Telemedicine For Prenatal Care: A Systematic Review

Objective: To evaluate the effectiveness of telehealth-enhanced prenatal care. Data Sources: We searched for primary literature in PubMed, EMBASE, and Cochrane Library databases. Methods of Study Selection: Studies were included if they were written in English and used telehealth as an adjunct to or substitute for elements of a comprehensive prenatal care system, with pregnant women as the study population. Studies were excluded if they did not involve comprehensive prenatal care, were not in English, or were abstracts only. Two reviewers independently screened studies by titles, abstracts, and full text. Conflicts were resolved by a third reviewer. Remaining conflicts were resolved by a fourth reviewer. Risk of bias was performed independently by two reviewers. Conflicts were resolved by a third reviewer. Tabulation, Integration and Results: The initial search identified 2707 studies, of which 7 met inclusion criteria. One additional study was identified in the grey literature. Studies included 4 non-randomized controlled studies, 1 randomized controlled trial, 2 qualitative studies, and 1 active clinical trial. Telehealth-enhanced prenatal care included remote monitoring and/or virtual visits. Interventions reduced the number of in-person appointments. Patients and providers had high rates of satisfaction with prenatal care delivered via telehealth. Pregnancy outcomes were similar between the intervention and control groups with the exception of one study identifying higher rates of pre-eclampsia and another showing higher rates of gestational diabetes in the telehealth group. Risk of bias assessment revealed moderate bias in all of the non-randomized studies. The randomized controlled trial had low risk of bias. Conclusion: Telemedicine-enhanced prenatal care may decrease the number of in-person prenatal care visits and increase access to care. Future studies should be done to determine neonatal and maternal outcomes of remote care and to study effectiveness of these interventions for women of color and low socioeconomic status.

Health Care Experience Among Women Who Completed Group Prenatal Care (CenteringPregnancy) Compared to Individual Prenatal Care Within Military Treatment Facilities

This study compared TRICARE, the health care program of the United States Department of Defense Military Health System, beneficiaries in CenteringPregnancy, an enhanced prenatal care model, to women in individual prenatal care within the same military treatment facility. Maternity patient experience ratings from May 2014 to February 2016 were compiled from the TRICARE Outpatient Satisfaction Survey. Centering patients had 1.91 higher odds of being satisfied with access to care ( p < .01, 95% CI = 1.2-3.1) than women in individual care. Specifically, the saw provider within 15 minutes of appointment measure found Centering patients to have 2.00 higher odds of being satisfied than women in individual care ( p < .01, 95% CI = 1.2-3.3). There were no other statistically significant differences between cohorts. Qualitative responses indicate most Centering patients surveyed had good experiences, appreciated the structure and communication with others, and would recommend the program. Providers identified command/leadership support, dedicated space, and buy-in from all staff as important factors for successful implementation. Enhanced prenatal care models may improve access to and experiences with care. Program evaluation will be important as the military health system continues to implement such programs.