Addressing Disparities in Prenatal Care via Telehealth During COVID-19: Prenatal Satisfaction Survey in East Harlem
Objective In the setting of an inner city, safety net hospital, patient satisfaction with prenatal care conducted via telehealth was compared with in-person visits at the height of the novel coronavirus disease 2019 (COVID-19) pandemic.
Study Design Through this cross-sectional study, patients were identified who received at least one televisit and one in-person visit during the COVID-19 pandemic. The Short Assessment of Patient Satisfaction (SAPS) survey was used to measure patient satisfaction. Surveys pertaining to in-person and televisits were conducted at the end of a telephone encounter, and overall satisfaction scores were documented. Patients were excluded if they received in-person or virtual care only and not both. The SAPS score correlated with the degree of patient satisfaction.
Results A total of 140 patients were identified who received both virtual and in-person prenatal care from March 1, 2020 to May 1, 2020. One hundred and four patients (74%) agreed to be surveyed: 77 (74%) self-identified as Hispanic and 56 (54%) stated that their primary language was Spanish. The overall median satisfaction score for televisits and in-person visits was 20 (interquartile range [IQR]: 20, 25) and 24 (IQR: 22, 26) (p = 0.008, Z score = 2.651). In patients who self-identified as Hispanic or identified their primary language as Spanish, there was no statistically significant difference in their satisfaction scores.
Conclusion While there were lower scores in patient satisfaction for televisits in every category, there were no clinically significant differences since all medians were in the “satisfied” range. By lowering patient exposure to severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), especially for those at risk for reduced access to care and higher COVID-19 cases by zip code, telehealth allowed for appropriate continuation of satisfactory prenatal care with no impact on patient perceived satisfaction of care.
Telehealth allowed for continuation of satisfactory prenatal care in Hispanic patients.
Hispanic patients are at risk for reduced access to care.
Telehealth was a useful tool for achieving patient-perceived satisfactory care.
Received: 29 July 2020
Accepted: 16 September 2020
10 October 2020 (online)
© 2020. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
- 1 Details on deaths. Accessed June 28, 2020 at: https://www1.nyc.gov/site/doh/covid/covid-19-data-deaths.page
- 2 Turner-Musa J, Ajayi O, Kemp L. Examining social determinants of health, stigma, and COVID-19 disparities. Healthcare (Basel) 2020; 8 (02) 168
- 3 Abuelgasim E, Saw LJ, Shirke M, Zeinah M, Harky A. COVID-19: unique public health issues facing Black, Asian and minority ethnic communities. Curr Probl Cardiol 2020; 45 (08) 100621
- 4 COVID-19 FAQs for obstetrician-gynecologists, telehealth. Accessed September 25, 2020 at: https://www.acog.org/clinical-information/physician-faqs/covid-19-faqs-for-ob-gyns-telehealth
- 5 Novel coronavirus “COVID-19”: special considerations for pregnant women. Accessed June 28, 2020 at: https://www.kff.org/coronavirus-covid-19/issue-brief/novel-coronavirus-covid-19-special-considerations-for-pregnant-women/
- 6 Telemedicine is poised to grow as its popularity increases among physicians and patients. Accessed April 24, 2020 at: https://www.healthcarefinancenews.com/news/telemedicine-poised-grow-its-popularity-increases-among-physicians-and-patients
- 7 COVID-19 may permanently alter the telehealth landscape, from reimbursement to utilization. Accessed April 24, 2020 at: https://www.healthcarefinancenews.com/node/140009
- 8 Long MC, Angtuaco T, Lowery C. Ultrasound in telemedicine: its impact in high-risk obstetric health care delivery. Ultrasound Q 2014; 30 (03) 167-172
- 9 Lowery C, Bronstein J, McGhee J, Ott R, Reece EA, Mays GP. ANGELS and University of Arkansas for Medical Sciences paradigm for distant obstetrical care delivery. Am J Obstet Gynecol 2007; 196 (06) 534.e1-534.e9
- 10 Odibo IN, Wendel PJ, Magann EF. Telemedicine in obstetrics. Clin Obstet Gynecol 2013; 56 (03) 422-433
- 11 Wood D. STORC helps deliver healthy babies: the telemedicine program that serves rural women with high-risk pregnancies. Telemed J E Health 2011; 17 (01) 2-4
- 12 Nudell J, Slade A, Jovanovič L, Hod M. Technology and pregnancy. Int J Clin Pract Suppl 2011; (170) 55-60
- 13 Pflugeisen BM, McCarren C, Poore S, Carlile M, Schroeder R. Virtual visits: managing prenatal care with modern technology. MCN Am J Matern Child Nurs 2016; 41 (01) 24-30
- 14 Implementing Telehealth in Practice. Implementing telehealth in practice. Obstet Gynecol 2020; 135 (02) e73-e79
- 15 Marko KI, Ganju N, Brown J, Benham J, Gaba ND. Remote prenatal care monitoring with digital health tools can reduce visit frequency while improving satisfaction. Obstet Gynec 2016;127(p1S)
- 16 McDuffie Jr RS, Beck A, Bischoff K, Cross J, Orleans M. Effect of frequency of prenatal care visits on perinatal outcome among low-risk women. A randomized controlled trial. JAMA 1996; 275 (11) 847-851
- 17 Hawthorne G, Sansoni J, Hayes L, Marosszeky N, Sansoni E. Measuring patient satisfaction with health care treatment using the Short Assessment of Patient Satisfaction measure delivered superior and robust satisfaction estimates. J Clin Epidemiol 2014; 67 (05) 527-537
- 18 Schoonjans F. MedCalc statistical software. Accessed June 28, 2020 at: https://www.medcalc.org/index.php
- 19 Wells KB, Golding JM, Hough RL, Burnam MA, Karno M. Acculturation and the probability of use of health services by Mexican Americans. Health Serv Res 1989; 24 (02) 237-257
- 20 Escarce JJ, Kapur K. Access to and Quality of Health Care. In: Tienda M, Mitchell F. eds. Hispanics and the Future of America: National Research Council (US) Panel on Hispanics in the United States. Washington, DC: National Academies Press (U.S.); 2006
- 21 David RA, Rhee M. The impact of language as a barrier to effective health care in an underserved urban Hispanic community. Mt Sinai J Med 1998; 65 (5-6): 393-397
- 22 Lewin-Epstein N. Determinants of regular source of health care in black, Mexican, Puerto Rican, and non-Hispanic white populations. Med Care 1991; 29 (06) 543-557
- 23 Nelson A. Unequal treatment: confronting racial and ethnic disparities in health care. J Natl Med Assoc 2002; 94 (08) 666-668
- 24 Leavitt M. Medscape's response to the Institute of Medicine Report: Crossing the quality chasm: a new health system for the 21st century. MedGenMed 2001; 3 (02) 2
- 25 Centers for Disease Control and prevention. Reduced access to care: household pulse survey. Published 2020. Accessed June 28, 2020 at: https://www.cdc.gov/nchs/covid19/pulse/reduced-access-to-care.htm
- 26 Total count of COVID-19 cases based on patient address by ZIP code. Accessed September 25, 2020 at: https://www1.nyc.gov/assets/doh/downloads/pdf/imm/covid-19-cases-by-zip-04032020-1.pdf