Outcomes for Virtual Prenatal, Postpartum Care Similar to In-Person Visits

Rapid telehealth implementation for prenatal and postpartum care services during the COVID-19 pandemic was proven to be feasible for underserved populations at a clinic in Massachusetts, according to a study published in Health Science Reports.

When stay-at-home orders first went into effect in March 2020, obstetricians, like many other physicians, turned to telehealth in order to continue providing prenatal and postpartum care to patients.

Researchers evaluated visits at an OB-GYN clinic in Springfield, Massachusetts, between March 19, 2020, and August 31, 2020, to understand if the sudden telehealth implementation saw success. They used the RE-AIM framework—reach, effectiveness, adoption, implementation, and maintenance—to reach their conclusions.

The study pool consisted of 558 prenatal patients and 209 postpartum patients. Most of the patients received insurance through Massachusetts’ Medicaid program (89 percent), and 60 percent identified as Hispanic. Nearly 40 percent of the 1,788 prenatal visits were conducted via telehealth, while 48 percent of the 230 postpartum visits were virtual.

The researchers took note of certain health outcomes among the patients, including the prevalence of hypertension, gestational diabetes, breastfeeding rates, and emergency department visits. The percentage of patients who experienced these outcomes did not differ substantially between the in-person patients and the telehealth patients.

Regarding telehealth adoption rates, all 30 providers at the clinic participated in setting up the program and continued offering virtual care throughout the study period.

For prenatal care, telehealth accounted for 57 percent of all visits of patients who were between 22 and 25 weeks along. Around half of the postpartum patients had at least one telehealth visit, with 52 percent of patients attending a virtual visit for both the two-week and six-week postpartum checkups.

Notably, only eight out of the 698 telehealth visits at the clinic involved videoconferencing, while the remaining were audio-only visits. Providers reported this could have been to due low digital literacy among providers and patients alike.

Telehealth visits increased from a baseline of zero to 83 during the last 12 days of March 2020, the study found. Massachusetts began to ease COVID-19 restrictions in June and in-person care became more available, but there were still 245 telehealth visits in July and 305 visits in August, indicating that the clinic was able to successfully maintain the telehealth program.

The low rate of video visits throughout the study period highlights the importance of audio-only telehealth. Restricting coverage for audio-only services may exacerbate care disparities, especially among underserved populations who may not have access to adequate internet or devices with camera capabilities.

The high volume of audio-only visits also suggests that telehealth feasibility and accessibility may depend on the mode of care delivery, as clinics that only utilize video visits could be excluding certain underserved populations.

Massachusetts’ payment parity policy likely also helped support the telehealth implementation. Governor Charlie Baker issued an executive order that required reimbursement parity between in-person and telehealth visits during the pandemic. Private payers were also required to reimburse at Medicaid levels for telehealth services. This likely made virtual prenatal and postpartum care more accessible to underserved communities.

“This study focused primarily on practice and organizational factors influencing implementation and maintenance, but the effect of public policy on equity in obstetric care should continue to be evaluated in systematic ways to better inform policymakers and healthcare providers about policy impacts,” the researchers concluded.