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Gerits ML, Bielen S, Lanssens D, Luyten J, Gyselaers W. Experience Counts: Unveiling Patients' Willingness to Pay for Remote Monitoring and Patient Self-Measurement. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:1270-1279. [PMID: 38795963 DOI: 10.1016/j.jval.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 04/18/2024] [Accepted: 05/13/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVES This study aimed to (1) estimate patients' willingness to pay (WTP) for remote monitoring (RM) and patient self-measurement (PSM) for pregnant women at risk of gestational hypertensive disorders, (2) assess the impact of experience with these technologies on WTP, and (3) determine their impact on health-related quality of life (HRQoL). METHODS Data collection was part of a multicentric randomized controlled trial, Pregnancy Remote Monitoring II, with 2 interventions: RM and PSM. A contingent valuation survey, combining a payment card and open-ended question, was completed twice by 199 participants. Two-part models analyze the impact of experience on WTP, regression models estimated using ordinary least squares the impact of RM and PSM on HRQoL. RESULTS The mean WTP amount was approximately €120 for RM and €80 for PSM. Compared with having no experience, WTP RM was €63 higher after a long-term exposure to RM (P = .01) and WTP PSM was €26 lower after a short-term exposure to RM (P = .07). No significant impact of RM or PSM on HRQoL was found. CONCLUSIONS This study contributes to the discussion on the impact of experience on WTP. Those who had a long-term experience with RM, were willing to pay more for RM than those without experience. This confirms our hypothesis that involving patients without experience with the valued treatment, possibly underestimates WTP. A long-term experience has, however, no impact on the WTP for technologies for which the potential benefits are apparent without experiencing them, such as PSM.
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Affiliation(s)
- Marie-Lien Gerits
- Faculty of Business Economics, Hasselt University, Hasselt, Limburg, Belgium.
| | - Samantha Bielen
- Faculty of Business Economics, Hasselt University, Hasselt, Limburg, Belgium
| | - Dorien Lanssens
- Department of Physiology, Hasselt University, Hasselt, Limburg, Belgium; Mobile health unit, Hasselt University, Hasselt, Limburg, Belgium
| | - Janis Luyten
- Faculty of Business Economics, Hasselt University, Hasselt, Limburg, Belgium
| | - Wilfried Gyselaers
- Department of Physiology, Hasselt University, Hasselt, Limburg, Belgium; Department of Obstetrics, Ziekenhuis Oost-Limburg, Genk, Limburg, Belgium
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Jones RD, Peng C, Jones CD, Long B, Helton V, Eswaran H. Cellular-Enabled Remote Patient Monitoring for Pregnancies Complicated by Hypertension. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2024; 5:156-163. [PMID: 38989044 PMCID: PMC11232352 DOI: 10.1016/j.cvdhj.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2024] Open
Abstract
Introduction Unmanaged hypertension in pregnancy is the second most common cause of direct maternal death and disproportionately affects women in rural areas. While telehealth technologies have worked to reduce barriers to healthcare, lack of internet access has created new challenges. Cellular-enabled remote patient monitoring devices provide an alternative option for those without access to internet. Objective This study aimed to assess maternal and neonatal clinical outcomes and patient acceptability of an integrated model of cellular-enabled remote patient monitoring devices for blood pressure supported by a 24/7 nurse call center. Methods In a mixed-methods study, 20 women with hypertension during pregnancy were given a cellular-enabled BodyTrace blood pressure cuff. Participants' blood pressures were continuously monitored by a nurse call center. Participants completed a baseline survey, post-survey, and semi-structured interview after 8 weeks of device use. Results Participants reported a significant decrease in perceived stress after device use (P = .0004), high satisfaction with device usability (mean = 78.38, SD = 13.68), and high intention to continue device use (mean = 9.05, SD = 1.96). Relatively low hospitalization and emergency department rates was observed (mean = 0.35, SD = 0.59; mean = 0.75, SD = 0.91). Participant-perceived benefits of device use included convenience, perceived better care owing to increased monitoring, and patient empowerment. Perceived disadvantages included higher blood pressure readings compared to clinical readings and excessive calls from call center. Conclusion Remote patient monitoring for women whose pregnancies are complicated by hypertension can reduce barriers and improve health outcomes for women living in rural and low-health-resource areas.
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Affiliation(s)
- Rebecca D Jones
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Cheng Peng
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Crystal D Jones
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Brianna Long
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Victoria Helton
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Hari Eswaran
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Lanssens D, Vandenberk T, Storms V, Thijs I, Grieten L, Bamelis L, Gyselaers W, Tang E, Luyten P. Changes in Intrapersonal Factors of Participants in the Pregnancy Remote Monitoring Study Who Are at Risk for Pregnancy-Induced Hypertension: Descriptive Quantitative Study. J Med Internet Res 2023; 25:e42686. [PMID: 37672324 PMCID: PMC10512113 DOI: 10.2196/42686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 05/25/2023] [Accepted: 06/23/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND The peripartum period, defined as the period from the beginning of the gestation until 1 year after the delivery, has long been shown to be potentially associated with increased levels of stress and anxiety with regard to one's transition to the status of parent and the accompanying parental tasks. Yet, no research to date has investigated changes in intrapersonal factors during the peripartum period in women at risk for pregnancy-induced hypertension (PIH). OBJECTIVE The aim of this study is to explore and describe changes in intrapersonal factors in participants at risk for PIH. METHODS We used an explorative design in which 3 questionnaires were sent by email to 110 participants the day following enrollment in the Pregnancy Remote Monitoring program for pregnant women at risk for PIH. Women were invited to complete the questionnaires at the beginning of their participation in the Pregnancy Remote Monitoring project (mostly at 14 weeks of gestation) and after approaching 32 weeks of gestational age (GA). The Generalized Anxiety Disorder-7 Scale (GAD-7) and the Patient Health Questionnaire-9 were used to assess anxiety and depression, and adaptation of the Pain Catastrophizing Scale was used to measure trait pain catastrophizing. RESULTS Scores were significantly higher at 32 weeks of GA than at the moment of enrollment (GAD-7 score=7, range 4-11 vs 5, range 3-8; P=.01; and Patient Health Questionnaire-9 score=6, range 4-10 vs 4, range 2-7; P<.001). The subscale scores of the Pain Catastrophizing Scale were all lower at 32 weeks of GA compared with 14 weeks of GA (rumination: 4, range 1-6 vs 5, range 2-9.5; P=.11; magnification: 3, range 1-5.5 vs 4, range 3-7; P=.04; and helplessness: 5, range 2-9 vs 6, range 3.5-12; P=.06). The proportion of women with a risk for depression (GAD-7 score >10) was 13.3% (10/75) at enrollment and had increased to 35.6% (26/75) at 32 weeks of GA. CONCLUSIONS This study shows that pregnant women at risk for PIH have higher levels of stress and anxiety at 32 weeks of GA than at the moment of enrollment. Further research is recommended to investigate potential strategies to help pregnant women at risk for PIH manage feelings of stress and anxiety. TRIAL REGISTRATION ClinicalTrials.gov NCT03246737; https://clinicaltrials.gov/study/NCT03246737.
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Affiliation(s)
- Dorien Lanssens
- Limburg Clinical Research Center/Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Department of Obstetrics and Gynaecology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Faculty Medicine and Life Sciences, Department of Physiology, Hasselt University, Diepenbeek, Belgium
| | - Thijs Vandenberk
- Limburg Clinical Research Center/Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Valerie Storms
- Limburg Clinical Research Center/Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Inge Thijs
- Limburg Clinical Research Center/Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Lars Grieten
- Limburg Clinical Research Center/Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Lotte Bamelis
- Centre for Translational Psychological Research TRACE, Ziekenhuis Oost Liburg, Genk, Belgium
| | - Wilfried Gyselaers
- Limburg Clinical Research Center/Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Department of Obstetrics and Gynaecology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Faculty Medicine and Life Sciences, Department of Physiology, Hasselt University, Diepenbeek, Belgium
| | - Eileen Tang
- Faculty of Psychology and Educational Sciences, KULeuven, Leuven, Belgium
| | - Patrick Luyten
- Faculty of Psychology and Educational Sciences, KULeuven, Leuven, Belgium
- Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussel, Belgium
- Educational and Health Psychology, Research Department of Clinical, University College London, London, United Kingdom
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Bekker MN, Koster MPH, Keusters WR, Ganzevoort W, de Haan-Jebbink JM, Deurloo KL, Seeber L, van der Ham DP, Zuithoff NPA, Frederix GWJ, van den Heuvel JFM, Franx A. Home telemonitoring versus hospital care in complicated pregnancies in the Netherlands: a randomised, controlled non-inferiority trial (HoTeL). Lancet Digit Health 2023; 5:e116-e124. [PMID: 36828605 DOI: 10.1016/s2589-7500(22)00231-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 10/19/2022] [Accepted: 11/14/2022] [Indexed: 02/24/2023]
Abstract
BACKGROUND Women with complicated pregnancies often require hospital admission. Telemonitoring at home is a promising alternative that fulfils a worldwide need in obstetric health care. Moreover, the COVID-19 pandemic has accelerated the transformation to digital care. The aim of this study was to evaluate safety, clinical effectiveness, patient satisfaction, and costs of home telemonitoring against hospital care in complicated pregnancies. METHODS We did a multicentre, randomised, controlled, non-inferiority trial in six hospitals (four general teaching hospitals and two university hospitals) in the Netherlands (located in Utrecht, Amsterdam, and Groningen). Women aged 18 years and older with singleton pregnancies (>26 weeks gestation) requiring monitoring for pre-eclampsia, fetal growth restriction, fetal anomaly, preterm rupture of membranes, reduced fetal movements, or history of fetal death were included in the study. Participants were randomly assigned to either hospital admission or telemonitoring in (1:1), stratified for the six diagnoses for inclusion and the six centres of inclusion, using block randomisation (block sizes of four and six). When assigned to telemonitoring, participants went home with devices for cardiotocography and blood pressure measurements and had daily contact with their care providers after digitally sending their home measurements. When assigned to hospital admission, participants received care as usual on the ward until the postpartum period. The primary outcome was a composite of adverse perinatal outcomes assessed after delivery, including mortality; an Apgar score below 7 after 5 min or an umbilical arterial pH at birth below 7·05; maternal morbidity; admission of the newborn to the neonatal intensive care unit; and rate of caesarean section. The primary outcome was assessed in the intention-to-treat population. The non-inferiority margin for the primary outcome was a 10% absolute increase in composite primary endpoint based on baseline 20% incidence. The study was registered at the Dutch Trial Registration (NL5888) and is now closed to new participants. FINDINGS From Dec 1, 2016, to Nov 30, 2019, 201 pregnant women were randomly assigned to an intervention procedure. 101 women were allocated to the telemonitoring group and 100 to the hospital admission group. One participant in the telemonitoring group withdrew consent before the intervention was initiated, and 100 participants were analysed for the primary outcome. In the hospital admission group, four participants did not receive the allocated intervention because they did not accept hospital admission. 100 participants in each group were analysed for the primary outcome according to the intention-to-treat principal. No participants were lost to follow-up. The primary outcome occurred in 31 (31%) of 100 participants in the telemonitoring group and in 40 (40%) of 100 participants in the hospital admission group. Adjusted for centre of inclusion, diagnosis, and nulliparity, the risk difference in primary outcome between both groups was 10·3% (95% CI -22·4 to 2·2) lower in the telemonitoring group, below the pre-defined non-inferiority margin of 10% absolute increase. A similar distribution for each of the individual components within the composite primary outcome was seen between groups. Five serious adverse events were reported: one neonatal death in the hospital admission group, in addition to one intra-uterine fetal death, two neonatal deaths, and one case of eclampsia in the telemonitoring group, all unrelated to the study. INTERPRETATION This non-inferiority trial shows the first evidence that telemonitoring might be as safe as hospital admission for monitoring complicated pregnancies. FUNDING Stichting Achmea Gezondheidszorg and ICT Healthcare Technology Solutions.
