 This reduction could be driven by concern about the risk of acquiring COVID-19 in health-care settings, governmental advice to stay at home, or reduced public transport and childcare access during lockdowns.…”

Comparison Between In-Person and Audio-Only Virtual Prenatal Visits and Perinatal Outcomes

“…10,11 With the onset of the pandemic, many institutions provided modified prenatal care using innovative platforms such as drive-through clinics and telehealth visits with varied results. [11][12][13][14][15][16] Telehealth visits may use synchronous video or audioonly technology, with each modality having both benefits and limitations. 17 Despite a lack of supporting data, video technology has de facto been considered superior to audio-only visits.…”