Quality framework for remote antenatal care: qualitative study with women, healthcare professionals and system-level stakeholders

Abstract

BackgroundHigh-quality antenatal care is important for ensuring optimal birth outcomes and reducing risks of maternal and fetal mortality and morbidity. The COVID-19 pandemic disrupted the usual provision of antenatal care, with much care shifting to remote forms of provision. We aimed to characterise what quality would look like for remote antenatal care from the perspectives of those who use, provide and organise it.MethodsThis UK-wide study involved interviews and an online survey inviting free-text responses with: those who were or had been pregnant since March 2020; maternity professionals and managers of maternity services and system-level stakeholders. Recruitment used network-based approaches, professional and community networks and purposively selected hospitals. Analysis of interview transcripts was based on the constant comparative method. Free-text survey responses were analysed using a coding framework developed by researchers.FindingsParticipants included 106 pregnant women and 105 healthcare professionals and managers/stakeholders. Analysis enabled generation of a framework of the domains of quality that appear to be most relevant to stakeholders in remote antenatal care: efficiency and timeliness; effectiveness; safety; accessibility; equity and inclusion; person-centredness and choice and continuity. Participants reported that remote care was not straightforwardly positive or negative across these domains. Care that was more transactional in nature was identified as more suitable for remote modalities, but remote care was also seen as having potential to undermine important aspects of trusting relationships and continuity, to amplify or create new forms of structural inequality and to create possible risks to safety.ConclusionsThis study offers a provisional framework that can help in structuring thinking, policy and practice. By outlining the range of domains relevant to remote antenatal care, this framework is likely to be of value in guiding policy, practice and research.

A mixed method exploration of the impact of Covid-19 on ethnic inequalities in maternal and neonatal outcomes

“…Trust exibility and proactivity allowed enhanced care to remain in place for women with high-risk pregnancies or who are from vulnerable backgrounds, and women who needed interpreters were still seen face to face. This demonstrates that staff were reacting to concerns that remote consultations can lead to inequitable care, a nding also established in other recent research (25,29). Staff reported that, in their Trusts, women from ethnic minorities were more likely to fall into these vulnerable groups.…”

‘Nesting networks’: Women's experiences of social network support in high-risk pregnancy

“…Three interviews were conducted during the COVID-19 pandemic. The rapid change to the provision of remote antenatal care, compelled women to adjust to new ways of accessing and receiving antenatal care and information [42,43].…”

Telemedis Dalam Pelayanan Perawatan Kehamilan

“…Meskipun OR-nya tampak tinggi, hanya dua penelitian yang melaporkan hasil ini, sehingga jumlahnya kecil. Mereka juga melaporkan bahwa wanita tidak mengalami peningkatan risiko kelahiran instrumental (OR 1,44 [95% CI 0,95, 2,18], p = 0,09; N = 1020) atau episiotomi (OR 1,04 [95% CI 0,20], p = 0,93; N = 244) (Güneş Öztürk, Akyıldız and Karaçam, 2022). Duryea dkk.…”

“…Tidak menunjukkan perbedaan antara telehealth dan perawatan konvensional untuk komplikasi neonatal. Ini termasuk skor Apgar 5 menit yang rendah <7 (OR 0,54 [95% CI 0,14, 2,14], p = 0,38; N = 236], sindrom gangguan pernapasan (OR 0,65 [95% CI 0,38,1,13], p = 0,99; N = 928), hipoglikemia (OR 1.18 [95% CI 0.74,1.87], p = 0.48; n = 701), dan hiperbilirubinemia (OR 0.86 [95% CI 0.48, 1.54], p = 0.61; N = 583) (Güneş Öztürk, Akyıldız and Karaçam, 2022). Penelitian lain mendukung temuan ini, selain tidak adanya peningkatan risiko asfiksia neonatal atau pH tali pusat yang rendah.…”