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Affiliation(s)
- Mireille N Bekker
- Department of Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht, Netherlands.
| | - Maria P H Koster
- Department of Obstetrics and Gynaecology, Erasmus Medical Centre, Rotterdam, Netherlands
| | - Willem R Keusters
- Department of Julius Center, Health Sciences, University Medical Center Utrecht, Utrecht, Netherlands
| | - Wessel Ganzevoort
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Jiska M de Haan-Jebbink
- Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
| | - Koen L Deurloo
- Department of Obstetrics and Gynaecology, Diakonessenhuis, Utrecht, Netherlands
| | - Laura Seeber
- Department of Obstetrics and Gynaecology, Sint Antonius Hospital, Nieuwegein, Netherlands
| | - David P van der Ham
- Department of Obstetrics and Gynaecology, Martini Hospital, Groningen, Netherlands
| | - Nicolaas P A Zuithoff
- Department of Julius Center, Health Sciences, University Medical Center Utrecht, Utrecht, Netherlands
| | - Geert W J Frederix
- Department of Julius Center, Health Sciences, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Arie Franx
- Department of Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht, Netherlands; Department of Obstetrics and Gynaecology, Erasmus Medical Centre, Rotterdam, Netherlands
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Cantor AG, Jungbauer RM, Totten AM, Tilden EL, Holmes R, Ahmed A, Wagner J, Hermesch AC, McDonagh MS. Telehealth Strategies for the Delivery of Maternal Health Care : A Rapid Review. Ann Intern Med 2022; 175:1285-1297. [PMID: 35878405 DOI: 10.7326/m22-0737] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Telehealth strategies to supplement or replace in-person maternity care may affect maternal health outcomes. PURPOSE To conduct a rapid review of the effectiveness and harms of telehealth strategies for maternal health care given the recent expansion of telehealth arising from the COVID-19 pandemic, and to produce an evidence map. DATA SOURCES Systematic searches of MEDLINE, the Cochrane Library, CINAHL, Embase, and Scopus for English-language studies (January 2015 to April 2022). STUDY SELECTION Randomized controlled trials (RCTs) and observational studies of maternal care telehealth strategies versus usual care. DATA EXTRACTION Dual data extraction and risk-of-bias assessment of studies, with disagreements resolved through consensus. DATA SYNTHESIS 28 RCTs and 14 observational studies (n = 44 894) were included. Maternal telehealth interventions supplemented in-person care for most studies of mental health and diabetes during pregnancy, primarily resulting in similar, and sometimes better, clinical and patient-reported outcomes versus usual care. Supplementing in-person mental health care with phone- or web-based platforms or mobile applications resulted in similar or better mental health outcomes versus in-person care. A reduced-visit prenatal care schedule using telehealth to replace in-person general maternity care for low-risk pregnancies resulted in similar clinical outcomes and higher patient satisfaction versus usual care. Overall, telehealth strategies were heterogeneous and resulted in similar obstetric and patient satisfaction outcomes. Few studies addressed disparities, health equity, or harms. LIMITATIONS Interventions varied, and evidence was inadequate for some clinical outcomes. CONCLUSION Replacing or supplementing in-person maternal care with telehealth generally results in similar, and sometimes better, clinical outcomes and patient satisfaction compared with in-person care. The effect on access to care, health equity, and harms is unclear. PRIMARY FUNDING SOURCE Patient-Centered Outcomes Research Institute. (PROSPERO: CRD42021276347).
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Affiliation(s)
- Amy G Cantor
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics & Clinical Epidemiology, Department of Family Medicine, and Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon (A.G.C.)
| | - Rebecca M Jungbauer
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon (R.M.J., A.M.T., R.H., A.A., J.W., M.M.)
| | - Annette M Totten
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon (R.M.J., A.M.T., R.H., A.A., J.W., M.M.)
| | - Ellen L Tilden
- Department of Obstetrics and Gynecology and School of Nursing, Oregon Health & Science University, Portland, Oregon (E.L.T.)
| | - Rebecca Holmes
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon (R.M.J., A.M.T., R.H., A.A., J.W., M.M.)
| | - Azrah Ahmed
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon (R.M.J., A.M.T., R.H., A.A., J.W., M.M.)
| | - Jesse Wagner
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon (R.M.J., A.M.T., R.H., A.A., J.W., M.M.)
| | - Amy C Hermesch
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon (A.C.H.)
| | - Marian S McDonagh
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon (R.M.J., A.M.T., R.H., A.A., J.W., M.M.)
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Mhajna M, Sadeh B, Yagel S, Sohn C, Schwartz N, Warsof S, Zahar Y, Reches A. A Novel, Cardiac-Derived Algorithm for Uterine Activity Monitoring in a Wearable Remote Device. Front Bioeng Biotechnol 2022; 10:933612. [PMID: 35928952 PMCID: PMC9343786 DOI: 10.3389/fbioe.2022.933612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 06/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Uterine activity (UA) monitoring is an essential element of pregnancy management. The gold-standard intrauterine pressure catheter (IUPC) is invasive and requires ruptured membranes, while the standard-of-care, external tocodynamometry (TOCO)’s accuracy is hampered by obesity, maternal movements, and belt positioning. There is an urgent need to develop telehealth tools enabling patients to remotely access care. Here, we describe and demonstrate a novel algorithm enabling remote, non-invasive detection and monitoring of UA by analyzing the modulation of the maternal electrocardiographic and phonocardiographic signals. The algorithm was designed and implemented as part of a wireless, FDA-cleared device designed for remote pregnancy monitoring. Two separate prospective, comparative, open-label, multi-center studies were conducted to test this algorithm.Methods: In the intrapartum study, 41 laboring women were simultaneously monitored with IUPC and the remote pregnancy monitoring device. Ten patients were also monitored with TOCO. In the antepartum study, 147 pregnant women were simultaneously monitored with TOCO and the remote pregnancy monitoring device.Results: In the intrapartum study, the remote pregnancy monitoring device and TOCO had sensitivities of 89.8 and 38.5%, respectively, and false discovery rates (FDRs) of 8.6 and 1.9%, respectively. In the antepartum study, a direct comparison of the remote pregnancy monitoring device to TOCO yielded a sensitivity of 94% and FDR of 31.1%. This high FDR is likely related to the low sensitivity of TOCO.Conclusion: UA monitoring via the new algorithm embedded in the remote pregnancy monitoring device is accurate and reliable and more precise than TOCO standard of care. Together with the previously reported remote fetal heart rate monitoring capabilities, this novel method for UA detection expands the remote pregnancy monitoring device’s capabilities to include surveillance, such as non-stress tests, greatly benefiting women and providers seeking telehealth solutions for pregnancy care.
