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Hybrid care programs bring advantages of virtual visits (cost, logistics and comfort) and in-person visits (doctor-patient relationship and extended clinical evaluation). For maternal-fetal telemedicine to become a mainstream of MFM, the virtual visits must be comprehensive, and extend beyond maternal assessment to fetal wellbeing. We sought to assess the feasibility of hybrid care for women with gestational diabetes mellitus (GDM).
Study Design
A prospective pilot clinical study. Women with a singleton pregnancy and GDM at ≥31 weeks of gestation were recruited. Patient journey included alternating in-person and remote visits for a duration of four weeks. The remote visit included maternal assessment - vital signs, glycemic control (documented in Datos app), urinalysis (Healthy.io), fetal heart rate assessment (INVU by Nuvo™) and ultrasound measured maximal vertical pocket (PulseNmore) yielding a modified biophysical profile (mBPP) [Figure1]. Total visit length was compared between the virtual and in-person visits. Usefulness, effectiveness, reliability, and patient satisfaction were assessed with the telehealth usability questionnaire (TUQ).
Results
20 participants with GDM between 31-34 gestational weeks at recruitment were enrolled [Table1]. One participant withdrew consent after one virtual visit. 38/39 (97.4%) of remote visits concluded in comprehensive assessment including mBPP to the physician's satisfaction. One referral to in-person monitoring occurred due to technical difficulties. Total remote visit length was significantly shorter (65.4±21.6 min) compared to the in-person visit (171.1±21.4 min, P< 0.001). TUQ results indicate high usability of the telehealth system (6.6/7). No adverse events or safety incidents occurred.
Conclusion
A hybrid maternal-fetal program consisting of alternating in-person and virtual visits is feasible, saves time and improves women satisfaction. Use of the service and technologies requires a learning process for both the care team and the women. Shifting maternal-fetal surveillance to women’s home or work has broad implications with many advantages.
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