Telemedicine has taken the feeling of “in the comfort of your own home” to a new level for parents.
New research indicates that the use of telemedicine by pregnant women and new moms may be here to stay, and women are thrilled.
In a rapid review of over 44,000 women published in the Annals of Internal Medicinethe researchers found that participants were equally or more satisfied with the quality of maternal care received during online appointments than mothers who had in-person visits.
“Virtual visits and home monitoring are promising strategies for tailoring care to individual patient needs: reducing the burden of missed work, travel or childcare, while ensuring patients have access to high-quality services,” said Alex Peahl, MD, committee chair of the American College of Obstetricians and Gynecologists (ACOG) Prenatal Care Redesign Initiative. The committee makes recommendations on best practices for providing prenatal care based on mothers’ preferences rather than tradition. Peahl did not participate in the study.
Telemedicine plays a critical and growing role in the committee’s work, as it has the potential to meet the social needs of patients, Peahl said.
Maternal care included prenatal and postnatal care, as well as mental health services. The researchers assessed previously published analyzes of a variety of online care delivery methods, including phone calls, video calls, text messages and apps.
For maternal care, telemedicine has been used in part to mitigate risk to the mother, according to Amy Cantor, MD, MPH, assistant professor of medical informatics and clinical epidemiology at Oregon Health and Science University in Portland, who conducted the study. Three years into the COVID-19 pandemic, online options continue to reduce the risk of infection and exposure to disease.
“Much of the rise in telehealth was in response to a global pandemic,” Cantor said. “There has been a huge pivot in how care needed to be delivered in order to keep people safe, and unfortunately we are still navigating how to deliver care in the midst of a pandemic.”
First or second line?
Although the ACOG committee recommends a minimum of four in-person visits prior to the use of telemedicine, some physicians argue that the immediate use of telemedicine for maternal care may be beneficial.
“Telemedicine should be the first line for most of these mothers,” said Rick Newell, MD, MPH, chief transformation officer at Vituity, an Emeryville, Calif.-based healthcare recruitment and delivery company. “While there are complex cases that require more physical procedures and in-person examinations, a front-line approach in this regard makes sense.”
In-person appointments can be booked for those who need 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 top-notch healthcare providers who can quickly identify patients and/or symptom types that are best treated for in-person or online care, and then to ensure that appropriate referral processes are in place to facilitate this care,” says Newell.
Grow with technology
“The maternal healthcare space is really a place where there’s a lot of room for innovation,” Cantor said. “The care provided is largely based on tradition, and there are many opportunities to really assess the effectiveness of some of these traditions.”
Innovation can come in the form of devices worn or used at home, such as blood pressure monitors, scales or ultrasound machines, Peahl said.
Physicians can also gain insight into their patients’ home lives that they likely miss during in-person visits.
“If the patient wishes, family members can more easily participate in the virtual visit and provide important information, ask relevant questions, and help engage with their loved ones’ level of care,” Newell said. “It also gives us the opportunity to assess their family situation.”
Refund all the way
With the growing telehealth model, reimbursement and coverage have become significant hurdles for providers.
Medicare is set to phase out coverage for audio-only visits with physicians at the end of the COVID-19 public health emergency, and will require at least one in-person visit to all mental health services per year to reimbursement. Most private insurers modify their coverage policies to align with what Medicare chooses to cover.
“The reimbursement model doesn’t follow what patients and providers know they should be doing,” Newell said. “And unfortunately, that probably translates to a large population of patients 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 up the pressure to keep the reimbursement waivers for telehealth to make sure it becomes permanent.”
Arianna Sarjoo is a Medscape intern and a biology major at Boston University.
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