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Affiliation(s)
- Muhammad Mhajna
- Nuvo-Group, Ltd, Tel-Aviv, Israel
- *Correspondence: Muhammad Mhajna,
| | | | - Simcha Yagel
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Christof Sohn
- Department of Obstetrics and Gynecology, University Hospital, Heidelberg, Germany
| | - Nadav Schwartz
- Maternal and Child Health Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Steven Warsof
- Ob-Gyn/MFM at Eastern Virginia Medical School, Norfolk, VA, United States
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Zielinska AP, Mullins E, Lees C. The feasibility of multimodality remote monitoring of maternal physiology during pregnancy. Medicine (Baltimore) 2022; 101:e29566. [PMID: 35777056 PMCID: PMC9239642 DOI: 10.1097/md.0000000000029566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
To ascertain whether remote multimodality cardiovascular monitoring of health in pregnancy is feasible, 24 participants were asked to daily monitor body weight, heart rate, blood pressure, activity levels, and sleep patterns. Study participants took on average 4.3 (standard deviation = 2.20) home recordings of each modality per week across the 3 trimesters and 2.0 postpartum (standard deviation = 2.41), out of a recommended maximum of 7. Thus, remote monitoring indicative of cardiovascular health throughout and after pregnancy might be feasible for routine clinical care or within the context of a research study.
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Affiliation(s)
- Agata P. Zielinska
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
| | - Edward Mullins
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
- Centre for Fetal Care, Queen Charlotte’s and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Christoph Lees
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
- Centre for Fetal Care, Queen Charlotte’s and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
- *Correspondence: Christoph Lees, Centre for Fetal Care, Queen Charlotte’s and Chelsea Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, United Kingdom (e-mail: )
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8
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Bossung V, Kast K. [Smart sensors in pregnancy: Narrative review on the use of smart home technology in routine prenatal care]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2021; 164:35-43. [PMID: 34215532 DOI: 10.1016/j.zefq.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/21/2021] [Accepted: 05/07/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Today's routine prenatal care in Germany includes regular in-person appointments of pregnant women with doctors or midwives. Considering an increasing digitalization of the health care sector and in view of the global COVID-19 pandemic, the frequency of in-person visits could be reduced by remote monitoring using smart sensor technology. We aim to give an overview of the current international research on the use of smart sensors in prenatal care and its benefits, costs and resource consumption. METHODS For this narrative review, PubMed and Science Direct were searched for clinical trials using smart sensors in prenatal care published in English or German language from 1/2016 to 12/2020. We included studies which addressed the benefits, costs and resource consumption of this innovative technology. RESULTS We identified 13 projects using smart sensors in the fields of basic prenatal care, prenatal care for patients with hypertensive disease in pregnancy and prenatal care for women with gestational diabetes. The projects detected positive effects of smart sensors on health care costs and resource consumption and at least equal benefits for the pregnant women. DISCUSSION AND CONCLUSIONS The current COVID-19 pandemic underlines the need for the introduction of smart sensor technology into German prenatal care routine. Remote monitoring could easily reduce the frequency of in-person visits by half. Smart sensor concepts could be approved as digital health applications in Germany. In order to increase user acceptance, there should not be any additional costs for pregnant women and health care professionals using modern health care apps. However, health insurance providers need to invest in smart sensor technology in order to eventually benefit from it.
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Affiliation(s)
- Verena Bossung
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland.
| | - Kristina Kast
- Rechts- und Wirtschaftswissenschaftliche Fakultät, Lehrstuhl für Gesundheitsmanagement, Friedrich-Alexander Universität Erlangen-Nürnberg, Nürnberg, Deutschland
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Runkle JD, Sugg MM, McCrory S, Coulson CC. Examining the Feasibility of Smart Blood Pressure Home Monitoring: Advancing Remote Prenatal Care in Rural Appalachia. TELEMEDICINE REPORTS 2021; 2:125-134. [PMID: 35720741 PMCID: PMC9049804 DOI: 10.1089/tmr.2020.0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/22/2020] [Indexed: 06/15/2023]
Abstract
BACKGROUND Hypertensive disorders of pregnancy are a leading cause of U.S. maternal morbidity and mortality. Home blood pressure (BP) monitoring can provide early detection of hypertension (HTN) outside of routine prenatal visits. Yet little is understood about how well self-monitored BP performs during pregnancy, particularly in rural America. OBJECTIVE To examine the feasibility and patient adherence to a self-monitoring BP program and to remotely collect data on pregnant women during the third trimester at a rural health clinic. MATERIALS AND METHODS A repeated-measures prospective design was used to remotely monitor home BP readings. We examined retention and persistence of weekly BP monitoring in late-stage pregnancy, differences between weekly self-monitored and clinic BP measures, the performance of self-monitored BP in early detection of pregnancy-induced HTN, and receptivity to technology-enabled prenatal monitoring. RESULTS A total of 30 women enrolled. Women reported high satisfaction with prenatal care, but missed 5 out of 13 clinic visits (54%). Women contributed an average of 31.2 days of home BP monitoring. Findings showed that home systolic and diastolic BP readings slightly varied from clinic readings. Women reported high health-related internet use and e-health literacy. Participants (93%, n = 25) reported a willingness to change their behavior during pregnancy in response to personalized recommendations from a smartphone. Although preliminary, we confirmed that remote monitoring can detect elevated BP earlier than in routine clinic visits. CONCLUSION Findings from this study can be used to inform a novel remote monitoring protocol to improve pregnancy care in a rural care setting.
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Affiliation(s)
- Jennifer D. Runkle
- North Carolina Institute for Climate Studies, North Carolina State University, Asheville, North Carolina, USA
| | - Maggie M. Sugg
- Department of Geography and Planning, Appalachian State University, Boone, North Carolina, USA
| | - Sena McCrory
- North Carolina Institute for Climate Studies, North Carolina State University, Asheville, North Carolina, USA
| | - Carol C. Coulson
- Department of Obstetrics and Gynecology, Mountain Area Health Education Center, Asheville, North Carolina, USA
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Lanssens D, Thijs IM, Gyselaers W. Design of the Pregnancy REmote MOnitoring II study (PREMOM II): a multicenter, randomized controlled trial of remote monitoring for gestational hypertensive disorders. BMC Pregnancy Childbirth 2020; 20:626. [PMID: 33059633 PMCID: PMC7565319 DOI: 10.1186/s12884-020-03291-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/27/2020] [Indexed: 12/24/2022] Open
Abstract
Background Observational data from the retrospective, non-randomized Pregnancy REmote MOnitoring I (PREMOM I) study showed that remote monitoring (RM) may be beneficial for prenatal observation of women at risk for gestational hypertensive disorders (GHD) in terms of clinical outcomes, health economics, and stakeholder perceptions. PREMOM II is a prospective, randomized, multicenter follow-up study that was performed to explore these promising results. Methods After providing written consent, 3922 pregnant women aged ≥18 years who are at increased risk of developing GHD will be randomized (1:1:1 ratio) to (a) conventional care (control group), (b) a patient self-monitoring group, and (c) a midwife-assisted RM group. The women in each group will be further divided (1:1 ratio) to evaluate the outcomes of targeted or non-targeted (conventional) antihypertensive medication. Women will be recruited in five hospitals in Flanders, Belgium: Ziekenhuis Oost-Limburg, Universitaire Ziekenhuis Antwerpen, Universitaire Ziekenhuis Leuven, AZ Sint Jan Brugge–Oostende, and AZ Sint Lucas Brugge. The primary outcomes are: (1) numbers and types of prenatal visits; (2) maternal outcomes; (3) neonatal outcomes; (4) the applicability and performance of RM; and (5) compliance with RM and self-monitoring. The secondary outcomes are: (1) cost-effectiveness and willingness to pay; (2) patient-reported outcome measures (PROMS) questionnaires on the experiences of the participants; and (3) the maternal and perinatal outcomes according to the type of antihypertensive medication. Demographic, and maternal and neonatal outcomes are collected from the patients’ electronic records. Blood pressure and compliance rate will be obtained from an online digital coordination platform for remote data handling. Information about the healthcare-related costs will be obtained from the National Coordination Committee of Belgian Health Insurance Companies (Intermutualistisch Agentschap). PROMS will be assessed using validated questionnaires. Discussion To our knowledge, this is the first randomized trial comparing midwife-assisted RM and self-monitoring of prenatal blood pressure versus conventional management among women at increased risk of GHD. Positive results of this study may lead to a practical framework for caregivers, hospital management, and payers to introduce RM into the prenatal care programs of high-risk pregnancies. Trial registration This study was registered on clinicaltrials.gov, identification number NCT04031430. Registered 24 July 2019, https://clinicaltrials.gov/ct2/show/NCT04031430?cond=premom+ii&draw=2&rank=1.
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Affiliation(s)
- Dorien Lanssens
- Ziekenhuis Oost-Limburg, Future Health Department, Limburg Clinical Research Center/Mobile Health Unit, Genk, Belgium. .,Department of Obstetrics and Gynaecology, Ziekenhuis Oost-Limburg, Genk, Belgium. .,Faculty of Medicine and Life Sciences, Limburg Clinical Research Center/Mobile Health, UnitUHasselt - ZOL, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium.
