Virtual visits for prenatal care

“The pandemic prompted the vast majority of prenatal care practices to implement virtual visits into their routine prenatal care services in an effort to decrease exposure to COVID-19,” said Katrina Wu, CNM, MSN, a certified nurse-midwife residing in Boston, Massachusetts. “However, there was very little guidance available on whether or not virtual visits would deliver quality care or how to conduct virtual visits.”

The purpose of the review was to offer best practices to prenatal care providers using all applicable research available. cliniciansguide clinicians synthesize all applicable research to offering routine prenatal care through telemedicine to guide clinicians on current best practice.

The authors identified original studies and quality improvement projects about telemedicine for prenatal care, published between 2010 and 2020, by searching the PubMed, Scopus, Cumulative Index to Nursing and Allied Health Literature and Google Scholar databases.

The 13 articles that met inclusion criteria indicated strong patient and health care provider satisfaction with the cost savings and convenience of virtual care. The articles also cited that clinic wait times and cancellation rates were improving.

Health care provider input and thoughtful organizational planning were key to a smooth telemedicine implementation process, according to Wu. Moreover, there were no significant differences in clinical outcomes between virtual care and in-person care.

“For virtual care, the studies comprising the review typically had pregnant patients use a Doppler ultrasound device to listen to fetal heart tones, plus the patients checked their own blood pressure and weighed themselves for each visit,” Wu told Contemporary OB/GYN®.

The review offers some reassurance and support for the current use of virtual visits for prenatal care during the pandemic, according to Wu, while also encouraging providers to consider how virtual visits might continue beyond the pandemic as part of a comprehensive strategy to improve access to prenatal care.

“When providers have input into how virtual care is implemented, the process is smoother and more easily operationalized,” said Wu, an assistant professor of nurse-midwifery at Bethel University in Saint Paul, Minnesota. “Sending patients reminders improved their attendance at virtual visits.”

The fewer the steps, the better. For instance, patients needing to purchase new equipment or navigate through a series of steps to connect may be barriers to attend virtual visits. Conversely, being able to simply click a link in an email to connect to the visit likely increases use.

The review found that patients in rural communities and multiparous pregnant women were particularly interested in having access to virtual visits.

Wu believes that maintaining an element of choice will help optimize the success of virtual visits. “These visits can be offered as either a set plan based on gestational age, whereby some visits are in-person; or on an as-needed basis for those who have difficulty with transportation or finding childcare, for example,” she said.

Wu noted that the pandemic offers an unprecedented opportunity for researchers to explore how telemedicine can improve healthcare access and health outcomes. “These benefits are likely to extend beyond the pandemic,” she said.

However, more research on patient and provider experiences with telemedicine for routine prenatal care is needed to understand how virtual visits have been implemented across a wide variety of settings, “with a focus on how telemedicine could be improved to enhance user experiences,” Wu said. “Additional research confirming safety would also be helpful, especially assessing the frequency of in-person visits, and whether or not virtual visits should include physical exam components like monitoring blood pressure and fetal heart tones.”

Reference

1. Wu KK, Lopez C, Nichols M. Virtual visits in prenatal care: an integrative review. J Midwifery Womens Health. 2022 Jan;67(1): 39-52.