Affiliation:
1. College of Nursing University of Colorado Anschutz Medical Campus Aurora Colorado
2. Department of Biostatistics and Informatics Colorado School of Public Health Aurora Colorado
3. Biostatistics Core University of Colorado Cancer Center Aurora Colorado
4. Department of Medicine, Division of Endocrinology, Metabolism, & Diabetes University of Colorado Anschutz Medical Campus Aurora Colorado
5. Children's Hospital Colorado, Anschutz Medical Campus Aurora Colorado
Abstract
IntroductionThe coronavirus disease 2019 (COVID‐19) pandemic created disruption in health care delivery, including a sudden transition to telehealth use in mid‐March 2020. The purpose of this study was to examine changes in the mode of prenatal care visits and predictors of telehealth use (provider‐patient messaging, telephone visits, and video visits) during the COVID‐19 pandemic among those receiving care in a large, academic nurse‐midwifery service.MethodsWe conducted a retrospective cohort study of those enrolled for prenatal care in 2 nurse‐midwifery clinics between 2019 and 2021 (n = 3172). Use outcomes included number and type of encounter: in‐person and telehealth (primary outcome). Comparisons were made in frequency and types of encounters before and during COVID‐19. A negative binomial regression was fit on the outcome of telehealth encounter count, with race/ethnicity, age, language, parity, hypertension, diabetes, and depression as predictors.ResultsWhen comparing pre–COVID‐19 (before March 2020) with during COVID‐19 (after March 2020), overall encounters increased from 15.9 to 19.5 mean number of encounters per person (P < .001). The increase was driven by telehealth encounters; there were no significant differences for in‐person prenatal visit counts before and during the pandemic period. Direct patient‐provider messaging was the most common type of telehealth encounter. Predictors of telehealth encounters included English as primary language and diagnoses of diabetes or depression.DiscussionNo differences in the frequency of in‐person prenatal care visits suggests that telehealth encounters led to more contact with midwives and did not replace in‐person encounters. Spanish‐speaking patients were least likely to use telehealth‐delivered prenatal care during the pandemic; a small, but significant, proportion of patients had no or few telehealth encounters, and a significant proportion had high use of telehealth. Integration of telehealth in future delivery of prenatal care should consider questions of equity, patient and provider satisfaction, access, redundancies, and provider workload.
Funder
Agency for Healthcare Research and Quality
National Center for Advancing Translational Sciences
Presbyterian Health Foundation
Eunice Kennedy Shriver National Institute of Child Health and Human Development
Subject
Maternity and Midwifery,Obstetrics and Gynecology