Schedule of Visits and Televisits for Routine Antenatal Care: A Systematic Review
Schedule of Visits and Televisits for Routine Antenatal Care: A Systematic Review
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常规产前护理的访视和电视访视时间表：系统回顾
DOI：
10.23970/ahrqepccer257
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
A. Peahl
中科院分区：
文献类型：
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作者：
E. Balk;Kristin J. Konnyu;W. Cao;M. R. Bhuma;V. Danilack;G. Adam;K. Matteson;A. Peahl
背景。美国妇产科医师学会和母胎医学学会计划一项新的基于证据的联合共识声明，以解决首选的就诊时间表和使用电视进行常规产前护理。这一系统综述将支持共识声明。方法。我们检索了PubMed®、Cochrane数据库、Embase®、CINAHL®、ClinicalTrials.gov、PsycINFO®和SocINDEX，检索时间从研究开始到2022年2月12日。我们纳入了来自高收入国家的比较研究，这些研究评估了定期产前检查的频率或常规电视检查的纳入情况，以及针对这两个主题的定性研究。我们评估了利益相关者优先考虑的15个结果的证据强度。结果。10项研究评估了常规访问的计划次数，7项研究评估了电视访问。九项定性研究也讨论了这些主题。研究评估了广泛的减少和传统的访问时间表和纳入电视访问的方法。在计划产前检查次数较少与标准次数的比较中，中等强度的证据没有发现出生时胎龄（4项研究）、胎龄（3项研究）、Apgar评分（5项研究）或新生儿重症监护病房（NICU）入院（5项研究）的差异。低强度证据未发现产妇焦虑（3项研究）、早产（3项研究）和低出生体重（4项研究）的差异。定性研究表明，提供者认为减少常规就诊可能对患者更方便，并可能腾出诊所时间为高危妊娠患者提供额外的护理，但患者和提供者都担心就诊次数减少可能导致护理减少。在混合（电视和面对面）与单独的面对面访问的比较中，低强度证据没有发现早产（4项研究）或新生儿重症监护病房入院（3项研究）的差异，但确实表明混合访问的满意度更高（2项研究）。定性研究表明，患者和提供者对减少常规产前护理的时间表和电视时间持开放态度，但重要的是，患者和提供者关心护理质量，提供者和诊所领导就如何最好地实施实践变化提出建议。结论。证据基础相对较少，许多优先结果的证据不足。研究采用的护理模式是异质的。在有足够证据得出结论的地方，研究没有发现不同模式对母亲或婴儿的危害有显著差异，但证据表明混合就诊对护理的满意度更高。定性证据表明，在减少常规产前保健的访问时间表或电视访问方面存在各种障碍和促进因素。鉴于证据基础的缺陷，除了证明结果的差异外，可能还需要考虑对临床实践的影响。需要新的研究来评估不同人群或环境的优先结果和潜在的差异效应。
Background. The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine plan a new evidence-based joint consensus statement to address the preferred visit schedule and the use of televisits for routine antenatal care. This systematic review will support the consensus statement. Methods. We searched PubMed®, Cochrane databases, Embase®, CINAHL®, ClinicalTrials.gov, PsycINFO®, and SocINDEX from inception through February 12, 2022. We included comparative studies from high-income countries that evaluated the frequency of scheduled routine antenatal visits or the inclusion of routine televisits, and qualitative studies addressing these two topics. We evaluated strength of evidence for 15 outcomes prioritized by stakeholders. Results. Ten studies evaluated scheduled number of routine visits and seven studies evaluated televisits. Nine qualitative studies also addressed these topics. Studies evaluated a wide range of reduced and traditional visit schedules and approaches to incorporating televisits. In comparisons of fewer to standard number of scheduled antenatal visits, moderate strength evidence did not find differences for gestational age at birth (4 studies), being small for gestational age (3 studies), Apgar score (5 studies), or neonatal intensive care unit (NICU) admissions (5 studies). Low strength evidence did not find differences in maternal anxiety (3 studies), preterm births (3 studies), and low birth weight (4 studies). Qualitative studies suggest that providers believe fewer routine visits may be more convenient for patients and may free up clinic time to provide additional care for patients with high-risk pregnancies, but both patients and providers had concerns about potential lesser care with fewer visits. In comparisons of hybrid (televisits and in-person) versus in-person only visits, low strength evidence did not find differences in preterm births (4 studies) or NICU admissions (3 studies), but did suggest greater satisfaction with hybrid visits (2 studies). Qualitative studies suggested patients and providers were open to reduced schedules and televisits for routine antenatal care, but importantly, patients and providers had concerns about quality of care, and providers and clinic leadership had suggestions on how to best implement practice changes. Conclusion. The evidence base is relatively sparse, with insufficient evidence for numerous prioritized outcomes. Studies were heterogeneous in the care models employed. Where there was sufficient evidence to make conclusions, studies did not find significant differences in harms to mother or baby between alternative models, but evidence suggested greater satisfaction with care with hybrid visits. Qualitative evidence suggests diverse barriers and facilitators to uptake of reduced visit schedules or televisits for routine antenatal care. Given the shortcomings of the evidence base, considerations other than proof of differences in outcomes may need to be considered regarding implications for clinical practice. New studies are needed to evaluate prioritized outcomes and potential differential effects among different populations or settings.