Holman Carly, Glover Annie, McKay Kimber, Gerard Courtney
Rural Institute for Inclusive Communities, University of Montana, Missoula, Montana, USA.
School of Public and Community Health Sciences, University of Montana, Missoula, Montana, USA.
Telemed Rep. 2023 Feb 24;4(1):1-9. doi: 10.1089/tmr.2023.0001. eCollection 2023.
Obstetric providers have used telemedicine to manage gestational diabetes, mental health, and prenatal care. However, the uptake of telemedicine in this field has not been universal. The COVID-19 pandemic catalyzed the adoption of telehealth in obstetric care, which will have lasting effects, especially for rural communities. We sought to understand the experience of adapting to telehealth among obstetric providers in the Rocky Mountain West to identify implications for policy and practice.
This study included 20 semi-structured interviews with obstetric providers in Montana, Idaho, and Wyoming. The interviews followed a moderator's guide based on the Aday & Andersen Framework for the Study of Access to Medical Care, exploring domains of health policy, the health system, the utilization of health services, and the population at risk. All the interviews were recorded, transcribed, and analyzed using thematic analysis.
Findings indicate that participants view telehealth as a useful tool during prenatal and postpartum care; many participants intend to continue telehealth practices after the pandemic. Participants shared that their patients reported benefits to telehealth beyond COVID-19 safety, including limiting travel time, reducing time off work, and alleviating childcare needs. Participants expressed concern that expanding telehealth will not equally benefit all patients and could widen existing health inequities.
Success moving forward will require a telehealth infrastructure, adaptive telehealth models, and provider and patient training. As obstetric telehealth expands, efforts must prioritize equitable access for rural and low-income communities, so all patients can benefit from the technological advancements to support health.
产科医疗服务提供者已使用远程医疗来管理妊娠期糖尿病、心理健康和产前护理。然而，远程医疗在该领域的应用并不普遍。2019冠状病毒病疫情促使产科护理采用远程医疗，这将产生持久影响，尤其是对农村社区。我们试图了解落基山脉西部产科医疗服务提供者适应远程医疗的经历，以确定对政策和实践的影响。
本研究包括对蒙大拿州、爱达荷州和怀俄明州的产科医疗服务提供者进行的20次半结构化访谈。访谈遵循基于阿代和安德森医疗服务可及性研究框架的主持人指南，探讨卫生政策、卫生系统、卫生服务利用和高危人群等领域。所有访谈均进行录音、转录，并采用主题分析法进行分析。
研究结果表明，参与者认为远程医疗在产前和产后护理中是一种有用的工具；许多参与者打算在疫情后继续采用远程医疗实践。参与者分享说，他们的患者报告了远程医疗除了COVID-19安全之外的好处，包括减少出行时间、减少工作请假时间和缓解育儿需求。参与者担心扩大远程医疗不会使所有患者平等受益，反而可能加剧现有的健康不平等。
未来的成功将需要远程医疗基础设施、适应性远程医疗模式以及提供者和患者培训。随着产科远程医疗的扩展，必须优先考虑农村和低收入社区的公平可及性，以便所有患者都能从支持健康的技术进步中受益。
