Reducing Disparities Using Telehealth Approaches for Postdelivery Preeclampsia Care

Abstract

The management of hypertensive disease of pregnancy presents an ongoing challenge after patients are discharged from delivery hospitalizations. Preeclampsia and other forms of postpartum hypertension increase the risk for severe maternal morbidity and mortality in the postpartum period, and both hypertension and its associated adverse events disproportionately affect black women. With its ability to transcend barriers to health care access, telemedicine can facilitate high-quality postpartum care delivery for preeclampsia management and thereby reduce racial disparities in obstetric care and outcomes. Here we discuss racial disparities in preeclampsia and the challenge of providing equitable postpartum preeclampsia care. We then describe the utility of novel telemedicine platforms and their application to combat these disparities in preeclampsia care.

Postpartum remote home blood pressure monitoring: the new frontier

“…Black patients suffer higher rates of preeclampsia, preeclampsia-related readmission, and subsequent long-term cardiac disease. 28 , 29 , 30 Postpartum, Black women have a slower decrease in blood pressure over a 6-week remote blood pressure monitoring program compared with White women, 29 and overall are more likely to be diagnosed with hypertension earlier in life and suffer from more significant morbidity related to hypertension, with 4 to 5 times greater mortality compared with non-Hispanic White Americans. 31 …”

“…In another study, >20% of Black women who missed an in-office appointment were initiated on medications via remote monitoring. 16 , 28 , 30 …”

Improving Postpartum and Long-Term Health After an Adverse Pregnancy Outcome: Examining Interventions From a Health Equity Perspective

“…Another technology-based intervention is mHealth, which refers to the use of mobile devices or Bluetooth technology in public health practice. mHealth may be particularly helpful among those with limited access to health care, as it enables health monitoring or education to occur virtually, overall reducing logistical barriers 89. Postpartum remote blood pressure monitoring through Bluetooth systems linked to clinics for individuals with HDP have high retention rates and show improvements in postpartum visit attendance 65–69.…”

“…mHealth may be particularly helpful among those with limited access to health care, as it enables health monitoring or education to occur virtually, overall reducing logistical barriers. 89 Postpartum remote blood pressure monitoring through Bluetooth systems linked to clinics for individuals with HDP have high retention rates and show improvements in postpartum visit attendance. [65][66][67][68][69] Many individuals report being satisfied with addressing health concerns at home rather than the clinic, which may be particularly burdensome among those with limited transportation or childcare.…”

The evolution of health system planning and implementation of maternal telehealth services during the COVID-19 Pandemic

“…38 , 39 Studies have shown promising results in this regard. 40 – 43 For example, a randomized control trial for postpartum hypertension shows that black women in the postpartum telehealth group had more than 90% utilization of services compared to 33% in the traditional in-person group. 40 Furthermore, evidence suggests that patients value having telehealth as an option.…”