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Pregnancy: Remote Monitoring Improves Satisfaction

Clicks:Updated:2016-05-18 09:05:00

WASHINGTON -- Low-risk pregnant patients who received some prenatal care through a remote monitoring system reported greater satisfaction with their care and less stress about their pregnancies than patients who received usual care, a small randomized trial presented here found.

Compared with patients randomized to usual prenatal care, patients in the OB Nest group -- who had remote monitoring -- reported higher satisfaction about their care at 36 weeks (95% versus 77%, respectively, P<0.001), reported Yvonne Butler Tobah, MD, of the Mayo Clinic in Rochester, Minn., and colleagues.

In an intent-to-treat analysis, patients randomized to OB Nest also reported significantly less pregnancy-related stress at both 14 and 36 weeks versus patients with usual care, though the difference was nonsignificant at 24 weeks. There was also no significant difference in perceived quality of care related to either communication or decision making between the two groups.

These results were presented at the American College of Obstetricians and Gynecologists annual meeting.

All patients were followed according to ACOG guidelines for lab testing, imaging, immunizations, and appropriate anticipatory guidance. The difference with OB Nest patients was they had fewer clinic visits. Instead of the usual 12 scheduled appointments, OB Nest patients had eight scheduled appointments and six "virtual care" visits with a trained nurse either via phone or email. They also monitored and reported their blood pressure and the baby's fetal heartbeat from home.

Co-author Abimbola Famuyide, MBBS, also of the Mayo Clinic, said that his team decided to test this approach after touring a Mayo Clinic Center of Excellence, where remote monitoring was being done on patients with end-stage kidney disease.

"We thought 'Wait a minute, this may have application for pregnant patients,' so we started looking around if people had looked at ways of doing home monitoring for pregnant women and there really wasn't much out there," he told MedPage Today. "That's how we came about to this project to see if it's possible for a pregnant woman to track her blood pressure and monitor the baby's heartbeat at home and share results with us."

Prior to conducting this trial, Tobah's team did a validation experiment with nine pregnant patients to ensure that patients were capable of doing accurate monitoring at home. For this trial, they analyzed 134 women in the OB Nest group and 133 women in the usual prenatal care group. Low-risk pregnant patients ages 18-39 years (mean age 29 years) were recruited at gestational age <13 weeks.

Not surprisingly, OB Nest patients also had 3.4 fewer outpatient scheduled clinic appointments, and 2.85 fewer scheduled appointments with a provider (P<0.001 for both) than patients receiving usual care. By contrast, nurses reported significantly more time spent with OB Nest patients compared vs the usual care group.

While patient satisfaction was the primary outcome, Tobah and colleagues also examined secondary outcomes, and found no significant difference in maternal/fetal events, incidence of cesarean delivery, preterm birth, birthweight, or an Apgar score <7. There was a higher portion of gestational diabetes in the OB Nest group (6 patients versus 0 patients in usual care), but the differences were not significant.

However, Tobah noted at the presentation that the study was not powered to detect differences in obstetrical outcomes, only patient outcomes. Other limitations included that the participants were not blinded to the method of care, which may have resulted in ascertainment bias, and the limited generalizability of the results, as most patients were married, Caucasian and well-educated.

Charles Lockwood, MD, of University of South Florida in Tampa, who was not involved in the study, said that although the results seemed promising, more research was needed into the concept.

"In value-based care we will be reimbursed both by the quality of care rendered (i.e., patient satisfaction, safety and outcomes) and its costs," he told MedPage Today via email. "While the study is intriguing, larger numbers of patients will need to be studied in various locales to confirm that comparability of maternal-fetal outcomes and confirm costs savings."

Famuyide agreed, saying that the next step of the research is to validate OB Nest in a community setting and his team has applied for a grant to study this in the Mayo Clinic Health System throughout the upper Midwest. He said he eventually hopes to examine remote monitoring for higher-risk patients, such as those with gestational diabetes, adding that systems like remote monitoring will be crucial with the anticipated healthcare shortfall.

"Right now nationally, about 90% of women delivered by physicians -- the vast majority by OB/GYNs," said Famuyide. "If we're going to have a shortfall in physicians, we're going to have to figure out a way to safely deliver care to pregnant women with fewer physician resources and this is one way to get us safely on that pathway."

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