Kishkovich Thomas P, James Kaitlyn E, Orona Katie C, Bernstein Sarah N, Cohen Jessica L, Clapp Mark A
Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA.
Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA, USA.
J Telemed Telecare. 2024 Dec 8:1357633X241297294. doi: 10.1177/1357633X241297294.
In obstetrics, telehealth is widely used in the provision of prenatal and postpartum care. The objective was to compare the utilization of commonly recommended services after delivery among individuals receiving telehealth versus in-person postpartum care.
We performed a retrospective cohort study of individuals receiving postpartum care at a single institution between 1 July 2020 and 30 June 2023. The primary exposure was the exclusive use of telehealth versus an in-person visit for postpartum care. Two primary outcomes were assessed between 0 and 365 days after the delivery: 1) long-acting reversible contraceptive (LARC) method use and 2) pap smear screening. Secondary outcomes occurring between 0 and 365 days after delivery included: clinic-based weight assessment, clinic-based blood pressure assessment, any prescription contraception use, primary care visit, and pregnancy within 1 year.
Among the 9953 individuals, 9058 (91.0%) had a postpartum visit. 1811 (19.9%) utilized telehealth exclusively, which peaked during the COVID-19 pandemic. Exclusive telehealth users were less likely to have a pap smear (21.6 vs. 40.1%, < 0.001) or use LARCs (8.6 vs. 19.4%, < 0.001) than those receiving in-person care. In the adjusted analysis, the odds ratio for receiving a pap smear was 0.38 (95% confidence interval [CI] 0.32-0.47) and for using a LARC was 0.38 (95% CI 0.31-0.47) when comparing telehealth to in-person care. Reduced odds of all secondary outcomes were seen in the exclusive telehealth use compared to the in-person cohort, with the exception of subsequent pregnancy within 1 year, which was not significantly different.
Acknowledging that telehealth now has become an important means for patients to access medical care, these findings should prompt clinicians to consider when an in-person postpartum visit should be offered or recommended over telehealth, especially when a patient may not have a preference or reported barriers to accessing an in-person visit.
在产科领域，远程医疗广泛应用于产前和产后护理。目的是比较接受远程医疗与面对面产后护理的个体在分娩后常用推荐服务的使用情况。
我们对2020年7月1日至2023年6月30日期间在单一机构接受产后护理的个体进行了一项回顾性队列研究。主要暴露因素是产后护理完全采用远程医疗与面对面就诊。在分娩后0至365天内评估了两个主要结局：1）长效可逆避孕（LARC）方法的使用；2）巴氏涂片筛查。分娩后0至365天内出现的次要结局包括：基于诊所的体重评估、基于诊所的血压评估、任何处方避孕的使用、初级保健就诊以及1年内再次怀孕。
在9953名个体中，9058名（91.0%）进行了产后就诊。1811名（19.9%）仅使用远程医疗，在新冠疫情期间达到峰值。与接受面对面护理的个体相比，仅使用远程医疗的用户进行巴氏涂片检查的可能性较小（21.6%对40.1%，<0.001）或使用LARC的可能性较小（8.6%对19.4%，<0.001）。在调整分析中，与面对面护理相比，接受远程医疗时进行巴氏涂片检查的比值比为0.38（95%置信区间[CI] 0.32 - 0.47），使用LARC的比值比为0.38（95%CI 0.31 - 0.47）。与面对面队列相比，仅使用远程医疗时所有次要结局的发生几率均降低，但1年内再次怀孕除外，其差异无统计学意义。
鉴于远程医疗现已成为患者获得医疗服务的重要手段，这些发现应促使临床医生考虑何时应提供或推荐面对面产后就诊而非远程医疗，尤其是当患者可能没有偏好或报告存在获得面对面就诊的障碍时。