| | - Inge M Thijs
- Ziekenhuis Oost-Limburg, Future Health Department, Limburg Clinical Research Center/Mobile Health Unit, Genk, Belgium.,Faculty of Medicine and Life Sciences, Limburg Clinical Research Center/Mobile Health, UnitUHasselt - ZOL, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium
| | - Wilfried Gyselaers
- Department of Obstetrics and Gynaecology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Faculty of Medicine and Life Sciences, Limburg Clinical Research Center/Mobile Health, UnitUHasselt - ZOL, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium
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11
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Feroz A, Saleem S, Seto E. Exploring perspectives, preferences and needs of a telemonitoring program for women at high risk for preeclampsia in a tertiary health facility of Karachi: a qualitative study protocol. Reprod Health 2020; 17:135. [PMID: 32928235 PMCID: PMC7491177 DOI: 10.1186/s12978-020-00979-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 08/09/2020] [Indexed: 01/09/2023] Open
Abstract
Background In Pakistan, deaths from preeclampsia/eclampsia (PE/E) represent one-third of maternal deaths reported at tertiary care hospitals. To reduce the morbidity and mortality associated with PE/E, an accessible strategy is to support pregnant women at high risk for preeclampsia (HRPE) by closely monitoring their blood pressures at home (i.e., telemonitoring) for the earliest signs of preeclampsia. This could lead to the earliest possible detection of high blood pressure, resulting in early intervention such as through medications, hospitalization, or delivery of the baby. The study aims to explore the perspectives, preferences and needs of telemonitoring (TM) for pregnant women at HRPE in Karachi, to inform future implementation strategies. Methods The study will employ an exploratory qualitative research design. The study will be conducted at the Jinnah Postgraduate Medical Centre (JPMC) hospital and Aga Khan University Hospital (AKUH) in Karachi, Sindh, Pakistan. Data will be collected through key-informant interviews (KIIs) and in-depth patient interviews (IDPIs). IDPIs will be conducted with the pregnant women at HRPE who are visiting the out-patient department/ antenatal clinics of JPMC hospital for antenatal check-ups and immunizations. KIIs will be conducted with the obstetricians, Maternal, neonatal and child health (MNCH) specialists and health care providers at JPMC, as well as TM experts from Karachi. Study data will be analyzed through conventional content analysis. Interviews are anticipated to begin in April 2020 and to be completed during the summer of 2020. Discussion This is the first study to explore the use of TM program for pregnant women at HRPE in a tertiary health facility in Karachi. The research will help explore perceived benefits associated with the use of a TM program alongside potential facilitators and barriers that may help inform the future implementation of a TM program for pregnant women at HRPE in Karachi.
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Affiliation(s)
- Anam Feroz
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan.
| | - Sarah Saleem
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan
| | - Emily Seto
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
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12
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Abstract
Telehealth interventions were associated with improvements in obstetric outcomes, perinatal smoking cessation, breastfeeding, early access to medical abortion services, and schedule optimization for high-risk obstetrics. OBJECTIVE: To systematically review the effectiveness of telehealth interventions for improving obstetric and gynecologic health outcomes. DATA SOURCES: We conducted a comprehensive search for primary literature in ClinicalTrials.gov, Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, EMBASE, PubMed, and MEDLINE. METHODS OF STUDY SELECTION: Qualifying primary studies had a comparison group, were conducted in countries ranked very high on the United Nations Human Development Index, published in English, and evaluated obstetric and gynecologic health outcomes. Cochrane Collaboration's tool and ROBINS-I tool were used for assessing risk of bias. Summary of evidence tables were created using the United States Preventive Services Task Force Summary of Evidence Table for Evidence Reviews. TABULATION, INTEGRATION, RESULTS: Of the 3,926 published abstracts identified, 47 met criteria for inclusion and included 31,967 participants. Telehealth interventions overall improved obstetric outcomes related to smoking cessation and breastfeeding. Telehealth interventions decreased the need for high-risk obstetric monitoring office visits while maintaining maternal and fetal outcomes. One study found reductions in diagnosed preeclampsia among women with gestational hypertension. Telehealth interventions were effective for continuation of oral and injectable contraception; one text-based study found increased oral contraception rates at 6 months. Telehealth provision of medication abortion services had similar clinical outcomes compared with in-person care and improved access to early abortion. Few studies suggested utility for telehealth to improve notification of sexually transmitted infection test results and app-based intervention to improve urinary incontinence symptoms. CONCLUSION: Telehealth interventions were associated with improvements in obstetric outcomes, perinatal smoking cessation, breastfeeding, early access to medical abortion services, and schedule optimization for high-risk obstetrics. Further well-designed studies are needed to examine these interventions and others to generate evidence that can inform decisions about implementation of newer telehealth technologies into obstetrics and gynecology practice.
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13
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Payakachat N, Rhoads S, McCoy H, Dajani N, Eswaran H, Lowery C. Using mHealth in postpartum women with pre-eclampsia: Lessons learned from a qualitative study. Int J Gynaecol Obstet 2020; 149:339-346. [PMID: 32119129 PMCID: PMC7239748 DOI: 10.1002/ijgo.13134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 01/03/2020] [Accepted: 02/27/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To explore perceptions and attitudes of postpartum women with pre-eclampsia towards remote monitoring (mHealth) and communication with the call center. METHODS A non-randomized cohort study was conducted in postpartum hypertensive women, recruited from a tertiary hospital between October 2015 and February 2016. Participants were categorized into users (using mHealth) and non-users (not using mHealth) to monitor vital signs at home over a 2-week period after discharge. Non-users were informed about functionality of mHealth. Both groups participated in a 30-minute phone interview at the end of the study. Directed content analysis of interview transcripts was conducted. RESULTS In total, 21 users and 16 non-users participated in the interview. Both groups perceived that mHealth helped manage their condition. However, non-users were concerned about the challenge of incorporating mHealth into their routine, whereas users mentioned that they liked using mHealth on a daily basis. They also stated that communication with nurses in the call center was helpful. Barriers identified by users included size of the blood pressure cuffs, size of the equipment set, wireless connection, and stress associated with mHealth monitoring. Users stated that they would have preferred using mHealth during pregnancy. CONCLUSION The findings provide useful insights to inform a successful remote monitoring program among perinatal and postpartum women.
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Affiliation(s)
- Nalin Payakachat
- Division of Pharmaceutical Evaluation and Policy, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Sarah Rhoads
- Department of Health Promotion and Disease Prevention, College of Nursing, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Hannah McCoy
- Institute for digital Health & Innovation, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Nafisa Dajani
- Department of Obstetrics & Gynecology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Hari Eswaran
- Institute for digital Health & Innovation, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Obstetrics & Gynecology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Curtis Lowery
- Institute for digital Health & Innovation, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Obstetrics & Gynecology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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14
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Aquino M, Munce S, Griffith J, Pakosh M, Munnery M, Seto E. Exploring the Use of Telemonitoring for Patients at High Risk for Hypertensive Disorders of Pregnancy in the Antepartum and Postpartum Periods: Scoping Review. JMIR Mhealth Uhealth 2020; 8:e15095. [PMID: 32301744 PMCID: PMC7195666 DOI: 10.2196/15095] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 10/15/2019] [Accepted: 01/24/2020] [Indexed: 12/15/2022] Open
Abstract
Background High blood pressure complicates 2% to 8% of pregnancies, and its complications are present in the antepartum and postpartum periods. Blood pressure during and after pregnancy is routinely monitored during clinic visits. Some guidelines recommend using home blood pressure measurements for the management and treatment of hypertension, with increased frequency of monitoring for high-risk pregnancies. Blood pressure self-monitoring may have a role in identifying those in this high-risk group. Therefore, this high-risk pregnancy group may be well suited for telemonitoring interventions. Objective The aim of this study was to explore the use of telemonitoring in patients at high risk for hypertensive disorders of pregnancy (HDP) during the antepartum and postpartum periods. This paper aims to answer the following question: What is the current knowledge base related to the use of telemonitoring interventions for the management of patients at high risk for HDP? Methods A literature review following the methodological framework described by Arksey et al and Levac et al was conducted to analyze studies describing the telemonitoring of patients at high risk for HDP. A qualitative study, observational studies, and randomized controlled trials were included in this scoping review. Results Of the 3904 articles initially identified, 20 met the inclusion criteria. Most of the studies (13/20, 65%) were published between 2017 and 2018. In total, there were 16 unique interventions described in the 20 articles, all of which provide clinical decision support and 12 of which are also used to facilitate the self-management of HDP. Each intervention’s design and process of implementation varied. Overall, telemonitoring interventions for the management of HDP were found to be feasible and convenient, and they were used to facilitate access to health services. Two unique studies reported significant findings for the telemonitoring group, namely, spontaneous deliveries were more likely, and one study, reported in two papers, described inductions as being less likely to occur compared with the control group. However, the small study sample sizes, nonrandomized groups, and short study durations limit the findings from the included articles. Conclusions Although current evidence suggests that telemonitoring could provide benefits for managing patients at high risk for HDP, more research is needed to prove its safety and effectiveness. This review proposes four recommendations for future research: (1) the implementation of large prospective studies to establish the safety and effectiveness of telemonitoring interventions; (2) additional research to determine the context-specific requirements and patient suitability to enhance accessibility to healthcare services for remote regions and underserved populations; (3) the inclusion of privacy and security considerations for telemonitoring interventions to better comply with healthcare information regulations and guidelines; and (4) the implementation of studies to better understand the effective components of telemonitoring interventions.
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Affiliation(s)
- Maria Aquino
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Sarah Munce
- Rumsey Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Janessa Griffith
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Maureen Pakosh
- Library & Information Services, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Mikayla Munnery
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Emily Seto
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
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15
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Gyselaers W, Lanssens D, Perry H, Khalil A. Mobile Health Applications for Prenatal Assessment and Monitoring. Curr Pharm Des 2020; 25:615-623. [PMID: 30894100 DOI: 10.2174/1381612825666190320140659] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 03/18/2019] [Indexed: 02/03/2023]
Abstract
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.
