Telehealth Uptake into Prenatal Care and Provider Attitudes during the COVID-19 Pandemic in New York City: A Quantitative and Qualitative Analysis
Telehealth Uptake into Prenatal Care and Provider Attitudes during the COVID-19 Pandemic in New York City: A Quantitative and Qualitative Analysis
复制标题
DOI：
10.1055/s-0040-1712939
复制
发表时间：
2020-08-01
影响因子：
2
通讯作者：
Ona, Samsiya
中科院分区：
文献类型：
--
作者：
Madden, Nigel;Emeruwa, Ukachi N.;Ona, Samsiya
目的 本研究旨在 (1) 确定在 2019 年新型冠状病毒病 (COVID-19) 大流行期间，纽约市两家附属医院相关产前诊所的产前护理能够在多大程度上转变为远程医疗，以及 (2) 描述提供者在这一转变方面的经验。研究设计 3 月 9 日至 4 月 12 日期间，在纽约市哥伦比亚大学欧文医学中心 (CUIMC) 附属的产前诊所，按周分析了 3 月 9 日至 4 月 12 日期间，在纽约市哥伦比亚大学欧文医学中心 (CUIMC) 附属产前诊所进行产前护理就诊是亲自进行还是通过远程医疗进行的趋势。对母胎医学 (MFM) 和普通产科医师实践以及为公共保险患者提供服务的诊所系统的就诊进行了分析。每周按就诊类型分析远程医疗就诊的比例。对提供者进行了调查和半结构化访谈，评估了采用远程医疗的资源和障碍。结果 在研究期间，共有 4,248 次就诊，其中约三分之一是通过远程医疗进行的（n = 1,352，31.8%）。到第五周，56.1% 的全科医生就诊、61.5% 的 MFM 就诊和 41.5% 的诊所就诊是通过远程医疗进行的。共有 36 家提供商完成了调查，其中 11 家接受了采访。使用远程医疗电子病历获取技术以及进行访问、记录和随访均受到提供者的青睐。在向远程医疗过渡的过程中，健康诊所面临的运营挑战比 MFM 和通才教师实践更为重大，接受公共保险的患者在护理方面遇到更大的困难和障碍。需要在患者和操作层面上提供更多资源，以优化临床患者的现场和视频就诊的出勤率。结论 远程医疗在 COVID-19 大流行的背景下迅速实施，并受到医疗服务提供者的好评。在为拥有商业保险的患者提供服务的实践中，观察到护理障碍有限。然而，为了优化患者获得医疗补助的机会，需要额外的患者层面和运营支持。
Objective This study aimed to (1) determine to what degree prenatal care was able to be transitioned to telehealth at prenatal practices associated with two affiliated hospitals in New York City during the novel coronavirus disease 2019 (COVID-19) pandemic and (2) describe providers' experience with this transition. Study Design Trends in whether prenatal care visits were conducted in-person or via telehealth were analyzed by week for a 5-week period from March 9 to April 12 at Columbia University Irving Medical Center (CUIMC)-affiliated prenatal practices in New York City during the COVID-19 pandemic. Visits were analyzed for maternal-fetal medicine (MFM) and general obstetrical faculty practices, as well as a clinic system serving patients with public insurance. The proportion of visits that were telehealth was analyzed by visit type by week. A survey and semistructured interviews of providers were conducted evaluating resources and obstacles in the uptake of telehealth. Results During the study period, there were 4,248 visits, of which approximately one-third were performed by telehealth (n = 1,352, 31.8%). By the fifth week, 56.1% of generalist visits, 61.5% of MFM visits, and 41.5% of clinic visits were performed via telehealth. A total of 36 providers completed the survey and 11 were interviewed. Accessing technology and performing visits, documentation, and follow-up using the telehealth electronic medical record were all viewed favorably by providers. In transitioning to telehealth, operational challenges were more significant for health clinics than for MFM and generalist faculty practices with patients receiving public insurance experiencing greater difficulties and barriers to care. Additional resources on the patient and operational level were required to optimize attendance at in-person and video visits for clinic patients. Conclusion Telehealth was rapidly implemented in the setting of the COVID-19 pandemic and was viewed favorably by providers. Limited barriers to care were observed for practices serving patients with commercial insurance. However, to optimize access for patients with Medicaid, additional patient-level and operational supports were required.