Telehealth Uptake into Prenatal Care and Provider Attitudes during the COVID-19 Pandemic in New York City: A Quantitative and Qualitative Analysis

Abstract

Objective This study aimed to (1) determine to what degree prenatal care was able to be transitioned to telehealth at prenatal practices associated with two affiliated hospitals in New York City during the novel coronavirus disease 2019 (COVID-19) pandemic and (2) describe providers' experience with this transition.

Study Design Trends in whether prenatal care visits were conducted in-person or via telehealth were analyzed by week for a 5-week period from March 9 to April 12 at Columbia University Irving Medical Center (CUIMC)-affiliated prenatal practices in New York City during the COVID-19 pandemic. Visits were analyzed for maternal-fetal medicine (MFM) and general obstetrical faculty practices, as well as a clinic system serving patients with public insurance. The proportion of visits that were telehealth was analyzed by visit type by week. A survey and semistructured interviews of providers were conducted evaluating resources and obstacles in the uptake of telehealth.

Results During the study period, there were 4,248 visits, of which approximately one-third were performed by telehealth (n = 1,352, 31.8%). By the fifth week, 56.1% of generalist visits, 61.5% of MFM visits, and 41.5% of clinic visits were performed via telehealth. A total of 36 providers completed the survey and 11 were interviewed. Accessing technology and performing visits, documentation, and follow-up using the telehealth electronic medical record were all viewed favorably by providers. In transitioning to telehealth, operational challenges were more significant for health clinics than for MFM and generalist faculty practices with patients receiving public insurance experiencing greater difficulties and barriers to care. Additional resources on the patient and operational level were required to optimize attendance at in-person and video visits for clinic patients.

Conclusion Telehealth was rapidly implemented in the setting of the COVID-19 pandemic and was viewed favorably by providers. Limited barriers to care were observed for practices serving patients with commercial insurance. However, to optimize access for patients with Medicaid, additional patient-level and operational supports were required.

Key Points

• Telehealth uptake differed based on insurance.

• Medicaid patients may require increased assistance for telehealth.

• Quick adoption of telehealth is feasible.

Keywords

telehealth - COVID-19 - health services - prenatal care

• References

• 1 WHO Director General's opening remarks at the media briefing on COVID-19. March 11, 2020. Available at: https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020 . Accessed May 13, 2020
• 2 Director-General WHO. Statement on the second meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV). January 30, 2020. Available at: www.who.int/news-room/detail/30-01-2020-statement-on-the-second-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-outbreak-of-novel-coronavirus-(2019-ncov) . Accessed May 13, 2020
• 3 Office NYSGs. Governor Cuomo Signs the 'New York State on PAUSE' Executive Order. Available at: /www.governor.ny.gov/news/governor-cuomo-signs-new-york-state-pause-executive-order . Accessed May 13, 2020
• 4 Lurie N, Carr BG. The role of telehealth in the medical response to disasters. JAMA Intern Med 2018; 178 (06) 745-746
• 5 Hollander JE, Carr BG. Virtually perfect? Telemedicine for Covid-19. N Engl J Med 2020; 382 (18) 1679-1681
• 6 Gagnon MP, Duplantie J, Fortin JP, Landry R. Implementing telehealth to support medical practice in rural/remote regions: what are the conditions for success?. Implement Sci 2006; 1: 18
• 7 Seto E, Smith D, Jacques M, Morita PP. Opportunities and challenges of telehealth in remote communities: case study of the Yukon telehealth system. JMIR Med Inform 2019; 7 (04) e11353
• 8 Castleberry A, Nolen A. Thematic analysis of qualitative research data: Is it as easy as it sounds?. Curr Pharm Teach Learn 2018; 10 (06) 807-815
• 9 Implementing Telehealth in Practice. Implementing telehealth in practice: ACOG committee opinion summary, number 798. Obstet Gynecol 2020; 135 (02) 493-494
• 10 DeNicola N, Grossman D, Marko K. , et al. Telehealth interventions to improve obstetric and gynecologic health outcomes: a systematic review. Obstet Gynecol 2020; 135 (02) 371-382