Pandemic Pregnancy Care: Telehealth versus Face-to-Face
In-person prenatal services declined by about 8% last year. How does telehealth for pregnant women compare to standard care?
When Australia was plunged into a slew of COVID-19 restrictions in early 2020, disruption occurred in many areas of healthcare.
For pregnant women, there was no exception, with one in 10 face-to-face antenatal care appointments replaced by telehealth, the majority (87.5%) of which were telephone consultations .
Following the March 2020 extension of telehealth to support care during the pandemic, including MBS articles to cover antenatal services, Australia reached a peak in use of antenatal telehealth services in April ( 17,987) and May (16,525).
These figures constitute the latest report from the Australian Institute of Health and Welfare (AIHW), summarizing the demands for Medicare antenatal care nationwide between January and December 2020, with comparisons to previous years.
In 2020, there were approximately 136,000 fewer face-to-face antenatal services compared to 2019, a decrease of 8.3%. However, face-to-face services still represented the majority (around 92%) of antenatal services treated in 2020.
Face-to-face prenatal services decreased 15% in the second quarter of 2020 compared to the same quarter in 2019. Nationwide, more than 1.6 million MBS services for antenatal care were processed in 2020 – a little less than in 2019.
So, are there any downsides to providing maternity care via telehealth versus face-to-face?
Dr Wendy Burton, RACGP Chair, Specific Interests in Antenatal and Postnatal Care, believes there is, but said gp news telehealth may be beneficial when no prenatal physical examination is required if the pregnancy is considered low risk.
âThere are downsides, especially in the second half of pregnancy,â she said.
‘It’s when we monitor blood pressure [BP], fetal growth and fetal heart rate up close. But BP can be monitored remotely with domestic machines. ‘
Dr Burton says some local maternity wards buy home BP units for women to rent, or GPs can buy them to lend to patients.
âEarly BP, height and weight checks are recommended, and some of this can be done by the woman,â she said. “Then we can manage most of the first half of the pregnancy with telehealth rather than face to face if there are no additional risk factors.”
Telehealth appointments can also cover issues such as alcohol and other drug use, mental health, and domestic violence, for which Dr Burton says screening should be considered on a case-by-case basis.
âScreening for domestic violence is more difficult and risky through telehealth – who could listen? ” she said.
“I think we’ve had to learn to manage mental health consultations through telehealth due to the demand, but there is so much that can be missed when you can’t understand body language and facial expressions.”
When you talk to gp news at the start of the pandemic, Dr Burton’s advice at the time was that low-risk women only attend three in-person antenatal visits throughout their pregnancy.
That advice remains the same, she said, with most state and territory guidelines allowing flexibility in visits based on the number of COVID-19 cases present.
“In areas with active COVID [low-risk women should have limited face-to-face visits]’Dr Burton said.
âMy experience is that there has been much less attendance at public hospitals – so keeping women away from crowded spaces such as outpatient departments, including antenatal clinics, has become a priority for hospitals. who were keen to ensure the safety of women. ”
Although it is currently considered that pregnant women are not at increased risk of COVID-19, RANZCOG still considers them a vulnerable group and advises to take all precautions to reduce the risk of infection. Recently updated guidance for pregnant women recommends that they should be able to routinely offer Pfizer vaccine at any stage of pregnancy.
For most states and territories, AIHW report shows decline after peak use of telehealth antenatal care services in April and May, with the exception of Victoria during its second wave of COVID-19 and restrictions increased. State services increased again after June, peaking in August, when one in five antenatal care services treated were telehealth.
In April 2020, nearly 106,000 face-to-face antenatal care services were treated, or 19.2% less than in April 2019. In May 2020, 112,000 antenatal care services were treated, or 24.7% less than in May 2019.
Overall, telehealth has been widely adopted by GPs and patients, hailed as “here to stay” by RACGP President Dr Karen Price.
When it comes to providing pregnancy care, Dr. Burton believes telehealth has its benefits.
âPersonally, I prefer face-to-face, but telehealth is convenient for many consumers and it can complement face-to-face visits and in some situations replace them,â she said.
The AIHW report only includes antenatal services treated with Medicare during COVID-19 by GPs, participating midwives, and Aboriginal and Torres Strait Islander health practitioners. Services provided in public hospitals that cannot be claimed on the MBS are not covered in the report.
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