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Affiliation(s)
- Wilfried Gyselaers
- Department of Obstetrics, Ziekenhuis Oost-Limburg, Genk, Belgium; 2Department of Physiology, Hasselt University, Hasselt, Belgium.,Department of Physiology, Hasselt University, Hasselt, Belgium
| | - Dorien Lanssens
- Department of Physiology, Hasselt University, Hasselt, Belgium.,Mobile Health Unit, Facultiy of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Helen Perry
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, Cranmer Terrace, London, SW17 0RE, United Kingdom.,Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St. George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, United Kingdom
| | - Asma Khalil
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, Cranmer Terrace, London, SW17 0RE, United Kingdom.,Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St. George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, United Kingdom
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16
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Vandenberk T, Storms V, Lanssens D, De Cannière H, Smeets CJ, Thijs IM, Batool T, Vanrompay Y, Vandervoort PM, Grieten L. A Vendor-Independent Mobile Health Monitoring Platform for Digital Health Studies: Development and Usability Study. JMIR Mhealth Uhealth 2019; 7:e12586. [PMID: 31663862 PMCID: PMC7017647 DOI: 10.2196/12586] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 12/22/2018] [Accepted: 06/15/2019] [Indexed: 01/24/2023] Open
Abstract
Background Medical smartphone apps and mobile health devices are rapidly entering mainstream use because of the rising number of smartphone users. Consequently, a large amount of consumer-generated data is being collected. Technological advances in innovative sensory systems have enabled data connectivity and aggregation to become cornerstones in developing workable solutions for remote monitoring systems in clinical practice. However, few systems are currently available to handle such data, especially for clinical use. Objective The aim of this study was to develop and implement the digital health research platform for mobile health (DHARMA) that combines data saved in different formats from a variety of sources into a single integrated digital platform suitable for mobile remote monitoring studies. Methods DHARMA comprises a smartphone app, a Web-based platform, and custom middleware and has been developed to collect, store, process, and visualize data from different vendor-specific sensors. The middleware is a component-based system with independent building blocks for user authentication, study and patient administration, data handling, questionnaire management, patient files, and reporting. Results A prototype version of the research platform has been tested and deployed in multiple clinical studies. In this study, we used the platform for the follow-up of pregnant women at risk of developing pre-eclampsia. The patients’ blood pressure, weight, and activity were semi-automatically captured at home using different devices. DHARMA automatically collected and stored data from each source and enabled data processing for the end users in terms of study-specific parameters, thresholds, and visualization. Conclusions The increasing use of mobile health apps and connected medical devices is leading to a large amount of data for collection. There has been limited investment in handling and aggregating data from different sources for use in academic and clinical research focusing on remote monitoring studies. In this study, we created a modular mobile health research platform to collect and integrate data from a variety of third-party devices in several patient populations. The functionality of the platform was demonstrated in a real-life setting among women with high-risk pregnancies.
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Affiliation(s)
- Thijs Vandenberk
- Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.,Future Health Department, Hospital Oost-Limburg, Genk, Belgium
| | - Valerie Storms
- Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.,Future Health Department, Hospital Oost-Limburg, Genk, Belgium
| | - Dorien Lanssens
- Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.,Future Health Department, Hospital Oost-Limburg, Genk, Belgium.,Department of Obstetrics & Gynecology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Hélène De Cannière
- Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.,Future Health Department, Hospital Oost-Limburg, Genk, Belgium.,Department of Cardiology, Hospital Oost-Limburg, Genk, Belgium
| | - Christophe Jp Smeets
- Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.,Future Health Department, Hospital Oost-Limburg, Genk, Belgium.,Department of Cardiology, Hospital Oost-Limburg, Genk, Belgium
| | - Inge M Thijs
- Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.,Future Health Department, Hospital Oost-Limburg, Genk, Belgium.,Department of Obstetrics & Gynecology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Tooba Batool
- Transportation Research Institute (IMOB), Hasselt University, Hasselt, Belgium
| | - Yves Vanrompay
- Transportation Research Institute (IMOB), Hasselt University, Hasselt, Belgium
| | - Pieter M Vandervoort
- Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.,Future Health Department, Hospital Oost-Limburg, Genk, Belgium.,Department of Cardiology, Hospital Oost-Limburg, Genk, Belgium
| | - Lars Grieten
- Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.,Future Health Department, Hospital Oost-Limburg, Genk, Belgium
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17
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Niela-Vilen H, Rahmani A, Liljeberg P, Axelin A. Being 'A Google Mom' or securely monitored at home: Perceptions of remote monitoring in maternity care. J Adv Nurs 2019; 76:243-252. [PMID: 31576577 DOI: 10.1111/jan.14223] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 08/13/2019] [Accepted: 09/24/2019] [Indexed: 12/17/2022]
Abstract
AIMS To understand the perspectives of both healthcare professionals in maternity care and pregnant women with higher risk pregnancies about remote monitoring in maternity care. DESIGN Qualitative descriptive design. METHODS Individual and focus group interviews were conducted in public maternity care and in a level III hospital in Finland during April-May 2018. The sample consisted of healthcare professionals working in the primary care and at the hospital and hospitalized pregnant women. Altogether, 17 healthcare professionals and 4 pregnant women participated in the study. The data were analysed using inductive thematic network analysis. RESULTS Many possibilities - and an equal number of concerns - were identified regarding remote monitoring in pregnancy, depending on the respondent's viewpoint from holistic to symptom-centred care. Healthcare staff had reservations about technology due to previous negative experiences and difficulties trusting technology. The pregnant women thought that monitoring would ease the staff's workload if the latter had enough technological skills. Remote monitoring could increase security in pregnancy care but create a feeling of false security if the women ignored their subjective symptoms. Face-to-face visits and the uniqueness of human contact were strongly favoured. Pregnant women wished to use monitoring as a confirmation of their subjective feelings. CONCLUSION Remote monitoring could be used as a supplementary system in pregnancy care, although it could replace only some healthcare visits. Pregnant women identified more possibilities for remote monitoring compared with the staff members both in primary care and the hospital. IMPACT A comprehensive understanding of pregnant women's and healthcare professionals' perceptions of remote monitoring in pregnancy was built to be able to develop new technologies in maternity care. In certain cases, remote monitoring would supplement traditional pregnancy follow-ups. Staff in primary and specialized care, and healthcare managers, should support teamwork to be able to understand different approaches to pregnancy care.
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Affiliation(s)
| | - Amir Rahmani
- Department of Computer Science and School of Nursing, University of California, Irvine, CA, USA
| | - Pasi Liljeberg
- Department of Future Technologies, University of Turku, Turku, Finland
| | - Anna Axelin
- Department of Nursing Science, University of Turku, Turku, Finland
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Pealing LM, Tucker KL, Mackillop LH, Crawford C, Wilson H, Nickless A, Temple E, Chappell LC, McManus RJ. A randomised controlled trial of blood pressure self-monitoring in the management of hypertensive pregnancy. OPTIMUM-BP: A feasibility trial. Pregnancy Hypertens 2019; 18:141-149. [DOI: 10.1016/j.preghy.2019.09.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/12/2019] [Accepted: 09/24/2019] [Indexed: 11/24/2022]
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Vandenberk T, Lanssens D, Storms V, Thijs IM, Bamelis L, Grieten L, Gyselaers W, Tang E, Luyten P. Relationship Between Adherence to Remote Monitoring and Patient Characteristics: Observational Study in Women With Pregnancy-Induced Hypertension. JMIR Mhealth Uhealth 2019; 7:e12574. [PMID: 31464190 PMCID: PMC6737887 DOI: 10.2196/12574] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/19/2019] [Accepted: 04/09/2019] [Indexed: 12/05/2022] Open
Abstract
Background Pregnancy-induced hypertension (PIH) is associated with high levels of morbidity and mortality in mothers, fetuses, and newborns. New technologies, such as remote monitoring (RM), were introduced in 2015 into the care of patients at risk of PIH in Ziekenhuis Oost-Limburg (Genk, Belgium) to improve both maternal and neonatal outcomes. In developing new strategies for obstetric care in pregnant women, including RM, it is important to understand the psychosocial characteristics associated with adherence to RM to optimize care. Objective The aim of this study was to explore the role of patients’ psychosocial characteristics (severity of depression or anxiety, cognitive factors, attachment styles, and personality traits) in their adherence to RM. Methods Questionnaires were sent by email to 108 mothers the day after they entered an RM program for pregnant women at risk of PIH. The Generalized Anxiety Disorder Assessment-7 and Patient Health Questionnaire-9 (PHQ-9) were used to assess anxiety and the severity of depression, respectively; an adaptation of the Pain Catastrophizing Scale was used to assess cognitive factors; and attachment and personality were measured with the Experiences in Close Relationships-Revised Scale (ECR-R), the Depressive Experiences Questionnaire, and the Multidimensional Perfectionism Scale, respectively. Results The moderate adherence group showed significantly higher levels of anxiety and depression, negative cognitions, and insecure attachment styles, especially compared with the over adherence group. The low adherence group scored significantly higher than the other groups on other-oriented perfectionism. There were no significant differences between the good and over adherence groups. Single linear regression showed that the answers on the PHQ-9 and ECR-R questionnaires were significantly related to the adherence rate. Conclusions This study demonstrates the relationships between adherence to RM and patient characteristics in women at risk of PIH. Alertness toward the group of women who show less than optimal adherence is essential. These findings call for further research on the management of PIH and the importance of individual tailoring of RM in this patient group. Trial Registration ClinicalTrials.gov NCT03509272; https://clinicaltrials.gov/ct2/show/NCT03509272
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Affiliation(s)
- Thijs Vandenberk
- Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.,Department of Obstetrics & Gynecology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Future Health, Ziekenhuis Oost-Limburg, Genk, Belgium.,Limburg Clinical Research Center, Hasselt University, Diepenbeek, Belgium.,Mobile Health Unit, Hasselt University, Diepenbeek, Belgium
| | - Dorien Lanssens
- Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.,Department of Obstetrics & Gynecology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Future Health, Ziekenhuis Oost-Limburg, Genk, Belgium.,Limburg Clinical Research Center, Hasselt University, Diepenbeek, Belgium.,Mobile Health Unit, Hasselt University, Diepenbeek, Belgium
| | - Valerie Storms
- Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.,Department of Obstetrics & Gynecology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Future Health, Ziekenhuis Oost-Limburg, Genk, Belgium.,Limburg Clinical Research Center, Hasselt University, Diepenbeek, Belgium
| | - Inge M Thijs
- Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.,Department of Obstetrics & Gynecology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Future Health, Ziekenhuis Oost-Limburg, Genk, Belgium.,Limburg Clinical Research Center, Hasselt University, Diepenbeek, Belgium.,Mobile Health Unit, Hasselt University, Diepenbeek, Belgium
| | - Lotte Bamelis
- Centre for Translational Psychological Research TRACE, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Lars Grieten
- Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.,Department of Obstetrics & Gynecology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Future Health, Ziekenhuis Oost-Limburg, Genk, Belgium.,Limburg Clinical Research Center, Hasselt University, Diepenbeek, Belgium.,Mobile Health Unit, Hasselt University, Diepenbeek, Belgium
| | - Wilfried Gyselaers
- Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.,Department of Obstetrics & Gynecology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Future Health, Ziekenhuis Oost-Limburg, Genk, Belgium.,Limburg Clinical Research Center, Hasselt University, Diepenbeek, Belgium.,Mobile Health Unit, Hasselt University, Diepenbeek, Belgium
| | - Eileen Tang
- Faculty of Psychology and Educational Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Patrick Luyten
- Faculty of Psychology and Educational Sciences, Katholieke Universiteit Leuven, Leuven, Belgium.,Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
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Khalil A, Perry H, Lanssens D, Gyselaers W. Telemonitoring for hypertensive disease in pregnancy. Expert Rev Med Devices 2019; 16:653-661. [PMID: 31282755 DOI: 10.1080/17434440.2019.1640116] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Introduction: Telemonitoring of hypertension in pregnancy is becoming increasingly common. Several small studies have described the potential benefits of patient-led remote monitoring, including fewer hospital visits, better blood pressure control, and cost savings. Areas covered: This review summarises the principles of prenatal remote monitoring of hypertension as well as the types of devices and applications currently in use. We summarise current evidence regarding the potential benefits and pitfalls with respect to outcomes for mothers, neonates and wider population health. Core topics for ongoing and future research are discussed, with special emphasis on feasibility and validation of technologies, methodological standardization, patient safety, privacy and acceptability, and health economics and governance. Expert opinion: Telemonitoring of hypertension in pregnancy is likely to become commonplace in the next five to ten years and research now must be directed to ensure it is used in the safest way before its general introduction into daily clinical practice can be recommended. Raising women's awareness of their health condition could improve both pregnancy and long-term health outcomes.
