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      Telehealth for High-Risk Pregnancies in the Setting of the COVID-19 Pandemic

      , MD, MPH 1 , , MD 1 , , MD, MPH 1 , , MD 1 , , MD 1 , , MD, MPH 1 , , MD, MHA 1 , , MD 1 , , MD, MS 1 , , MD 2 , , MD 1 , , MD, MS 1 , , MD 3 , , MD 1 , , PhD 1 , 4 , 5 , , MD 1 , , MD 1 , , MD 6 , , MD 1 , , MS 1 , , MD 1 , , JD, MPH 1 , , MD, MPH 1
      American Journal of Perinatology
      Thieme Medical Publishers
      coronavirus, COVID-19, telehealth, prenatal care

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          As New York City became an international epicenter of the novel coronavirus disease 2019 (COVID-19) pandemic, telehealth was rapidly integrated into prenatal care at Columbia University Irving Medical Center, an academic hospital system in Manhattan. Goals of implementation were to consolidate in-person prenatal screening, surveillance, and examinations into fewer in-person visits while maintaining patient access to ongoing antenatal care and subspecialty consultations via telehealth virtual visits. The rationale for this change was to minimize patient travel and thus risk for COVID-19 exposure. Because a large portion of obstetric patients had underlying medical or fetal conditions placing them at increased risk for adverse outcomes, prenatal care telehealth regimens were tailored for increased surveillance and/or counseling. Based on the incorporation of telehealth into prenatal care for high-risk patients, specific recommendations are made for the following conditions, clinical scenarios, and services: (1) hypertensive disorders of pregnancy including preeclampsia, gestational hypertension, and chronic hypertension; (2) pregestational and gestational diabetes mellitus; (3) maternal cardiovascular disease; (4) maternal neurologic conditions; (5) history of preterm birth and poor obstetrical history including prior stillbirth; (6) fetal conditions such as intrauterine growth restriction, congenital anomalies, and multiple gestations including monochorionic placentation; (7) genetic counseling; (8) mental health services; (9) obstetric anesthesia consultations; and (10) postpartum care. While telehealth virtual visits do not fully replace in-person encounters during prenatal care, they do offer a means of reducing potential patient and provider exposure to COVID-19 while providing consolidated in-person testing and services.

          Key Points

          • Telehealth for prenatal care is feasible.

          • Telehealth may reduce coronavirus exposure during prenatal care.

          • Telehealth should be tailored for high risk prenatal patients.

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          Most cited references11

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          Telehealth Interventions to Improve Obstetric and Gynecologic Health Outcomes

          Telehealth interventions were associated with improvements in obstetric outcomes, perinatal smoking cessation, breastfeeding, early access to medical abortion services, and schedule optimization for high-risk obstetrics.
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            Randomized comparison of a reduced-visit prenatal care model enhanced with remote monitoring

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              Is Open Access

              Implementing telehealth to support medical practice in rural/remote regions: what are the conditions for success?

              Background Telehealth, as other information and communication technologies (ICTs) introduced to support the delivery of health care services, is considered as a means to answer many of the imperatives currently challenging health care systems. In Canada, many telehealth projects are taking place, mostly targeting rural, remote or isolated populations. So far, various telehealth applications have been implemented and have shown promising outcomes. However, telehealth utilisation remains limited in many settings, despite increased availability of technology and telecommunication infrastructure. Methods A qualitative field study was conducted in four remote regions of Quebec (Canada) to explore perceptions of physicians and managers regarding the impact of telehealth on clinical practice and the organisation of health care services, as well as the conditions for improving telehealth implementation. A total of 54 respondents were interviewed either individually or in small groups. Content analysis of interviews was performed and identified several effects of telehealth on remote medical practice as well as key conditions to ensure the success of telehealth implementation. Results According to physicians and managers, telehealth benefits include better access to specialised services in remote regions, improved continuity of care, and increased availability of information. Telehealth also improves physicians' practice by facilitating continuing medical education, contacts with peers, and access to a second opinion. At the hospital and health region levels, telehealth has the potential to support the development of regional reference centres, favour retention of local expertise, and save costs. Conditions for successful implementation of telehealth networks include the participation of clinicians in decision-making, the availability of dedicated human and material resources, and a planned diffusion strategy. Interviews with physicians and managers also highlighted the importance of considering telehealth within the broader organisation of health care services in remote and rural regions. Conclusion This study identified core elements that should be considered when implementing telehealth applications with the purpose of supporting medical practice in rural and remote regions. Decision-makers need to be aware of the specific conditions that could influence telehealth integration into clinical practices and health care organisations. Thus, strategies addressing the identified conditions for telehealth success would facilitate the optimal implementation of this technology.

                Author and article information

                Am J Perinatol
                Am J Perinatol
                American Journal of Perinatology
                Thieme Medical Publishers (333 Seventh Avenue, New York, NY 10001, USA. )
                June 2020
                12 May 2020
                : 37
                : 8
                : 800-808
                [1 ]Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
                [2 ]Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
                [3 ]Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
                [4 ]Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
                [5 ]New York State Psychiatric Institute, New York, New York
                [6 ]Department of Anesthesiology, Vagelos College of Physicians and Surgeons, Columbia University, New York
                Author notes
                Address for correspondence Alexander M. Friedman, MD, MPH Division of Maternal-Fetal Fetal Medicine, Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University 622 West 168th Street, New York, NY 10032 amf2104@ 123456cumc.columbia.edu

                This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

                : 23 April 2020
                : 24 April 2020
                Funding None.
                Original Article

                coronavirus,covid-19,telehealth,prenatal care
                coronavirus, covid-19, telehealth, prenatal care


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