Telehealth Uptake into Prenatal Care and Provider Attitudes during the COVID-19 Pandemic in New York City: A Quantitative and Qualitative Analysis

Abstract

Objective This study aimed to (1) determine to what degree prenatal care was able to be transitioned to telehealth at prenatal practices associated with two affiliated hospitals in New York City during the novel coronavirus disease 2019 (COVID-19) pandemic and (2) describe providers' experience with this transition. Study Design Trends in whether prenatal care visits were conducted in-person or via telehealth were analyzed by week for a 5-week period from March 9 to April 12 at Columbia University Irving Medical Center (CUIMC)-affiliated prenatal practices in New York City during the COVID-19 pandemic. Visits were analyzed for maternal-fetal medicine (MFM) and general obstetrical faculty practices, as well as a clinic system serving patients with public insurance. The proportion of visits that were telehealth was analyzed by visit type by week. A survey and semistructured interviews of providers were conducted evaluating resources and obstacles in the uptake of telehealth. Results During the study period, there were 4,248 visits, of which approximately one-third were performed by telehealth (n = 1,352, 31.8%). By the fifth week, 56.1% of generalist visits, 61.5% of MFM visits, and 41.5% of clinic visits were performed via telehealth. A total of 36 providers completed the survey and 11 were interviewed. Accessing technology and performing visits, documentation, and follow-up using the telehealth electronic medical record were all viewed favorably by providers. In transitioning to telehealth, operational challenges were more significant for health clinics than for MFM and generalist faculty practices with patients receiving public insurance experiencing greater difficulties and barriers to care. Additional resources on the patient and operational level were required to optimize attendance at in-person and video visits for clinic patients. Conclusion Telehealth was rapidly implemented in the setting of the COVID-19 pandemic and was viewed favorably by providers. Limited barriers to care were observed for practices serving patients with commercial insurance. However, to optimize access for patients with Medicaid, additional patient-level and operational supports were required. Key Points

Differential Uptake of Telehealth for Prenatal Care in a Large New York City Academic Obstetrical Practice during the COVID-19 Pandemic

“…A decreased number of inperson visits supplemented by telehealth may be a safe and effective model for prenatal care. 3,7 We show that women with public insurance in a single NYC academic obstetric practice were significantly less likely to utilize telehealth for prenatal care than patients with private insurance. Women with public insurance have been shown to have lower rates of early and adequate prenatal care, often attributed to difficulties enrolling and changes in insurance, 8 and in our population, we also saw lower rates of telehealth utilization.…”

Restructuring maternal services during the covid-19 pandemic: Early results of a scoping review for non-infected women

“…A North-American initiative carried out in New York City modified the clinical pattern of ANC, transforming one third of face-to-face visits into distant contacts, a result judged as fairly successful in spite of not achieving the planned 50% reduction of in-person visits ( Aziz et al., 2020 ; Madden et al., 2020 ).…”

“…To some extent, relying on community resources with decentralization of primary levels of care should integrate most modern solutions: use of community facilities as well as epidemic-free hospitals should be electively selected for ANC follow-up including ultrasound consultations. This approach certainly applies more to limited-resource settings where telemedicine and drive-through are not affordable ( Aziz et al., 2020 ; Madden et al., 2020 ; Turrentine et al., 2020 ).…”

Clinical guidance and perinatal care in the era of coronavirus disease 2019 (COVID-19)

“…The availability and incorporation of telemedicine has increased dramatically during the COVID-19 pandemic, and has proved an important complement to necessary in-person patient visits, along with combined multi-disciplinary visits for routine and higher-risk pregnancy indications, and limiting antenatal fetal surveillance to what is safe and appropriate [41]. Telemedicine-based care for high-risk obstetric patients has also been described [42]. However, barriers to access of telemedicine should be assessed, including lack of access to technology or Internet, lack of privacy due to residential constraints, concerns about intimate partner violence, or presence of hearingimpairment (REF: Duzyj, Thornburg, Han.…”