Telemedicine took the sentiment of “from the comfort of your own home” to a new level for parents.
New research indicates that the use of telemedicine by expectant and new moms may be here to stay, and women are pleased.
In a rapid review of over 44,000 women that was published in the Annals of Internal Medicine, researchers found that participants were equally satisfied or more satisfied with the quality of maternal care received during online appointments than were mothers who had in-person visits.
“Virtual visits and home monitoring are promising strategies for tailoring care to patients’ individual needs: reducing the burden of missed work, travel, or childcare, while ensuring patients have access to high-quality services,” said Alex Peahl, MD, director of the Redesigning Prenatal Care Initiative committee of the American College of Obstetricians and Gynecologists (ACOG). The committee makes recommendations on the best practices for prenatal care delivery on the basis of mothers’ preferences rather than tradition. Peahl was not involved with the study.
Telemedicine plays an essential and growing role in the work of the committee, inasmuch as it has potential to meet patients’ social needs, Peahl said.
Maternal care included prenatal and postnatal care, as well as mental health services. Researchers assessed previously published analyses of a variety of online methods of care delivery, including phone calls, video calls, text messages, and apps.
For maternal care, telemedicine was used in part to mitigate risk to the mother, according to Amy Cantor, MD, MPH, an assistant professor of medical informatics and clinical epidemiology at Oregon Health and Science University in Portland, who led the study. Three years into the COVID-19 pandemic, online options continue to reduce the risk of infection and exposure to disease.
“A lot of the increase in telehealth was in response to a global pandemic,” Cantor said. “There was a huge pivot in the way that care had to be delivered in order to keep people safe, and unfortunately, we’re still navigating how to offer care in the midst of a pandemic.”
First or Second Line?
Although ACOG’s committee recommends a minimum of four in-person visits before telemedicine is used, some physicians say that the immediate use of telemedicine for maternal care may be beneficial.
“Telemedicine should be the front line for most of these mothers,” said Rick Newell, MD, MPH, chief transformation officer at Vituity, a staffing and healthcare delivery company based in Emeryville, California. “While there are going to be complex cases which require more physical procedures and in-person examinations, a frontline approach to this makes sense.”
In-person appointments can be reserved for those who require such care, Newell said. But for telehealth to serve as the first point of access for patients, healthcare providers must be able to accurately assess whether patients need in-person referrals.
“The key to maintaining patient safety is having topnotch healthcare providers that can quickly identify patients and/or types of symptoms that are best handled for in-person or online care, and then ensuring appropriate referral processes are in place to facilitate that care,” Newell said.
Growing With Technology
“The maternal healthcare space is really a place where there’s a lot of innovation that’s possible,” Cantor said. “Delivered care is largely based on tradition, and there’s lots of opportunities to really evaluate how effective some of those traditions are.”
Innovation may come in the way of devices worn or used in the home, such as blood pressure monitors, scales, or ultrasound devices, Peahl said.
Physicians also can gain insights into their patients’ home lives that they likely miss during in-person visits.
“If the patient so desires, family members can more easily participate in the virtual visit and provide important information, ask relevant questions, and help participate in their loved ones’ level of care,” Newell said. “It also provides us an opportunity to assess their home situation.”
Reimbursement Down the Line
With the growing telehealth model, reimbursement and coverage have become significant hurdles for providers.
Medicare is set to phase out coverage of audio-only visits with physicians at the end of the COVID-19 public health emergency, and it will require at least one in-person visit for all mental health services per year for reimbursement. Most private insurers modify their coverage policies to align with what Medicare chooses to cover.
“The reimbursement model is not keeping up with what both patients and providers know that they should be doing,” Newell said. “And unfortunately, that results in probably a large patient population not having access to telehealth when they should, and a large number of physicians not being able to provide telehealth when they want to…. We need to keep the pressure on keeping reimbursement waivers for telehealth to make sure it becomes permanent.”
Arianna Sarjoo is an intern at Medscape and biology major at Boston University.