Audio-Only 'Virtual' Prenatal Care Not Tied to Worse Perinatal Outcomes

By Linda Carroll

April 19, 2021

(Reuters Health) - Pregnant patients who were given the opportunity to have some of their prenatal appointments virtually, as audio-only visits, during the pandemic attended more of them than patients offered only in-person visits the prior year, a new study finds.

Moreover, the analysis of data from more than 12,000 patients revealed no negative impact on perinatal outcomes from having women make some of their visits virtually, according to the report published in JAMA Network Open.

"Our evidence suggests that audio-only virtual visits should be considered a legitimate type of telehealth visit even beyond the pandemic, based on patient satisfaction and obstetric outcome," said the study's lead author, Dr. Elaine Duryea, an assistant professor of obstetrics and gynecology at UT Southwestern Medical Center and medical director of the maternal-fetal medicine clinic at Parkland Health and Hospital System.

"We are so hopeful this can continue," Dr. Duryea said. "Just talking on the phone breaks down so many barriers. Our patients are predominantly insured by Medicaid and many live far from the hospital. The feedback has been overwhelmingly positive. Patients have been telling us this means they don't have to borrow a car or take multiple busses. They don't have to find someone to watch their kids or miss work."

The option of virtual visits will continue at Parkland even if the compensation isn't there after the pandemic is over, Dr. Duryea said. Still, not all of the patients' visits can be done virtually, she said, adding that visits need to be in-person when ultrasounds and blood draws are required.

To take a closer look at the impact of offering virtual prenatal visits, Dr. Duryea and her colleagues compared perinatal outcomes of 6,559 patients who delivered between May 1 and October 31, 2019 and received only in-person prenatal visits with 6,048 women who delivered between May 1 and October 31, 2020, when audio-only virtual visits were integrated into prenatal care in response to the COVID-19 pandemic.

The mean age of the women who delivered in 2019 was 27.8, with 77.1% identifying as Hispanic, 16.3% as non-Hispanic Black, while the rest identified as white or other. The mean age of those who delivered in 2020 was 27.7, with 75.5% identifying as Hispanic, 18.0% as non-Hispanic Black and the rest identifying as white or other.

Among those who delivered in 2020, 4,067 women (67.2%) attended at least one virtual visit, while 1,216 (20.1%) attended at least three virtual visits. Overall, women who delivered in 2020 attended a greater mean number of prenatal visits compared with those who delivered in 2019 (9.8 versus 9.4). Approximately 86% of the deliveries at Parkland Hospital were funded by Medicaid or the Children's Health Insurance Program.

Among the women who delivered in 2020, 173 (2.9%) experienced the composite outcome of placental abruption, stillbirth, neonatal intensive care unit admission in a full-term (greater than or equal to 37 weeks) infant, or umbilical cord blood pH less than 7.0. There was no statistically significant difference from the 195 (3.0%) who experienced the composite outcome in 2019.

When it came to other obstetrical outcomes in 2020 versus 2019, there was no significant difference in the frequency of gestational hypertension (19.0% versus 20.1%), preeclampsia with severe features (10.7% versus 10.6%), or preterm birth (9.8% versus 10.2%).

"This is a great study," said Dr. Donna Neale, an assistant professor of gynecology and obstetrics and a maternal-fetal medicine specialist at Johns Hopkins School of Medicine in Baltimore. "I applaud the researchers for looking at more than 12,000 women."

"Going forward, this should be a shout-out to insurance companies that this is a model that is feasible and useful," said Dr. Neale, who was not involved in the new research. "It may be preferred by some patients and it doesn't lead to poor outcomes."

It's important to point out that these virtual visits do not completely take the place of in-person visits, Dr. Neale said. "But there is a role for audio-only virtual visits complementing those in-person visits for patients who are not at high risk," she added.

SOURCE: https://bit.ly/3giGNbE JAMA Network Open, online April 14, 2021.

Comments

3090D553-9492-4563-8681-AD288FA52ACE

processing....