05 August 2022
2 minutes reading
Source/Revelations
disclosures: Candor reports that it has received a PCORI award in support of the research. See the study for the relevant disclosures from all other authors.
According to a study published in Annals of Internal Medicine.
Maternal mortality, morbidity and near misses “are unacceptably high” in the United States, “despite extraordinarily high costs”, Amy G. Cantor, MD, MPH, a primary care physician specializing in primary care for women at the Pacific Northwest Evidence-based Practice Center in Portland, Oregon, and colleagues wrote. The numbers only worsened during the pandemic, with maternal deaths rising 33% and outcomes worse for those in underrepresented populations.
As the field of maternity care is “ripe for innovation,” the researchers wrote that these findings suggest that telehealth can improve practices and outcomes.
cantor and colleagues conducted a rapid review of 28 randomized controlled trials and 14 observational studies involving 44,894 women. They analyzed telehealth strategies used as an alternative to in-person visits for prenatal care, diabetes or hypertension monitoring during pregnancy and postpartum depression during the COVID-19 pandemic.
The review addressed four key questions:
- Are maternal telehealth strategies yielding similar results?
- Do maternal telecare strategies ensure equal access to care or health inequalities?
- What gaps are there in the current research?
- What are the disadvantages of telehealth strategies for maternal health?
Overall, telehealth strategies resulted in comparable obstetric and patient satisfaction outcomes to personal care, according to Cantor and colleagues. The researchers found that supplementing personal care with telecare led to comparable or better mental health outcomes. In addition, the use of telecare to reduce prenatal home visits for low-risk pregnancies was associated with comparable clinical outcomes to face-to-face care and higher patient satisfaction.
However, the researchers were unable to analyze equal access to care. Although little harm was reported, most studies did not assess health differences and “there was no evidence to inform how outcomes differed” in underrepresented populations, Cantor and colleagues wrote.
In addition to health disparities, other clinical areas that lack evidence and show gaps in research include obstetric outcomes for weight gain during pregnancy, smoking cessation, gestational hypertension, and prenatal mental health interventions. More gaps that “could be used by stakeholders to inform priorities for future research” consist of obstetric and breastfeeding use outcomes and adverse effects of telehealth interventions, the researchers wrote.
Cantor and colleagues also found that there was a difference in whether the interventions supplemented or replaced usual care. Most of the studies in the review “evaluated two-way telehealth interventions that complemented in-person care,” resulting in largely similar results, the researchers wrote. However, with strategies that completely replaced it, the use of care was better, she added.
Overall, the study suggests “that telehealth strategies may help achieve prenatal care goals,” the researchers wrote.
“These findings also highlight the ongoing need to include methods to evaluate and improve health equity, an important element missing from these telehealth studies,” they wrote. “Future research should focus on larger studies with broader inclusion criteria, examine the effects of telehealth interventions in rural populations, and evaluate outcomes based on population characteristics to inform the effect of telehealth on health disparities and health equity and potential harms of telehealth interventions. “
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