In the year 2016, we can do almost everything from our phones. We can have face-to-face conversations with family on the other side of the world, and we can ask Google for the answer to every imaginable question. With the advent of telemedicine, many people can even chose to see their doctors across a digital divide. But remote clinic visits for prenatal care has been slow to catch on due to the high stakes and the vital measurements taken at each appointment- blood pressure, weight, and the fetal heart rate. Two new studies are now pushing the limits of the obstetrician’s office.
The first study comes from the Mayo Clinic in Rochester, Minnesota. Doctors enrolled 300 expecting patients to participate in the study. 150 of the women were assigned to care as usual- 12 planned office visits with their physician or midwife. The other 150 women were assigned to a new model of care, dubbed the “OB Nest.” Patients in the OB Nest had 8 planned office visits with their doctor or midwife plus 6 virtual visits with a nurse. They were given home monitors: an automatic blood pressure cuff, a fetal Doppler monitor (a hand-held machine that detects the fetus’s heart rate), and a curated social network. They also recorded their weight from their home scales. Women could use their fancy toolkit anytime they wanted; the study coordinators asked participants to measure their blood pressure at least once a week and obtain fetal heart readings once a week from week 12 to 28. All the data was recorded in a pregnancy journal, which patients discussed with their nurses during the virtual visits. The social network was open to only Mayo Clinic participants and monitored by a nurse.
At the end, patients were more satisfied with the OB Nest model than the traditional in-person clinic appointments, with a satisfaction score of 94 versus 79 out of 100. The women in the OB Nest program also had lower pregnancy stress at 14 weeks and 36 weeks pregnant, but the same levels of stress at 24 weeks. The two groups had no differences in perceived quality of care or pregnancy outcomes. However, it’s important to note that the study was too small to detect differences in pregnancy outcomes. The participants in the study were also highly selected to have only low-risk pregnancies. They had a mean age of 29 and were mostly highly-educated, white, and married. The economists amongst us might be wondering if remote prenatal care might save the healthcare system some money in the future. Probably not. The women in the OB Nest had 3.4 fewer in-office appointments, but they required more nursing time out-of-office and their in-office visits were significantly longer.
The second study tested a new mobile phone app called Babyscripts. Babyscripts sponsored this clinical trial with doctors at the George Washington University. 90 patients participated in the study. 49 were assigned to the Babyscripts group; they had 8 in-office visits with outpatient monitoring of their blood pressure and weight using Babyscripts integrated platform. The app communicates wirelessly with a special scale and blood pressure cuff. As in the Mayo study, patients were asked to check their blood pressure and weight once a week. 41 patients were assigned to usual prenatal care with 14 in-office prenatal visits.
Patients in the Babyscripts group were more satisfied with their prenatal care at 20 weeks, and they were very engaged with the wireless toys. They checked their blood pressure 1.4 times per week on average and their weight twice a week. Dr. Nihar Ganju, who ran the study, hopes that this new technology will enable doctors to do a better job of tracking excessive weight gain in pregnancy. Again, there was no difference in pregnancy outcomes between the two groups.
Personally, I am very excited about the future of connected health for prenatal care. Imagine the time, effort, and money saved if you could click in to a virtual appointment with your MD and she still had all the information she needed?! No driving time, parking tickets, or time spent in the clinic waiting room? Count me in!