The use of a combination of telemedicine (TM) and in-person visits for prenatal care

QUESTION

Prenatal care using a combination of TM and FTF visits is becoming more acceptable by patients and providers as a result of using it during the COVID-19 pandemic. Providing an appropriate schedule, appropriate monitoring equipment, and enhanced educational materials can bring this into a new standard of care. Evidence shows that TM provides comparable health outcomes to the traditional FTF in-office delivery of care without compromising quality of care as defined by standard statistics used by ACOG (American College of Obstetricians and Gynecologists Presidential Task Force of Telehealth, 2020, February, Butler-Tobah, et. al., 2019, Pflugeisen, et. al., 2016). Advantages for women who choose this hybrid model of prenatal care include increased access, significant feelings of satisfaction with their care, savings in time, savings of money, flexibility with work schedules, and a decreased stress level, and significant feelings of satisfaction with their care. This model also allows providers to open slots for high-risk patients in the office.

There are many opportunities to expand access using TM in caring for maternity patients. Prior to 2020, telemedicine in obstetrics was minimal due to lack of interest, cost, limited internet access in rural areas, and inconsistent reimbursement across different state Medicaid programs (Yasgur, 2020, April 28; Weigel, et. al., 2020, February 26). As progress occurs with the ability to provide visits and monitor equipment to patients, services can expand further to include some patients with high-risk conditions such as gestational diabetes or preeclampsia. Expansion of an interdisciplinary team can include consultation with maternal-fetal-medicine (MFM) specialists, consultation with geneticists, lactation support services, nutrition services, and mental health care (Weigel, et. al., 2020, February 26). Future studies should include increasing access to women in rural communities where obstetricians and gynecologists are not readily available and evaluating use among a variety of demographics. Caution should be taken, however, in regard to state licensure, state laws, liability insurance specific to telemedicine, Health Insurance Portability and Accountability Act (HIPAA) regulations, access to the necessary hardware and software, and reliable internet access when implementing these types of new protocols (American College of Obstetricians and Gynecologists Presidential Task Force of Telehealth, 2020, February; Yasgur, 2020).

Smith, D. H. (2021). Increasing access using a hybrid model of prenatal care: A systematic literature review and program implementation. [Doctoral dissertation, Marymount University]. ProQuest Dissertation & Theses Global.

Convert Dr. Smith’s Summary section into an outline that includes the following headings and uses bullet points to concisely summarize the relevant information provided in the excerpt:

• Summary of results or key findings
• Implications of the results for clinical practice
• Limitations and opportunities for improvement
• Suggestions for future clinical projects or research

ANSWER

Summary of Results or Key Findings

The use of a combination of telemedicine (TM) and in-person visits for prenatal care is gaining acceptance among patients and providers during the COVID-19 pandemic.
Evidence suggests that TM provides comparable health outcomes to traditional face-to-face (FTF) in-office care without compromising quality as defined by standard statistics used by ACOG.
Women who choose the hybrid model of prenatal care report increased access, satisfaction with care, time and cost savings, flexibility with work schedules, decreased stress levels, and providers can allocate more in-office slots for high-risk patients.

Implications of the Results for Clinical Practice

The use of TM in prenatal care can expand access and improve patient experiences, particularly in terms of convenience and flexibility.
Providers should consider providing appropriate schedules, monitoring equipment, and enhanced educational materials to facilitate the adoption of the hybrid model of care.
The hybrid model allows for opening slots for high-risk patients in the office, ensuring appropriate attention to their needs.

Limitations and Opportunities for Improvement

Prior to 2020, telemedicine in obstetrics was limited due to various factors such as lack of interest, cost, limited internet access, and inconsistent reimbursement.
Expansion opportunities exist to include patients with high-risk conditions and involve interdisciplinary teams for consultation and support services.
Further studies should focus on increasing access in rural communities, evaluating use among different demographics, and addressing legal, regulatory, and technological challenges.

Suggestions for Future Clinical Projects or Research

Future projects should explore the implementation of the hybrid model of prenatal care in diverse settings, considering factors such as state licensure, liability insurance, HIPAA regulations, and access to necessary hardware and reliable internet.
Research should continue to assess the impact of TM in maternity care, including its effectiveness in managing conditions like gestational diabetes and preeclampsia.
Additionally, there is a need for studies to examine the long-term outcomes and cost-effectiveness of the hybrid model of care.