In March 2020, our institution deployed a COVID-19 prenatal care model, incorporating reduced frequency visits and virtual visits in response to the pandemic.
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Early findings on alternative prenatal care approaches are critical to helping hospitals and health systems make decisions on how to sustain or modify COVID-19–related prenatal care adaptations made rapidly in response to the pandemic. 14, 15 Thus, the COVID-19 pandemic provides a unique opportunity to evaluate reduced visit schedules and virtual visits in real-world settings. Existing data are limited by highly controlled settings and minimal evaluations of patient or provider perspectives. These included concerns that unequal access to virtual visits could deepen existing maternity care inequities, concerns that the lack of home devices (eg, blood pressure cuffs) would affect care quality and safety, and dissatisfaction with poor patient-provider continuity and inadequate expectation setting for the virtual visit experience.Įarly findings on the COVID-19 prenatal care model at a single institution are promising but require further evaluation in more diverse populations.Īlthough randomized controlled trials (RCTs) of reduced frequency visits and virtual visits during pregnancy are promising, these approaches are understudied in real-world settings.
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Perceived drivers of negative care experience were also similar for patients and providers, but less common. In free-text responses, drivers of positive care experiences were similar for patients and providers and included perceived improved access to care through decreased barriers (eg, transportation, childcare), perceived high quality of virtual visits for low-risk patients and increased safety during the pandemic, and improved satisfaction through better patient counseling. Most reported satisfaction with the coronavirus disease 2019 model (patients, 196 of 253 providers, 64 of 77 ). Nearly all believed that home blood pressure cuffs were important for virtual visits (patients, 213 of 231 providers, 63 of 66 ). More than half of respondents (patients, 124 of 253 providers, 41 of 77 ) believed that virtual visits were safe. Most patients and almost all providers reported that virtual visits improved access to care (patients, 174 of 253 providers, 74 of 77 ). Provider respondents were predominantly white (44 of 66 66.7%) and female (50 of 66 75.8%). The rates of chronic conditions and pregnancy complications also differed from national prevalence. Patient respondents were largely white (180 of 253 71.1%) and privately insured (199 of 253 78.7%), reflecting the study site population. Of those eligible, 74.8% of providers (77 of 103) and 15.0% of patients (253 of 1690) participated in the surveys. After the coronavirus disease 2019 model adoption, average weekly prenatal visit volume fell by 16.1%, from 898 to 761 weekly visits the average weekly proportion of prenatal visits conducted virtually increased from 10.8% (97 of 898) to 43.3% (330 of 761) and the average visit no-show rate remained stable (preimplementation, 4.3% postimplementation, 4.2%).
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