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BRIEF RESEARCH ARTICLE
Year : 2022  |  Volume : 66  |  Issue : 2  |  Page : 210-213  

Outcomes of teleconsultation services and patient satisfaction among pregnant women delivering at a tertiary care center in South India during coronavirus disease 2019 pandemic


1 Assistant Professor, Department of Obstetrics and Gynecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
2 Intern, Department of Obstetrics and Gynecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
3 Professor, Department of Obstetrics and Gynecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
4 Additional Professor, Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
5 Junior Resident, Department of Obstetrics and Gynecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

Date of Submission18-Oct-2021
Date of Decision11-Jan-2022
Date of Acceptance19-Feb-2022
Date of Web Publication12-Jul-2022

Correspondence Address:
T Naik Parvathi
Department of Obstetrics and Gynecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijph.ijph_1942_21

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   Abstract 


Coronavirus disease 2019 pandemic has disrupted the antenatal care in low- and middle-income countries such as India. Telemedicine was introduced for the first time in India for continuing antenatal care. Hence, a questionnaire-based descriptive cross-sectional study is done to assess the outcomes of teleconsultation services, factors influencing it, and patient's perceived satisfaction. Three hundred and fifty-five women who delivered the following teleconsultation from July 2020 to October 2020 were included in the study. Thirty-two percent were high-risk pregnancies and 15% of the babies required neonatal intensive care unit admission. Ninety-eight percent could convey their health concerns, 18% had a referral to other departments, and 25% had visited casualty. Sixty-three percent procured medicine through e-prescription. Seventy-six percent were happy with teleconsultation overcrowded clinic, 82% were happy about saving travel expenditure, whereas overall satisfaction was 50%. Fourteen percent did not have access to smartphone and 9% did not receive the call at scheduled time. Telemedicine has a vital role in managing pregnancy concerns during this pandemic.

Keywords: Coronavirus disease 2019, patient satisfaction, teleconsultation


How to cite this article:
Devi R S, Parvathi T N, Murugan R R, Sagili H, Lakshminarayanan S, Priyadarshini T. Outcomes of teleconsultation services and patient satisfaction among pregnant women delivering at a tertiary care center in South India during coronavirus disease 2019 pandemic. Indian J Public Health 2022;66:210-3

How to cite this URL:
Devi R S, Parvathi T N, Murugan R R, Sagili H, Lakshminarayanan S, Priyadarshini T. Outcomes of teleconsultation services and patient satisfaction among pregnant women delivering at a tertiary care center in South India during coronavirus disease 2019 pandemic. Indian J Public Health [serial online] 2022 [cited 2022 Aug 13];66:210-3. Available from: https://www.ijph.in/text.asp?2022/66/2/210/350669



Coronavirus disease 2019 (COVID-19), the severe acute respiratory syndrome caused by coronavirus 2 (SARS-CoV-2), was declared a pandemic by the World Health Organization on March 11, 2020.[1] Globally, the infection has partially or entirely disrupted the existing health services. In low- and middle-income countries such as India, the impact of lockdown, quarantine, and diversion of the resources has disrupted essential health services, including maternal and child health care. India entered a nationwide lockdown on March 25, 2020, as a measure for containment of COVID-19 infection. The most crucial part of tackling this pandemic would be prioritizing context-relevant essential health care for the vulnerable population, including pregnant women. Pregnancy involves immunological transformation, thereby increasing susceptibility to viral infection. Delayed access to health care due to lockdown, pandemic, and fear of contracting the infection could delay in identifying the warning signs resulting in more maternal and neonatal deaths. Several international organizations such as the American College of Obstetrics and Gynecology and Royal College of Obstetrics and Gynecology have released guidelines for prenatal and postnatal services during pandemics including telehealth.[2],[3]

Indian organizations such as the Indian Council of Medical Research (ICMR) and the Federation of Obstetric and Gynecological Societies of India Good Clinical Practice Recommendations (FOGSI GCPR) have also recommended telehealth.[4],[5] Telemedicine came as a boon during this pandemic when the Government of India and Medical Council of India released new guidelines on March 25, 2020, which was published as an extraordinary gazette notification on May 14, 2020.[6]

Although the literature suggests that telehealth provides comparable health outcomes when compared with traditional methods of health-care delivery, there are no studies that have explored the outcomes of teleconsultation, factors influencing it, and patient satisfaction among pregnant women in developing countries. Hence, this study was carried out to assess the same at a tertiary care center in South India during the COVID-19 pandemic.

This was a questionnaire-based study carried out in a tertiary care hospital, Puducherry, in South India. Around 1200–1500 vaginal deliveries and 350–400 cesarean sections are being performed monthly, accounting for total deliveries of approximately 1500–1900. However, during the COVID-19 pandemic, all routine services were closed down for 8 months. Our institution initiated telemedicine services for continued maternity services and follow-up of high-risk pregnancies. The protocol for the research project was approved by Institute Scientific Advisory Committee (JSAC/88/2020/502), Ethics Committee (JIP/IEC/2020/334), and it conforms to the provisions of the Declaration of Helsinki.

