Cost-effectiveness of home telemedical cardiotocography compared with traditional outpatient monitoring

Mobile Health Applications for Prenatal Assessment and Monitoring

BACKGROUND

A mobile health application is an exciting, fast-paced domain that is likely to improve prenatal care.

METHODS

In this narrative review, we summarise the use of mobile health applications in this setting with a special emphasis on both the benefits of remote monitoring devices and the potential pitfalls of their use, highlighting the need for robust regulations and guidelines before their widespread introduction into prenatal care.

RESULTS

Remote monitoring devices for four areas of prenatal care are reported: (1) cardio-tocography; (2) blood glucose levels; (3) blood pressure; and (4) prenatal ultrasound. The majority of publications are pilot projects on remote consultation, education, coaching, screening, monitoring and selective booking, mostly reporting potential medical and/or economic benefits by mobile health applications over conventional care for very specific situations, indications and locations, but not always generalizable.

CONCLUSIONS

Despite the potential advantages of these devices, some caution must be taken when implementing this technology into routine daily practice. To date, the majority of published research on mobile health in the prenatal setting consists of observational studies and there is a need for high-quality randomized controlled trials to confirm the reported clinical and economic benefits as well as the safety of this technology. There is also a need for guidance and governance on the development and validation of new apps and devices and for the implementation of mobile health technology into healthcare systems in both high and low-income settings. Finally, digital communication technologies offer perspectives towards exploration and development of the very new domain of tele-pharmacology.

A new, phonocardiography-based telemetric fetal home monitoring system

The purpose of this article is to describe a new, phonocardiography-based fetal telemonitoring system, which, due to its passive nature, allows long-term measurements even at the home of the pregnant woman. The input element of the system was the home monitor with two sensors for recording the trans-abdominal fetal heart signal and the uterine contractions. The recorded signal was transmitted by mobile network and Internet to an Evaluation Center, where it was analyzed in detail to obtain information about possible dysfunction of the fetal heart. The investigations on this system made clear that by advanced processing of the recorded signal the system captured many additional cardiac features compared with the traditional ultrasound-based cardiotocographic procedure.

Telemedicine for antenatal surveillance of high-risk pregnancies with ambulatory and home fetal heart rate monitoring--an update

Antepartum fetal surveillance is routinely used to assess the risk of fetal death in high-risk pregnancies. Traditionally, testing is performed in the hospital or outpatient clinic by trained medical staff. New equipment is now available that is easy to operate and can be used for self-monitoring of the fetal heart rate (FHR) in the home setting. The tracings are transmitted by modem to a referral center for immediate interpretation by a health provider. The aim of this review was to assess the current data on the application of this new technology with regard to feasibility, access to care, maternal and neonatal outcome, patient and physician satisfaction, and cost-effectiveness.

An economic evaluation of the Highlands and Islands teledentistry project

A 12-month trial of teledentistry was conducted in two general dental practices (one in the Orkney Islands and one in the Scottish Highlands at Kingussie). The dental practices had a PC-based videoconferencing link, connected by ISDN at 128 kbit/s, to a restorative specialist at a hospital in Aberdeen. Twenty-five patients were recruited into the trial. A cost-minimization analysis was undertaken by comparing the costs of teledentistry with two alternatives: outreach visits, where the specialist regularly visited the remote communities, and hospital visits, where patients in remote communities travelled to hospital for consultation. For Orkney patients, dental teleconsultations cost the National Health Service (NHS) an additional 36 per patient compared with outreach visits, but cost-savings of 270 per patient could be achieved compared with hospital visits. For Kingussie patients, teleconsultations cost the NHS an additional 44 and there were cost-savings of 1.54 compared with outreach visits and hospitals visits, respectively. However, patients incurred additional costs for radiographs and photographs, and the general dental practitioner incurred additional preparation time costs. When the value of patient time was included, there were cost-savings of around 900 per Orkney patient compared with hospital visits, but compared with outreach visits teledentistry cost an additional 180 per patient. Based on the trial data, there were no cost-savings from teledentistry for Kingussie patients, even when the value of time was included. These results were relatively robust in a sensitivity analysis. However, we estimated that the cost-effectiveness of teledentistry would improve with greater familiarity and use of equipment. Benefits and cost-savings would be greatest in island or remote communities, where patients have to travel long distances to hospital for specialist consultations.