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Affiliation(s)
- Asma Khalil
- a Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London , London , UK.,b Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust , London , UK
| | - Helen Perry
- a Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London , London , UK.,b Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust , London , UK
| | - Dorien Lanssens
- c Department of Physiology, Hasselt University, Hasselt, Belgium and Mobile Health Unit, Facultiy of Medicine and Life Sciences, Hasselt University , Hasselt , Belgium
| | - Wilfried Gyselaers
- d Department of Obstetrics, Ziekenhuis Oost-Limburg, Genk, Belgium and Department of Physiology, Hasselt University , Hasselt , Belgium
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21
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Haddad SM, Souza RT, Cecatti JG. Mobile technology in health (mHealth) and antenatal care–Searching for apps and available solutions: A systematic review. Int J Med Inform 2019; 127:1-8. [DOI: 10.1016/j.ijmedinf.2019.04.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 04/09/2019] [Accepted: 04/10/2019] [Indexed: 01/20/2023]
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22
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Mendez DD, Sanders SA, Karimi HA, Gharani P, Rathbun SL, Gary-Webb TL, Wallace ML, Gianakas JJ, Burke LE, Davis EM. Understanding Pregnancy and Postpartum Health Using Ecological Momentary Assessment and Mobile Technology: Protocol for the Postpartum Mothers Mobile Study. JMIR Res Protoc 2019; 8:e13569. [PMID: 31244478 PMCID: PMC6617916 DOI: 10.2196/13569] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/12/2019] [Accepted: 05/12/2019] [Indexed: 12/24/2022] Open
Abstract
Background There are significant racial disparities in pregnancy and postpartum health outcomes, including postpartum weight retention and cardiometabolic risk. These racial disparities are a result of a complex interplay between contextual, environmental, behavioral, and psychosocial factors. Objective This protocol provides a description of the development and infrastructure for the Postpartum Mothers Mobile Study (PMOMS), designed to better capture women’s daily experiences and exposures from late pregnancy through 1 year postpartum. The primary aims of PMOMS are to understand the contextual, psychosocial, and behavioral factors contributing to racial disparities in postpartum weight and cardiometabolic health, with a focus on the daily experiences of stress and racism, as well as contextual forms of stress (eg, neighborhood stress and structural racism). Methods PMOMS is a longitudinal observation study that is ancillary to an existing randomized control trial, GDM2 (Comparison of Two Screening Strategies for Gestational Diabetes). PMOMS uses an efficient and cost-effective approach for recruitment by leveraging the infrastructure of GDM2, facilitating enrollment of participants while consolidating staff support from both studies. The primary data collection method is ecological momentary assessment (EMA) and through smart technology (ie, smartphones and scales). The development of the study includes: (1) the pilot phase and development of the smartphone app; (2) feedback and further development of the app including selection of key measures; and (3) implementation, recruitment, and retention. Results PMOMS aims to recruit 350 participants during pregnancy, to be followed through the first year after delivery. Recruitment and data collection started in December 2017 and are expected to continue through September 2020. Initial results are expected in December 2020. As of early May 2019, PMOMS recruited a total of 305 participants. Key strengths and features of PMOMS have included data collection via smartphone technology to reduce the burden of multiple on-site visits, low attrition rate because of participation in an ongoing trial in which women are already motivated and enrolled, high EMA survey completion and the use of EMA as a unique data collection method to understand daily experiences, and shorter than expected timeframe for enrollment because of the infrastructure of the GDM2 trial. Conclusions This protocol outlines the development of the PMOMS, one of the first published studies to use an ongoing EMA and mobile technology protocol during pregnancy and throughout 1 year postpartum to understand the health of childbearing populations and enduring racial disparities in postpartum weight and cardiometabolic health. Our findings will contribute to the improvement of data collection methods, particularly the role of EMA in capturing multiple exposures and knowledge in real time. Furthermore, the results of the study will inform future studies investigating weight and cardiometabolic health during pregnancy and the postpartum period, including how social determinants produce population disparities in these outcomes. International Registered Report Identifier (IRRID) DERR1-10.2196/13569
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Affiliation(s)
- Dara D Mendez
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Sarah A Sanders
- Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Hassan A Karimi
- Geoinformatics Laboratory, School of Computing and Information, University of Pittsburgh, Pittsburgh, PA, United States
| | - Pedram Gharani
- Geoinformatics Laboratory, School of Computing and Information, University of Pittsburgh, Pittsburgh, PA, United States
| | - Stephen L Rathbun
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, United States
| | - Tiffany L Gary-Webb
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States.,Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Meredith L Wallace
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - John J Gianakas
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Lora E Burke
- Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States
| | - Esa M Davis
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
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Vonck S, Staelens AS, Lanssens D, Tomsin K, Oben J, Bruckers L, Gyselaers W. Development of a biophysical screening model for gestational hypertensive diseases. J Biomed Sci 2019; 26:38. [PMID: 31109316 PMCID: PMC6528347 DOI: 10.1186/s12929-019-0530-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 05/05/2019] [Indexed: 02/08/2023] Open
Abstract
Background To investigate the possibility of using maternal biophysical parameters only in screening for the different types of gestational hypertensive diseases. Methods A total of 969 pregnant women were randomly screened in first and second trimester, of which 8 developed Early-onset Preeclampsia, 29 Late-onset Preeclampsia, 35 Gestational Hypertension and 897 women had a normal outcome. An observational maternal hemodynamics assessment was done via standardized electrocardiogram-Doppler ultrasonography, Impedance Cardiography and bio-impedance, acquiring functional information on heart, arteries, veins and body fluid. Preliminary prediction models were developed to test the screening potential for early preeclampsia, late preeclampsia and gestational hypertension using a Partial Least Square Discriminant Analysis. Results A combined model using maternal characteristics with cardiovascular parameters in first and second trimester offers high screening performance with Area Under the Curve of 99,9% for Early-onset Preeclampsia, 95,3% for Late-onset Preeclampsia and 94% for Gestational Hypertension. Conclusions Using biophysical parameters as fundament for a new prediction model, without the need of biochemical parameters, seems feasible. However, validation in a large prospective study will reveal its true potential.