Pregnant women aged >18 years who had delivered from July 2020 to October 2020 at our hospital following teleconsultation were included in the study. The contact details of patients were obtained from the confinement register, their hospital IDs were cross verified with completed sessions in the hospital information system telehealth module. Approximately 850 women were delivered following teleconsultation during the study period.

Sample size calculation: Assuming 30% of teleconsultation women were called for in-person visits, the sample size was estimated to be 323, with absolute precision of 5%, a confidence level of 95% frequency in a population, using OpenEpi:Open Source Epidemiologic Statistics for Public Health, Version 3.0. www.OpenEpi.com, updated 2013/04/06. Considering nonresponse of 10%, the final sample size was 355. Simple random sampling was done; the random numbers were generated using Microsoft Excel.

Women were contacted through a telephonic call by the principal/co-investigator, verbal telephonic consent was obtained, following which the investigator administered the questionnaire to collect the data inputs. The questionnaire was designed to capture the awareness of teleconsultation and its outcome, patient's perceived satisfaction, and factors affecting the teleconsultation services. Questionnaire was face validated, piloted, and modified accordingly. Patient's demographic details were noted. Responses were entered in Epicollect Version 5, then transferred to Microsoft Excel and analyzed using Stata version 14.2 (StataCorp, College Park, TX, USA). Continuous variables were expressed as mean (standard deviation), and categorical variables were expressed as proportions; patient's perceived satisfaction was assessed using Likert scale.

We contacted a total of 355 women, and the response rate was 100%. Two percent were elderly gravida, 85% were educated having at least high school education, and 44% belong to middle- and low-socioeconomic class, respectively. Ninety-eight percent could reach the nearest health center within 30 min, whereas 82% were within 50 km from our hospital. Primigravida (54.37%) and multigravida (45.52%) were almost in equal proportion. Thirty-two percent (114) of them were high-risk pregnancies comprising 7% hypertensive disorders of pregnancy, 6% anemia, 5% intrauterine fetal growth restriction, 3% women had gestational diabetes, previous Lower Segment Cesarean Section (LSCS), and oligohydramnios each, 2% heart disease, 1.6% had twin pregnancy, anomalous baby, seizure disorder, and hypothyroid contributing to 1%–2%. 76.6% of our study participants had a vaginal delivery, 18% had a cesarean section, and 5% had instrumental delivery. 67.8% of the babies were of normal weight, 30% were low birth weight babies, and 1.5% weighed more than 3.5 kg. Fifteen percent of the babies required neonatal intensive care unit admission.

As teleconsultation was new to the hospital, 45% of them were aware of teleconsultation only after visiting the hospital and 30% by word of mouth. The outcomes of teleconsultation services and factors influencing them are depicted in [Table 1]. On average, each woman had 2–3 teleconsultations during their antenatal period. Thirty-two percent could not procure medicines through e-prescription as 10% did not receive the message, 11% could not open the link while 12% got it from local health-care workers. Two hundred and eighteen (62%) of our study population preferred both teleconsultation and hospital visit, 110 (31.2%) wanted only hospital visits, and 24 (7%) opted for teleconsultation. Seventy-three percent were comfortable with teleconsultations when compared to the crowded clinic. Eighty-two percent of women felt that the teleconsultation had saved their travel expenditures.
Table 1: Outcomes of teleconsultation services and factors influencing it

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The patient's perceived satisfaction about the new modality of antenatal services through teleconsultation is depicted in [Table 2].
Table 2: Patients satisfaction of teleconsultation

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In view of the ongoing pandemic SARS-CoV-2 and the lockdowns, the methods of delivering health-care services have drastically changed even though the needs of the pregnant women have remained the same that is to have a safe motherhood. To ensure this, telemedicine has been included in various guidelines as an alternative to in-person visits including antenatal care. Before COVID-19 pandemic, telemedicine had not been widely used by Indian physicians. Hence, to help the obstetricians in India, ICMR,[4] FOGSI GCPR[5] Ministry of Health and Family Welfare[6] has provided guidelines to ensure the utmost care to the pregnant women.

Eighty-three percent of women were within 50 km from our center, whereas 87% of them were from nearby locality in another Indian study during the COVID-19 pandemic.[7] As most of our women had basic education, it was easy to educate them the need for teleconsultation and also as most of them belong to low- and middle-socioeconomic class got benefited by curtailing their traveling expenditure during this pandemic.

