Sudden Shift to Telehealth in COVID-19: A Retrospective Cohort Study of Disparities in Use of Telehealth for Prenatal Care in a Large Midwifery Service.
Denise C Smith, E Brie Thumm, Jessica Anderson and 6 others
PMID 38111228WHAT IT FOUND
Prenatal telehealth use rose during the pandemic, especially through patient messages, while in-person visits did not decrease.
English-speaking White patients used telehealth more, so virtual care alone did not close access gaps.
Key findings
01Mean overall encounters rose from 15.9 before March 2020 to 19.5 after March 2020, while in-person prenatal visit counts did not significantly change.
02The increase came from telehealth, especially portal messages, which rose from 2.0 to 4.1 per person per pregnancy.
03Telehealth use was unequal: 14.3% of participants did not use telehealth, and moderate or high telehealth users were nearly all English speakers and 57.5% identified as White.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was retrospective, so it could not fully control for factors that may have influenced telehealth use. It was conducted in one large nurse-midwifery service during a pandemic, so the pattern may not apply to planned telehealth programs or other settings. Virtual prenatal care was not delivered uniformly: some patients could check blood pressure, weight, or fetal heart tones at home, while others could not. The data did not include where prenatal care was delivered or patient educational level, and interpreter support for virtual visits was inconsistent. Portal messages were counted as telehealth, but they may not replace scheduled prenatal visits.
Declared interests
The authors declared no conflicts of interest. The publication types list NIH extramural and non-U.S. government research support.
The easy way to misread this
Do not conclude that telehealth replaced in-person prenatal care or improved access for all patients. In-person visit counts did not significantly change, and telehealth use was lower among patients who did not speak English or who identified as patients of color.