Increased hybrid prenatal care use during COVID-19 pandemic reported

Increased hybrid prenatal care use during COVID-19 pandemic reported | Image Credit: © Andrey Popov - © Andrey Popov - stock.adobe.com.

Hybrid prenatal care use significantly rose during the COVID-19 public health emergency (PHE), according to a recent study published in JAMA Network Open.¹

The odds of not receiving prenatal care are 3.5% in non-Hispanic Black patients and 2.7% in Hispanic patients, highlighting an increased risk compared to non-Hispanic White patients at 1.4%. Telehealth has been endorsed by multiple federal agencies for use in some aspects of prenatal care, potentially eliminating barriers to care.

The Centers for Medicare and Medicaid Services allowed physicians for telehealth services to receive reimbursement during the COVID-19 PHE.² However, data about the use of telehealth services among racial and ethnic groups remains unclear.¹

To evaluate telehealth and in-person prenatal care before and during the COVID-19 PHE, investigators conducted a retrospective cohort study. Data was obtained from the National COVID Cohort Collaborative (N3C) Data Enclave.

The N3C includes hospital visit records and EHR data for patients with and without COVID-19 starting January 2017. There were 349,682 childbirths included in the cohort through May 31, 2022.

Gestational week during childbirth was reported, then converted into days and subtracted from the childbirth date to determine the pregnancy conception date. Prenatal care data was assessed from prenatal care initiation to childbirth delivery date.

This data was used to identify care at in-person visits vs telehealth visits. Hybrid care was defined as having at least 1 of each visit type.

Eligible patients included pregnant individuals aged 15 to 49 years with delivery occurring between June 1, 2018, and May 31, 2022. No participant received exclusively telehealth care, with hybrid prenatal care reported as the primary outcome.

Modalities of telehealth included interactive video or audio communication, texting, digital evaluation and management services, asynchronous telecommunication platforms, and other telehealth concepts. COVID-19 PHE was defined as an exposure, alongside urban vs rural status and race and ethnicity.

Participants were aged a mean 29.4 years, and 4.2% of pregnancies were in Asian patients, 18.8% Black, 17.1% Hispanic, 46.5% White, and 13.4% non-Hispanic individuals of another race. No prepregnancy overweight or obesity was reported in 69.3% of patients, a singleton birth in 95.1%, and vaginal delivery in 88.7%.

A median 14 visits were reported in the study sample. This included a median 13 in-person visits in the overall population and a median 2 telehealth visits among telehealth users. Prenatal PHE exposure was linked to a slight reduction in the number of prenatal care visits over time, from a median 15 visits without PHE exposure to 13 with prenatal PHE exposure.

An increase in telehealth visits was also reported alongside the decrease in overall visits, from an average of 0.4% to 2.2% in the total study population. Telehealth visits comprised a mean under 1% of visits in pregnancies without PHE exposure, vs 1.9% in the partially overlapping group and 2.2% in the fully overlapping group.

Prenatal care initiation occurred most often at 8- to 10-weeks’ gestation overall, vs 9- to 13-weeks’ gestation for initial telehealth visits. Hybrid prenatal care steadily rose between March and July of 2020, and the peak of 8.1% was observed in November 2020.

In the full PHE exposure cohort, the highest rates of hybrid prenatal care use were observed among Asian and Black individuals, at 11.5% and 10.3%, respectively. Hispanic patients also had an increased rate compared to White patients, at 10% vs 8.3%, respectively. Urban residents had higher rates than rural residents, but both groups experienced increases from PHE exposure.

These results indicated an increase in prenatal telehealth care during the COVID-19 PHE. However, telehealth use remained low, indicating the benefits of telehealth expansion have not been fully realized.

References

1. Hung P, Yu J, Harrison SE, et al. Racial and ethnic and rural variations in the use of hybrid prenatal care in the US. JAMA Netw Open. 2024;7(12):e2449243. doi:10.1001/jamanetworkopen.2024.49243
2. The coronavirus aid, relief, and economic security act: summary of key health provisions. Kaiser Family Foundation. Accessed January 02, 2024. https://www.kff.org/coronavirus-covid-19/issue-brief/the-coronavirus-aid-relief-and-economic-security-act-summary-of-key-health-provisions/