- At the onset of the COVID-19 pandemic, physicians at Massachusetts General Hospital developed a risk-stratified protocol for prenatal care that increased the interval between visits and incorporated virtual visits
- This prospective quality improvement study assessed the acceptability of the protocol to patients and explored their preferences for care during subsequent pregnancies after the pandemic
- 95% of patients felt virtual care should continue to be offered, and 65% said they would prefer to have virtual visits in a future pregnancy
- Despite efforts to provide equitable virtual care, preferences differed by race; 81% of patients who self-identified as white said they would prefer virtual visits in the future, significantly higher than patients of other races (P=0.027)
The standard model of prenatal care includes 10 to 14 in-person, individual visits, as recommended by the American College of Obstetricians and Gynecologists. At the onset of the COVID-19 pandemic, physicians in the Department of Obstetrics and Gynecology at Massachusetts General Hospital developed a risk-stratified protocol that increased the interval between visits and incorporated virtual visits.
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A quality improvement study to gauge the protocol's acceptability was later conducted by Sarah N. Bernstein, MD, a maternal-fetal medicine specialist, Mackenzie W. Sullivan, MD, a resident in the Department, and colleagues. In The Journal of Maternal–Fetal & Neonatal Medicine, the researchers report virtual visits were acceptable to patients and most would like to incorporate them into their post-pandemic pregnancy care. However, preferences differed by race.
For a prospective quality improvement study, the researchers assembled a convenience sample of all 100 patients who received prenatal care at Mass General, were admitted for delivery between October and December 2020, and were willing to complete a feedback form.
The median age was 33 and most patients were white (65%), privately insured (83%), primiparous (55%), college-educated (89%), and employed full-time (65%). 72% of the patients had at least one telephone visit and 28% had at least one video visit.
Opinions and Preferences About the Future
Patients expressed strong support for virtual care:
- 95% felt virtual visits should continue to be offered
- 65% said they would prefer to incorporate virtual visits in a future pregnancy
The most commonly cited reasons for preferring virtual prenatal care were convenience, safety during the pandemic, avoiding long wait times, compatibility with working from home, avoiding commuting/parking, and not needing to arrange childcare.
The most commonly cited negative factors were a feeling of missing out on important parts of prenatal care, a feeling of not receiving the same amount of provider attention, and not feeling a strong provider connection.
Factors Affecting Preferences
Age, education, insurance, employment, parity, and number of children at home were not associated with desiring virtual prenatal care in the future.
When designing the new protocol the researchers were concerned about providing equitable care. They had instructions and logs translated into multiple languages, emphasized to patients the importance of using interpretation services, and developed a plan to provide insurance coverage for home blood pressure cuffs.
Even so, there were statistically significant differences in preference by race. 81% of white individuals reported they would prefer virtual visits in the future, significantly higher than patients who self-identified with other racial categories (Black, 67%; Asian, 56%; Hispanic/Latinx, 25%; P=0.027).
If telemedicine is incorporated into prenatal care after the pandemic ends, obstetricians will need to determine how to do so equitably. The findings from this study indicate some of the most vulnerable patients may not appreciate this option.
Learn more about the Maternal-Fetal Medicine Program
Refer a patient to the Department of Obstetrics & Gynecology