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Affiliation(s)
- Sharona Vonck
- Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan, 3590, Diepenbeek, Belgium. .,Department of Obstetrics & Gynaecology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium.
| | - Anneleen S Staelens
- Department of Obstetrics & Gynaecology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Dorien Lanssens
- Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan, 3590, Diepenbeek, Belgium.,Department of Obstetrics & Gynaecology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Kathleen Tomsin
- Department of Obstetrics & Gynaecology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Jolien Oben
- Department of Obstetrics & Gynaecology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Liesbeth Bruckers
- Interuniversity Institute for Biostatistics and statistical Bioinformatics, Hasselt University, Agoralaan, 3590, Diepenbeek, Belgium
| | - Wilfried Gyselaers
- Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan, 3590, Diepenbeek, Belgium.,Department Physiology, Hasselt University, Agoralaan, 3590, Diepenbeek, Belgium
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24
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Lanssens D, Vandenberk T, Lodewijckx J, Peeters T, Storms V, Thijs IM, Grieten L, Gyselaers W. Midwives', Obstetricians', and Recently Delivered Mothers' Perceptions of Remote Monitoring for Prenatal Care: Retrospective Survey. J Med Internet Res 2019; 21:e10887. [PMID: 30985286 PMCID: PMC6487343 DOI: 10.2196/10887] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 12/02/2018] [Accepted: 12/31/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The Pregnancy Remote Monitoring (PREMOM) study enrolled pregnant women at increased risk of developing hypertensive disorders of pregnancy and investigated the effect of remote monitoring in addition to their prenatal follow-up. OBJECTIVE The objective of this study was to investigate the perceptions and experiences of remote monitoring among mothers, midwives, and obstetricians who participated in the PREMOM study. METHODS We developed specific questionnaires for the mothers, midwives, and obstetricians addressing 5 domains: (1) prior knowledge and experience of remote monitoring, (2) reactions to abnormal values, (3) privacy, (4) quality and patient safety, and (5) financial aspects. We also questioned the health care providers about which issues they considered important when implementing remote monitoring. We used a 5-point Likert scale to provide objective scores. It was possible to add free-text feedback at every question. RESULTS A total of 91 participants completed the questionnaires. The mothers, midwives, and obstetricians reported positive experiences and perceptions of remote monitoring, although most of them had no or little prior experience with this technology. They supported a further rollout of remote monitoring in Belgium. Nearly three-quarters of the mothers (34/47, 72%) did not report any problems with taking the measurements at the required times. Almost half of the mothers (19/47, 40%) wanted to be contacted within 3 to 12 hours after abnormal measurement values, preferably by telephone. CONCLUSIONS Although most of midwives and obstetricians had no or very little experience with remote monitoring before enrolling in the PREMOM study, they reported, based on their one-year experience, that remote monitoring was an important component in the follow-up of high-risk pregnancies and would recommend it to their colleagues and pregnant patients. TRIAL REGISTRATION ClinicalTrials.gov NCT03246737; https://clinicaltrials.gov/ct2/show/NCT03246737 (Archived by WebCite at http://www.webcitation.org/76KVnHSYY).
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Affiliation(s)
- Dorien Lanssens
- Limburg Clinical Research Program, Mobile Health Unit, Hasselt University, Diepenbeek, Belgium.,Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.,Department of Cardiology & Future Health, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Thijs Vandenberk
- Limburg Clinical Research Program, Mobile Health Unit, Hasselt University, Diepenbeek, Belgium.,Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Joy Lodewijckx
- Limburg Clinical Research Program, Mobile Health Unit, Hasselt University, Diepenbeek, Belgium.,Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Tessa Peeters
- Limburg Clinical Research Program, Mobile Health Unit, Hasselt University, Diepenbeek, Belgium.,Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Valerie Storms
- Limburg Clinical Research Program, Mobile Health Unit, Hasselt University, Diepenbeek, Belgium.,Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Inge M Thijs
- Limburg Clinical Research Program, Mobile Health Unit, Hasselt University, Diepenbeek, Belgium.,Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.,Department of Cardiology & Future Health, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Lars Grieten
- Limburg Clinical Research Program, Mobile Health Unit, Hasselt University, Diepenbeek, Belgium.,Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Wilfried Gyselaers
- Limburg Clinical Research Program, Mobile Health Unit, Hasselt University, Diepenbeek, Belgium.,Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.,Department of Cardiology & Future Health, Ziekenhuis Oost-Limburg, Genk, Belgium
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25
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Lanssens D, Vonck S, Vandenberk T, Schraepen C, Storms V, Thijs IM, Grieten L, Gyselaers W. A Prenatal Remote Monitoring Program in Pregnancies Complicated with Gestational Hypertensive Disorders: What Are the Contributors to the Cost Savings? Telemed J E Health 2018; 25:686-692. [PMID: 30376412 DOI: 10.1089/tmj.2018.0147] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: In 2015, we performed a cost analysis of a prenatal remote monitoring (RM) program compared with conventional care (CC) for women diagnosed with gestational hypertensive disorders (GHD). Introduction: We investigated where the cost savings were distributed by dividing our patient population into three subgroups, according to the gestational age (GA) at the time of delivery: (1) <34 weeks; (2) 34-37 weeks; and (3) >37 weeks of GA. Materials and Methods: Health care costs were calculated from patient-specific hospital bills at Ziekenhuis Oost Limburg (Genk, Belgium) in 2015-2016. Cost comparisons were made from the perspectives of the Belgium national health care system (HCS), the National Institution for Insurance of Disease and Disability (RIZIV), and the costs to individual patients. Results: A total of 256 pregnant women were included, 80 (31.25%) of whom received RM and 176 (68.75%) of whom received CC. The greatest difference in costs between RM and CC was in the group that delivered before 34 weeks of GA, followed by the group who delivered after 37 weeks of GA, and then the group of women who delivered at 34-37 weeks of GA. Most of the cost savings were in neonatal care, for both the three separate study subgroups and the total study group. Discussion and Conclusion: Our data showed that RM is more cost-effective than CC for pregnant women with GHD. Further investigation of the effects of RM on the long-term economic and social costs is recommended, together with an analysis of the price that should be asked for RM services.
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Affiliation(s)
- Dorien Lanssens
- 1Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,2Department of Gynaecology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Sharona Vonck
- 2Department of Gynaecology, Ziekenhuis Oost-Limburg, Genk, Belgium.,3Department of Health and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Thijs Vandenberk
- 1Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Cédric Schraepen
- 1Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Valerie Storms
- 1Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Inge M Thijs
- 1Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,4Future Health Department, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Lars Grieten
- 1Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Wilfried Gyselaers
- 1Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,2Department of Gynaecology, Ziekenhuis Oost-Limburg, Genk, Belgium.,5Department of Physiology, Hasselt University, Hasselt, Belgium
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26
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Cairns AE, Tucker KL, Leeson P, Mackillop LH, Santos M, Velardo C, Salvi D, Mort S, Mollison J, Tarassenko L, McManus RJ. Self-Management of Postnatal Hypertension: The SNAP-HT Trial. Hypertension 2018; 72:425-432. [PMID: 29967037 DOI: 10.1161/hypertensionaha.118.10911] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 02/15/2018] [Accepted: 05/18/2018] [Indexed: 12/24/2022]
Abstract
Hypertension affects 1 in 10 pregnancies, often persisting postpartum, when antihypertensive requirements may vary substantially. This unmasked, randomized controlled trial evaluated the feasibility and effects on blood pressure (BP) of self-management of postpartum hypertension. Women with gestational hypertension or preeclampsia, requiring postnatal antihypertensive treatment, were randomized to self-management or usual care. Self-management entailed daily home BP monitoring and automated medication reduction via telemonitoring. Women attended 5 follow-up visits during 6 months. The primary outcome was feasibility: specifically recruitment, retention, and compliance with follow-up rates. Secondary outcomes included BP control and safety, analyzed on an intention-to-treat basis. Forty-nine percent (91/186) of those women approached were randomized (45 intervention, 46 control), and 90% (82/91) finished follow-up. The groups had similar baseline characteristics. After randomization, BP was lower in the intervention group, most markedly at 6 weeks: intervention group mean (SD), systolic 121.6 (8.7)/diastolic 80.5 (6.6) mm Hg; control group, systolic 126.6 (11.0)/diastolic 86.0 (9.7) mm Hg; adjusted differences (95% confidence interval), systolic -5.2 (-9.3 to -1.2)/diastolic -5.8 (-9.1 to -2.5) mm Hg. Diastolic BP remained significantly lower in those self-managing to 6 months: adjusted difference -4.5 (-8.1 to -0.8) mm Hg. This is the first randomized evaluation of BP self-management postpartum and indicates it would be feasible to trial this intervention in larger studies. Self-management resulted in better diastolic BP control to 6 months, even beyond medication cessation. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT02333240.
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Affiliation(s)
- Alexandra E Cairns
- From the Nuffield Department of Primary Care Health Sciences (A.E.C., K.L.T., S.M., J.M., R.J.M.)
| | - Katherine L Tucker
- From the Nuffield Department of Primary Care Health Sciences (A.E.C., K.L.T., S.M., J.M., R.J.M.)
| | - Paul Leeson
- Cardiovascular Clinical Research Facility (P.L.)
| | | | - Mauro Santos
- Institute of Biomedical Engineering (M.S., C.V., D.S., L.T.), University of Oxford, United Kingdom
| | - Carmelo Velardo
- Institute of Biomedical Engineering (M.S., C.V., D.S., L.T.), University of Oxford, United Kingdom
| | - Dario Salvi
- Institute of Biomedical Engineering (M.S., C.V., D.S., L.T.), University of Oxford, United Kingdom
| | - Sam Mort
- From the Nuffield Department of Primary Care Health Sciences (A.E.C., K.L.T., S.M., J.M., R.J.M.)
| | - Jill Mollison
- From the Nuffield Department of Primary Care Health Sciences (A.E.C., K.L.T., S.M., J.M., R.J.M.)
| | - Lionel Tarassenko
- Institute of Biomedical Engineering (M.S., C.V., D.S., L.T.), University of Oxford, United Kingdom
| | - Richard J McManus
- From the Nuffield Department of Primary Care Health Sciences (A.E.C., K.L.T., S.M., J.M., R.J.M.)
