Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA.
Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA.
J Matern Fetal Neonatal Med. 2022 Dec;35(25):8836-8843. doi: 10.1080/14767058.2021.2005566. Epub 2021 Nov 21.
Telehealth has gained popularity, particularly in the COVID-19 era. The use of telehealth is now being applied to preoperative evaluation clinics in an effort to overcome barriers to antenatal anesthesia assessment of high-risk obstetrical patients.
The objective of this study is to determine if the quality of antenatal anesthesia telehealth consults of high-risk obstetric patients is comparable to in-person encounters. This is determined by assessing if telehealth consults are feasible and meet the standards of care, as well as the level of patient satisfaction and ease of use as reported by providers.
This retrospective study assessed patients prior to delivery who completed a video-telehealth anesthesia consultation (51 cases) from November 1st, 2019 to November 30th, 2020 and all of those for patients receiving an in-person anesthesia consultation (171 controls) from November 2017 through October 2019. Our primary hypothesis was that telehealth and in-person consultations would not result in different standards of care. The primary outcome was an indicator of meeting the standard of care, and the difference in proportions between the telehealth and in-person consultation was tested by Fisher's exact test. Our secondary hypotheses were that patients reported high levels of satisfaction and could use telehealth easily and providers could use the platform easily. Secondary outcomes were assessed by using the Consultation and Relational Empathy (CARE) and the Telehealth Usability Questionnaire (TUQ) surveys, respectively.
For the primary outcome, 94.1% (48/51) of telehealth and 89.5% (153/171) of in-person visits met the standard of care, indicating no significant difference between groups (-value = .4204). The CARE score was 46 [41,50] {median [interquartile range]}, (-value < .0001), indicating patient satisfaction with telehealth. The use-average scores on the TUQ for the patient and provider were 6.67 [6.33, 7] and 6 [5.33, 7] respectively, indicating great system usability.
This study demonstrates no significant difference in the standard of care between in-person and telehealth visits. Furthermore, telehealth consultation was feasible and associated with high patient satisfaction and platform usability. Preoperative consultation of high-risk obstetric patients using telehealth visits should be routinely considered in clinical practice. There is no significant difference in the standard of care between in-person and telehealth antenatal anesthesia consultations, and patients report high satisfaction and platform usability.Telehealth is gaining popularity, but its role in antenatal anesthesia consultation of high risk obstetrical patients has not yet been defined with respect to standard of care, patient satisfaction, and platform usability.There was no significant difference in standard of care between in-person and telehealth antenatal anesthesia consultations, and patients reported high satisfaction and platform usability.Telehealth should be considered as an alternative to in-person antenatal anesthesia consultation of high risk obstetrical patients. It is a particularly attractive alternative to in-person consultation due to cost-savings, increased patient accessibility, and ease of use.
远程医疗在 COVID-19 时代得到了普及。现在，远程医疗的应用范围正在扩大到术前评估诊所，以克服高风险产科患者进行产前麻醉评估的障碍。
本研究的目的是确定高风险产科患者的远程产前麻醉咨询的质量是否与面对面就诊相当。这是通过评估远程咨询是否可行以及是否符合护理标准来确定的，以及提供者报告的患者满意度和易用性的水平。
这项回顾性研究评估了在 2019 年 11 月 1 日至 2020 年 11 月 30 日期间通过视频远程医疗咨询完成麻醉咨询的分娩前患者（51 例），以及 2017 年 11 月至 2019 年 10 月期间接受面对面麻醉咨询的所有患者（171 例对照）。我们的主要假设是远程医疗和面对面咨询不会导致护理标准的不同。主要结果是符合护理标准的指标，通过 Fisher 精确检验检验远程医疗和面对面咨询之间的比例差异。我们的次要假设是患者报告了高水平的满意度，并且可以轻松使用远程医疗，并且提供者可以轻松使用该平台。通过使用咨询和关系同理心（CARE）和远程医疗可用性问卷（TUQ）调查分别评估次要结果。
对于主要结果，94.1%（48/51）的远程医疗和 89.5%（153/171）的面对面访问符合护理标准，表明两组之间没有显著差异（-值=0.4204）。CARE 评分 46 [41,50]（中位数[四分位距]），（-值<0.0001），表明患者对远程医疗的满意度。患者和提供者的 TUQ 使用平均得分为 6.67 [6.33,7]和 6 [5.33,7]，表明系统具有很好的可用性。
本研究表明，面对面和远程医疗就诊之间在护理标准方面没有显著差异。此外，远程医疗咨询是可行的，并且与患者满意度和平台可用性高度相关。在临床实践中，应常规考虑使用远程医疗访问对高危产科患者进行术前咨询。面对面和远程产前麻醉咨询的护理标准没有显著差异，患者报告满意度高，平台可用性高。远程医疗越来越受欢迎，但它在高危产科患者产前麻醉咨询中的作用在护理标准、患者满意度和平台可用性方面尚未确定。面对面和远程产前麻醉咨询的护理标准没有显著差异，患者报告满意度高，平台可用性高。远程医疗应被视为高危产科患者产前麻醉咨询的替代方案。由于节省成本、增加患者可及性和易用性，它是面对面咨询的特别有吸引力的替代方案。
