Adherence and acceptability of telehealth appointments for high-risk obstetrical patients during the coronavirus disease 2019 pandemic.
Adherence and acceptability of telehealth appointments for high-risk obstetrical patients during the coronavirus disease 2019 pandemic.
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DOI：
10.1016/j.ajogmf.2020.100233
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发表时间：
2020-11
影响因子：
6.3
通讯作者：
Meirowitz N
中科院分区：
文献类型：
--
作者：
Jeganathan S;Prasannan L;Blitz MJ;Vohra N;Rochelson B;Meirowitz N
远程保健已成功地用于提供产科护理。然而，关于高危产科患者和提供者的态度和接受度，以及远程保健模式的实施是否改善了非农村环境中的护理机会，人们知之甚少。本研究旨在描述在城市和郊区环境下的大型医疗系统中，患者和提供者对远程医疗提供高危产科护理的态度，并确定远程医疗模式的实施是否提高了患者对预定预约的依从性。设计了两个自填式调查。第一项调查是在2020年3月1日至2020年5月30日期间对所有接受远程医疗访问的高危产科患者进行的。第二项调查是为参与这些访问的提供者设计的。我们还比较了2020年远程医疗实施和远程医疗与面对面就诊之前(2019年3月1日至5月30日)和实施后(2020年3月1日至5月30日)的就诊率、取消就诊率和缺勤率。我们回顾了预定的高危产前护理预约、糖尿病教育会议、遗传咨询和母婴医学会诊。总共分析了91项患者调查和33项提供者调查。总体而言，86.9%的患者对他们得到的护理感到满意，78.3%的患者会建议他人远程医疗。值得注意的是，87.8%的提供者报告了使用远程医疗的积极体验，90.9%的人认为远程医疗改善了患者获得护理的机会。当比较患者和提供者在经历远程医疗后对未来产科护理的偏好时，73.8%的患者希望在怀孕期间面对面和远程医疗相结合的就诊。然而，提供者更喜欢面对面就诊的比率明显高于远程医疗就诊(56%对23%，P=.024)。对比2019年和2020年的就诊情况，随着远程医疗的实施，患者取消预约的比例(7.06%比4.96%，P<；.001)和患者当天取消预约的比例(2.30%比1.35%，P<；.001)显著降低。在2020年，接受远程医疗就诊的患者取消预约的比例(3.82%比5.44%，P=.021)和患者当天取消预约的比例(0.60%比1.65%，P=0.002)也显著低于面对面就诊。在高危产科实施远程保健模式，有可能通过减少错过预约的比率，改善获得高危产科护理的机会。接受调查的患者和提供者都表示对远程医疗就诊的满意率很高，并希望将远程医疗整合到传统的高危产科护理模式中。
Telehealth has been successfully implemented for the delivery of obstetrical care. However, little is known regarding the attitudes and acceptability of patients and providers in high-risk obstetrics and whether the implementation of a telehealth model improves access to care in nonrural settings. This study aimed to describe patient and provider attitudes toward telehealth for the delivery of high-risk obstetrical care in a large healthcare system with both urban and suburban settings and to determine whether the implementation of a telehealth model improves patient adherence to scheduled appointments in this patient population. Two self-administered surveys were designed. The first survey was sent to all high-risk obstetrical patients who received a telehealth visit between March 1, 2020, and May 30, 2020. The second survey was designed for providers who participated in these visits. We also compared the attended, cancelled, and no-show visit rates before (March 1 to May 30, 2019) and after (March 1 to May 30, 2020) the telehealth implementation and telehealth vs in-person visits in 2020. We reviewed scheduled high-risk prenatal care appointments, diabetes mellitus education sessions, and genetic counseling and Maternal-Fetal Medicine consultations. A total of 91 patient surveys and 33 provider surveys were analyzed. Overall, 86.9% of patients were satisfied with the care they received and 78.3% would recommend telehealth visits to others. Notably, 87.8% of providers reported having a positive experience using telehealth, and 90.9% believed that telehealth improved patients’ access to care. When comparing patient and provider preference regarding future obstetrical care after experiencing telehealth, 73.8% of patients desired a combination of in-person and telehealth visits during their pregnancy. However, a significantly higher rate of providers preferred in-person than telehealth visits (56% vs 23%, P=.024, respectively). When comparing visits between 2019 and 2020, there was a significantly lower rate of no-show appointments (8.49% vs 4.61%, P<.001), patient-cancelled appointments (7.06% vs 4.96%, P<.001), and patient same-day cancellations (2.30% vs 1.35%, P<.001) with the implementation of telehealth. There was also a significantly lower rate of patient-cancelled appointments (3.82% vs 5.44%, P=.021) and patient same-day cancellations (0.60% vs 1.65%, P=.002) with those receiving telehealth visits than in-person visits in 2020. The implementation of a telehealth model in high-risk obstetrics has the potential to improve access to high-risk obstetrical care, by reducing the rate of missed appointments. Both patients and providers surveyed expressed a high rate of satisfaction with telehealth visits and a desire to integrate telehealth into the traditional model of high-risk obstetrical care.
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