mHealth App Improves Patient-Provider Communication During Pregnancy

An mHealth application could help identify pregnant people at-risk for preeclampsia and increase prophylactic low-dose aspirin intake through improved patient-provider communication, a study from the University of Pittsburgh Medical Center (UPMC) revealed.

Preeclampsia is a pregnancy complication characterized by high blood pressure and is associated with maternal and infant morbidity and mortality. Taking low-dose aspirin during pregnancy has been shown to prevent preeclampsia in patients who are at moderate or high risk of the complication.

However, the efficacy of low-dose aspirin is dependent upon three factors. At-risk patients must be identified early in the pregnancy, as prophylaxis works best if started before the patient is 16 weeks gestation. Low-dose aspirin use is also only successful if there is adequate, clear patient-provider communication that outlines the recommendation. Following the recommendation, patients must also show adherence to taking the aspirin daily.

UPMC’s MyHealthyPregnancy mHealth application aimed to address these factors and improve patient education about and adherence to using low-dose aspirin to avoid preeclampsia.

UPMC practitioners recommended the mHealth app to 3,484 pregnant individuals during their first prenatal care appointment. Of those patients, 2,563 patients downloaded and started using the app between September 23, 2019 and August 31, 2020.

The app offers educational content, a contraction timer, opportunities for patients to document experiences, and routine screenings to check for symptoms and risks. The app can also help patients contact useful sources for any issues they submit to the app, according to the study.

Perhaps most importantly for pregnant patients, the app can use the patient-provided data and high-risk criteria responses to identify risk factors that are then transferred to the practitioners through an Epic EHR system, the researchers stated.

“We see this app as a way to augment the patient-provider dyad, Hyagriv Simhan, MD, senior author of the study and director of clinical innovation for the Women’s Health Service Line at UPMC Magee-Womens Hospital, stated in an accompanying press release. “This digital tool has potential to offer additional support and information for patients to navigate on their own and also facilitate further conversation with their providers about aspirin eligibility.”

The researchers first identified patients with moderate or high risk of preeclampsia. More than 10 percent of users (316 patients) met at least one high-risk criteria, while 40.9 percent met two or more moderate-risk criteria.

The mHealth app asked users about aspirin recommendations they had received from providers and aspirin adherence.

Out of the high-risk patients, 124 responded to the aspirin recommendation question before their 16-week gestation period. The researchers looked at the medical records for the 124 patients and found that 90 of them (72.6 percent) had a documented low-dose aspirin recommendation from their provider and 34 patients did not.

However, out of the 90 patients who had a documented recommendation, 33 patients (36.7 percent) said that they were unaware of this recommendation, indicating a flaw in patient-provider communication.

Only 46 percent of high-risk patients were aware that their practitioner had recommended low-dose aspirin use to them. Out of these patients, 47.4 percent adhered to the recommended guidelines.

The findings suggest that practitioners need to perfect their methods of identifying patients at risk for preeclampsia and improve their communication with patients about low-dose aspirin use.

Some practitioners may have added the low-dose aspirin recommendation to the patient’s EHR but did not have a verbal conversation with the patient, the study authors noted.

“Data from a prenatal app may offer an opportunity to identify patients requiring better communication from their healthcare practitioner about their eligibility for prophylactic aspirin, and electronic best-practice alerts embedded in the health record may offer an opportunity to prompt practitioners to incorporate risk factors that are underused,” the study stated.

The mHealth app could help bridge the gap between pregnant patients and their providers to ensure they are aware of preeclampsia risks and treatments and adhere to recommended low-dose aspirin use.