Action Points
- Note that this study was published as an abstract and presented at a conference. These data and conclusions must be considered to be preliminary until published in a peer-reviewed journal.
- Low-risk pregnant patients receiving some prenatal care through a remote monitoring system reported higher satisfaction along with their care and much less tension concerning their pregnancies compared to patients receiving usual care, according to a small randomized trial.
- Note that while there was no considerable difference in maternal/fetal events, incidence of cesarean delivery, preterm birth, birthweight or an Apgar score <7, the study was not powered to detect differences in obstetrical outcomes.
WASHINGTON — Low-risk pregnant patients that received some prenatal care through a remote monitoring system reported higher satisfaction along with their care and much less tension concerning their pregnancies compared to patients that received usual care, a small randomized trial presented right here found.
Compared along with patients randomized to usual prenatal care, patients in the OB Nest group — that had remote monitoring — reported better satisfaction concerning their care at 3six 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-manage analysis, patients randomized to OB Nest likewise reported significantly much less pregnancy-related tension at the 2 14 and 3six weeks versus patients along with usual care, though the difference was nonsignificant at 24 weeks. There was likewise no considerable difference in perceived quality of care related to either communication or decision making between the 2 groups.
These outcomes 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 right anticipatory guidance. The difference along with OB Nest patients was they had fewer clinic visits. As opposed to the usual 12 scheduled appointments, OB Nest patients had eight scheduled appointments and 6 “virtual care” visits along with a trained nurse either via phone or email. They likewise monitored and reported their blood stress and the baby’s fetal heartbeat from home.
Co-author Abimbola Famuyide, MBBS, likewise of the Mayo Clinic, said that his group decided to test this approach after touring a Mayo Clinic Focus of Excellence, where remote monitoring was being done on patients along with end-stage kidney disease.
“We believed ‘Wait a minute, this Could have actually application for pregnant patients,’ so we started looking about if individuals had looked at methods of performing house monitoring for pregnant women and there actually wasn’t a lot out there,” he told MedPage Today. “That’s exactly how we came concerning to this project to see if it’s feasible for a pregnant woman to monitor her blood stress and monitor the baby’s heartbeat at house and share outcomes along with us.”
Prior to conducting this trial, Tobah’s group did a validation experiment along with nine pregnant patients to make sure that patients were capable of performing 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 likewise had 3.4 fewer outpatient scheduled clinic appointments, and 2.85 fewer scheduled appointments along with a provider (P<0.001 for both) compared to patients receiving usual care. By contrast, nurses reported significantly a lot more time spent along with OB Nest patients compared vs the usual care group.
While patient satisfaction was the primary outcome, Tobah and colleagues likewise examined secondary outcomes, and located no considerable difference in maternal/fetal events, incidence of cesarean delivery, preterm birth, birthweight, or an Apgar score <7. There was a better section of gestational diabetes in the OB Nest group (six patients versus 0 patients in usual care), Yet the differences were not significant.
However, Tobah noted at the presentation that the study was not powered to detect differences in obstetrical outcomes, just patient outcomes. Various other limitations included that the participants were not blinded to the way of care, which Could have actually 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, that was not involved in the study, said that even though the outcomes seemed promising, a lot more research was called for in to the concept.
“In value-based care we will certainly be reimbursed the 2 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 certainly should 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 group has actually applied for a grant to study this in the Mayo Clinic Good health System throughout the top Midwest. He said he eventually hopes to examine remote monitoring for higher-risk patients, such as those along with gestational diabetes, adding that units love remote monitoring will certainly be essential along with the anticipated healthcare shortfall.
“Right now nationally, concerning 90% of women delivered by physicians — the vast majority by OB/GYNs,” said Famuyide. “If we’re going to have actually a shortfall in physicians, we’re going to have actually to identify a method to safely deliver care to pregnant women along with fewer physician resources and this is one method to grab us safely on that pathway.”
Tobah disclosed employment by the Mayo Clinic.
Famuyide disclosed employment and research grants from the Mayo Clinic Foundation.
Other co-authors disclosed no conflicts of interest.
last updated 05.17.2016