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van den Heuvel JF, Groenhof TK, Veerbeek JH, van Solinge WW, Lely AT, Franx A, Bekker MN. eHealth as the Next-Generation Perinatal Care: An Overview of the Literature. J Med Internet Res 2018; 20:e202. [PMID: 29871855 PMCID: PMC6008510 DOI: 10.2196/jmir.9262] [Citation(s) in RCA: 169] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 01/19/2018] [Accepted: 03/10/2018] [Indexed: 12/15/2022] Open
Abstract
Background Unrestricted by time and place, electronic health (eHealth) provides solutions for patient empowerment and value-based health care. Women in the reproductive age are particularly frequent users of internet, social media, and smartphone apps. Therefore, the pregnant patient seems to be a prime candidate for eHealth-supported health care with telemedicine for fetal and maternal conditions. Objective This study aims to review the current literature on eHealth developments in pregnancy to assess this new generation of perinatal care. Methods We conducted a systematic literature search of studies on eHealth technology in perinatal care in PubMed and EMBASE in June 2017. Studies reporting the use of eHealth during prenatal, perinatal, and postnatal care were included. Given the heterogeneity in study methods, used technologies, and outcome measurements, results were analyzed and presented in a narrative overview of the literature. Results The literature search provided 71 studies of interest. These studies were categorized in 6 domains: information and eHealth use, lifestyle (gestational weight gain, exercise, and smoking cessation), gestational diabetes, mental health, low- and middle-income countries, and telemonitoring and teleconsulting. Most studies in gestational diabetes and mental health show that eHealth applications are good alternatives to standard practice. Examples are interactive blood glucose management with remote care using smartphones, telephone screening for postnatal depression, and Web-based cognitive behavioral therapy. Apps and exercise programs show a direction toward less gestational weight gain, increase in step count, and increase in smoking abstinence. Multiple studies describe novel systems to enable home fetal monitoring with cardiotocography and uterine activity. However, only few studies assess outcomes in terms of fetal monitoring safety and efficacy in high-risk pregnancy. Patients and clinicians report good overall satisfaction with new strategies that enable the shift from hospital-centered to patient-centered care. Conclusions This review showed that eHealth interventions have a very broad, multilevel field of application focused on perinatal care in all its aspects. Most of the reviewed 71 articles were published after 2013, suggesting this novel type of care is an important topic of clinical and scientific relevance. Despite the promising preliminary results as presented, we accentuate the need for evidence for health outcomes, patient satisfaction, and the impact on costs of the possibilities of eHealth interventions in perinatal care. In general, the combination of increased patient empowerment and home pregnancy care could lead to more satisfaction and efficiency. Despite the challenges of privacy, liability, and costs, eHealth is very likely to disperse globally in the next decade, and it has the potential to deliver a revolution in perinatal care.
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Affiliation(s)
| | - T Katrien Groenhof
- Division of Woman and Baby, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Jan Hw Veerbeek
- Division of Woman and Baby, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Wouter W van Solinge
- Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - A Titia Lely
- Division of Woman and Baby, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Arie Franx
- Division of Woman and Baby, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Mireille N Bekker
- Division of Woman and Baby, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
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28
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Lanssens D, Vonck S, Storms V, Thijs IM, Grieten L, Gyselaers W. The impact of a remote monitoring program on the prenatal follow-up of women with gestational hypertensive disorders. Eur J Obstet Gynecol Reprod Biol 2018; 223:72-78. [DOI: 10.1016/j.ejogrb.2018.02.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 02/12/2018] [Accepted: 02/15/2018] [Indexed: 01/23/2023]
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Perry H, Sheehan E, Thilaganathan B, Khalil A. Home blood-pressure monitoring in a hypertensive pregnant population. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 51:524-530. [PMID: 29468771 DOI: 10.1002/uog.19023] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 01/05/2018] [Accepted: 01/30/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The majority of patients with chronic or gestational hypertension do not develop pre-eclampsia. Home blood-pressure monitoring (HBPM) has the potential to offer a more accurate and acceptable means of monitoring hypertensive patients during pregnancy compared with traditional pathways of frequent outpatient monitoring. The aim of this study was to determine whether HBPM reduces visits to antenatal services and is safe in pregnancy. METHODS This was a case-control study of 166 hypertensive pregnant women, which took place at St George's Hospital, University of London. Inclusion criteria were: chronic hypertension, gestational hypertension or high risk of developing pre-eclampsia, no significant proteinuria (≤ 1+ proteinuria on dipstick testing) and normal biochemical and hematological markers. Exclusion criteria were maternal age < 16 years, systolic blood pressure > 155 mmHg or diastolic blood pressure > 100 mmHg, significant proteinuria (≥ 2+ proteinuria on dipstick testing or protein/creatinine ratio > 30 mg/mmol), evidence of small-for-gestational age (estimated fetal weight < 10th centile), signs of severe pre-eclampsia, significant mental health concerns or insufficient understanding of the English language. Pregnant women in the HBPM group were taught how to measure and record their blood pressure using a validated machine at home and attended every 1-2 weeks for assessment depending on clinical need. The control group was managed as per the local protocol prior to the implementation of HBPM. The two groups were compared with respect to number of visits to antenatal services and outcome. RESULTS There were 108 women in the HBPM group and 58 in the control group. There was no difference in maternal age, parity, body mass index, ethnicity or smoking status between the groups, but there were more women with chronic hypertension in the HBPM group compared with the control group (49.1% vs 25.9%, P = 0.004). The HBPM group had significantly fewer outpatient attendances per patient (6.5 vs 8.0, P = 0.003) and this difference persisted when taking into account differences in duration of monitoring (0.8 vs 1.6 attendances per week, P < 0.001). There was no difference in the incidence of adverse maternal, fetal or neonatal outcome between the two groups. CONCLUSION HBPM in hypertensive pregnancies has the potential to reduce the number of hospital visits required by patients without compromising maternal and pregnancy outcomes. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- H Perry
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - E Sheehan
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - B Thilaganathan
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - A Khalil
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, UK
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30
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Lanssens D, Vandenberk T, Smeets CJ, De Cannière H, Vonck S, Claessens J, Heyrman Y, Vandijck D, Storms V, Thijs IM, Grieten L, Gyselaers W. Prenatal Remote Monitoring of Women With Gestational Hypertensive Diseases: Cost Analysis. J Med Internet Res 2018; 20:e102. [PMID: 29581094 PMCID: PMC5891672 DOI: 10.2196/jmir.9552] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 01/23/2018] [Accepted: 01/23/2018] [Indexed: 11/13/2022] Open
Abstract
Background Remote monitoring in obstetrics is relatively new; some studies have shown its effectiveness for both mother and child. However, few studies have evaluated the economic impact compared to conventional care, and no cost analysis of a remote monitoring prenatal follow-up program for women diagnosed with gestational hypertensive diseases (GHD) has been published. Objective The aim of this study was to assess the costs of remote monitoring versus conventional care relative to reported benefits. Methods Patient data from the Pregnancy Remote Monitoring (PREMOM) study were used. Health care costs were calculated from patient-specific hospital bills of Ziekenhuis Oost-Limburg (Genk, Belgium) in 2015. Cost comparison was made from three perspectives: the Belgian national health care system (HCS), the National Institution for Insurance of Disease and Disability (RIZIV), and costs for individual patients. The calculations were made for four major domains: prenatal follow-up, prenatal admission to the hospital, maternal and neonatal care at and after delivery, and total amount of costs. A simulation exercise was made in which it was calculated how much could be demanded of RIZIV for funding the remote monitoring service. Results A total of 140 pregnancies were included, of which 43 received remote monitoring (30.7%) and 97 received conventional care (69.2%). From the three perspectives, there were no differences in costs for prenatal follow-up. Compared to conventional care, remote monitoring patients had 34.51% less HCS and 41.72% less RIZIV costs for laboratory test results (HCS: mean €0.00 [SD €55.34] vs mean €38.28 [SD € 44.08], P<.001; RIZIV: mean €21.09 [SD €27.94] vs mean €36.19 [SD €41.36], P<.001) and a reduction of 47.16% in HCS and 48.19% in RIZIV costs for neonatal care (HCS: mean €989.66 [SD €3020.22] vs mean €1872.92 [SD €5058.31], P<.001; RIZIV: mean €872.97 [SD €2761.64] vs mean €1684.86 [SD €4702.20], P<.001). HCS costs for medication were 1.92% lower in remote monitoring than conventional care (mean €209.22 [SD €213.32] vs mean €231.32 [SD 67.09], P=.02), but were 0.69% higher for RIZIV (mean €122.60 [SD €92.02] vs mean €121.78 [SD €20.77], P<.001). Overall HCS costs for remote monitoring were mean €4233.31 (SD €3463.31) per person and mean €4973.69 (SD €5219.00) per person for conventional care (P=.82), a reduction of €740.38 (14.89%) per person, with savings mainly for RIZIV of €848.97 per person (23.18%; mean €2797.42 [SD €2905.18] vs mean €3646.39 [SD €4878.47], P=.19). When an additional fee of €525.07 per month per pregnant woman for funding remote monitoring costs is demanded, remote monitoring is acceptable in their costs for HCS, RIZIV, and individual patients. Conclusions In the current organization of Belgian health care, a remote monitoring prenatal follow-up of women with GHD is cost saving for the global health care system, mainly via savings for the insurance institution RIZIV.
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Affiliation(s)
- Dorien Lanssens
- Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Department of Gynaecology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Thijs Vandenberk
- Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Christophe Jp Smeets
- Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Hélène De Cannière
- Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Sharona Vonck
- Department of Gynaecology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Department of Health and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Jade Claessens
- Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Yenthel Heyrman
- Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Dominique Vandijck
- Department of Health and Life Sciences, Hasselt University, Hasselt, Belgium.,Faculty of Medicine and Life Sciences, Ghent University, Gent, Belgium
| | - Valerie Storms
- Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Inge M Thijs
- Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Future Health Department, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Lars Grieten
- Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Wilfried Gyselaers
- Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Department of Gynaecology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Department of Physiology, Hasselt University, Hasselt, Belgium
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