Seventy-two percent of the women were called to attend in-person visits to outpatient department (OPD). The average number of teleconsultations was 2–3 in the antenatal period, reflecting the results of another study done in Hyderabad which says multiple teleconsultations were required for antenatal women.[7] Twenty-eight of the women were followed up only in teleconsultation thus decreasing the crowd in the OPD. About 30% of the women had pregnancy complications which is a similar finding seen in a study done at East Harlem[8] but lesser than Peahl et al.'s study. Around 98% of the women were satisfied with teleconsultation with regard to conveying their health concerns in our study, while it was 84% in a study done in the United States during the COVID-19 pandemic.[9] Sixty-two percent preferred both teleconsultation and hospital visits to continue in the future which reflects the acceptance rate of change in trends of health-care system among pregnant women. Whereas 40% of women would like to continue teleconsultations even after COVID-19 in a study done in the United States.[10]

Although there are multiple benefits to telemedicine, there are some barriers that need to be addressed such as lack of resources, infrastructure, inability of patient to adapt to the change, and lack of effective communication which may cause dissatisfaction to the patient. The major factor influencing teleconsultation in our study was fixing an appointment faced by 48% of the women, while 22% had difficulty in understanding the SMS and difficulty in understanding the doctor's language, respectively. Discomfort with telehealth visits and technology, data connection was some of the barriers to telehealth in an analysis done at Columbia University, New York.[10]

It is one of few studies done in developing countries to evaluate the outcomes of teleconsultation and the patient's perceived satisfaction in antenatal care. The limitations of the study being single centre study with retrospective design. Women had recall bias and could not spare enough time due to their domestic responsibilities.

Telemedicine has provided us the opportunity to manage pregnancy concerns during this pandemic of COVID-19. By implementing the triage pathway through teleconsultation, we can minimize the risk of exposure for both patients and health-care teams. More robust data are needed to evaluate the effectiveness of telemedicine to manage antenatal women in India for continuity of care during the ongoing COVID-19 pandemic.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
World Health Organization. Coronavirus Disease (COVID-19) Pandemic. Available form: https://www.who.int/emergencies/diseases/novel-coronaviruss-2019. [Lastaccessed on 2020 May 05].  Back to cited text no. 1
    
2.
Novel Coronavirus 2019 (COVID-19). ACOG; 2020. Available from: https://www.acog.org/en/Clinical/Clinical-Guidance/Practice-Advisory/Articles/2020/03/Novel-Coronavirus-2019. [Last accessed on 2021 May 25].  Back to cited text no. 2
    
3.
Royal College of Obstetricians & Gynaecologists. Guidance for Antenatal and Postnatal Services in the Evolving Coronavirus (COVID-19) Pandemic. RCOG; 2020. Available from: https://www.rcog.org.uk/en/guidelines-research-services/guidelines/coronavirus-pregnancy. [Last accessed on 2021 May 25].  Back to cited text no. 3
    
4.
Indian Council of Medical Research. Guidance for Management of Pregnant Women in COVID-19 Pandemic. India: ICMR; 2020. Available from: https://www.icmr.gov.in/pdf/covid/techdoc/Guidancefor ManagementofPregnantWomenin COVID19Pandemic12042020.pdf. [Last accessed on 2021 May 25].  Back to cited text no. 4
    
5.
Gandhi A, Ganatra A, Tank P, editors. FOGSI GCPR on Pregnancy with COVID-19 infection Version 2, Federation of Obstetric and Gynaecological Societies of India; 2020. Available from: https://www.fogsi.org/fogsi-gcpr-on-pregnancy-with-covid-19-infection-version-2/. [Last accessed on 2021 May 25].  Back to cited text no. 5
    
6.
Telemedicine Practice Guidelines Enabling Registered Medical Prectioners to Provide Healthcare Using Telemedicine; 2020. Available from: http://www.mohfw.gov.in/pdf/Telemedicine.pdf. [Last acessed on 2020 Mar 25].  Back to cited text no. 6
    
7.
Bindra V. Telemedicine for women's health during COVID-19 pandemic in India: A short commentary and important practice points for obstetricians and gynaecologists. J Obstet Gynaecol India 2020;70:279-82.  Back to cited text no. 7
    
8.
Futterman I, Rosenfeld E, Toaff M, Boucher T, Golden-Espinal S, Evans K, et al. Addressing disparities in prenatal care via telehealth during COVID-19: Prenatal satisfaction survey in East Harlem. Am J Perinatol 2021;38:88-92.  Back to cited text no. 8
    
9.
Peahl AF, Powell A, Berlin H, Smith RD, Krans E, Waljee J, et al. Patient and provider perspectives of a new prenatal care model introduced in response to the coronavirus disease 2019 pandemic. Am J Obstet Gynecol 2021;224:384.e1-11.  Back to cited text no. 9
    
10.
Madden N, Emeruwa UN, Friedman AM, Aubey JJ, Aziz A, Baptiste CD, et al. Telehealth uptake into prenatal care and provider attitudes during the COVID-19 pandemic in New York city: A quantitative and qualitative analysis. Am J Perinatol 2020;37:1005-14.  Back to cited text no. 10
    



 
 
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  [Table 1], [Table 2]



 

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