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Structured Abstract
Background:
The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine plan a new evidence-based joint consensus statement to address the preferred visit schedule and the use of televisits for routine antenatal care. This systematic review will support the consensus statement.
Methods:
We searched PubMed®, Cochrane databases, Embase®, CINAHL®, ClinicalTrials.gov, PsycINFO®, and SocINDEX from inception through February 12, 2022. We included comparative studies from high-income countries that evaluated the frequency of scheduled routine antenatal visits or the inclusion of routine televisits, and qualitative studies addressing these two topics. We evaluated strength of evidence for 15 outcomes prioritized by stakeholders.
Results:
Ten studies evaluated scheduled number of routine visits and seven studies evaluated televisits. Nine qualitative studies also addressed these topics. Studies evaluated a wide range of reduced and traditional visit schedules and approaches to incorporating televisits.
In comparisons of fewer to standard number of scheduled antenatal visits, moderate strength evidence did not find differences for gestational age at birth (4 studies), being small for gestational age (3 studies), Apgar score (5 studies), or neonatal intensive care unit (NICU) admissions (5 studies). Low strength evidence did not find differences in maternal anxiety (3 studies), preterm births (3 studies), and low birth weight (4 studies). Qualitative studies suggest that providers believe fewer routine visits may be more convenient for patients and may free up clinic time to provide additional care for patients with high-risk pregnancies, but both patients and providers had concerns about potential lesser care with fewer visits.
In comparisons of hybrid (televisits and in-person) versus in-person only visits, low strength evidence did not find differences in preterm births (4 studies) or NICU admissions (3 studies), but did suggest greater satisfaction with hybrid visits (2 studies). Qualitative studies suggested patients and providers were open to reduced schedules and televisits for routine antenatal care, but importantly, patients and providers had concerns about quality of care, and providers and clinic leadership had suggestions on how to best implement practice changes.
Conclusion:
The evidence base is relatively sparse, with insufficient evidence for numerous prioritized outcomes. Studies were heterogeneous in the care models employed. Where there was sufficient evidence to make conclusions, studies did not find significant differences in harms to mother or baby between alternative models, but evidence suggested greater satisfaction with care with hybrid visits. Qualitative evidence suggests diverse barriers and facilitators to uptake of reduced visit schedules or televisits for routine antenatal care. Given the shortcomings of the evidence base, considerations other than proof of differences in outcomes may need to be considered regarding implications for clinical practice. New studies are needed to evaluate prioritized outcomes and potential differential effects among different populations or settings.
Contents
Suggested citation:
Balk EM, Konnyu KJ, Cao W, Reddy Bhuma M, Danilack VA, Adam GP, Matteson KA, Peahl AF. Schedule of Visits and Televisits for Routine Antenatal Care: A Systematic Review. Comparative Effectiveness Review No. 257. (Prepared by the Brown Evidence-based Practice Center under Contract No. 75Q80120D00001.) AHRQ Publication No. 22-EHC031. Rockville, MD: Agency for Healthcare Research and Quality; June 2022. DOI: https://www.doi.org/10.23970/AHRQEPCCER257. Posted final reports are located on the Effective Health Care Program search page.
This report is based on research conducted by the Brown Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 75Q80120D00001). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.
The information in this report is intended to help healthcare decision makers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of healthcare services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.
This report is made available to the public under the terms of a licensing agreement between the author and the Agency for Healthcare Research and Quality. Most AHRQ documents are publicly available to use for noncommercial purposes (research, clinical or patient education, quality improvement projects) in the United States, and do not need specific permission to be reprinted and used unless they contain material that is copyrighted by others. Specific written permission is needed for commercial use (reprinting for sale, incorporation into software, incorporation into for-profit training courses) or for use outside of the U.S. If organizational policies require permission to adapt or use these materials, AHRQ will provide such permission in writing.
AHRQ or U.S. Department of Health and Human Services endorsement of any derivative products that may be developed from this report, such as clinical practice guidelines, other quality enhancement tools, or reimbursement or coverage policies, may not be stated or implied.
A representative from AHRQ served as a Contracting Officer’s Representative and reviewed the contract deliverables for adherence to contract requirements and quality. AHRQ did not directly participate in the literature search, determination of study eligibility criteria, data analysis, interpretation of data, or preparation or drafting of this report.
AHRQ appreciates appropriate acknowledgment and citation of its work. Suggested language for acknowledgment: This work was based on an evidence report, Schedule of Visits and Televisits for Routine Antenatal Care: A Systematic Review, by the Evidence-based Practice Center Program at the Agency for Healthcare Research and Quality (AHRQ).
- NLM CatalogRelated NLM Catalog Entries
- Reduced Compared With Traditional Schedules for Routine Antenatal Visits: A Systematic Review.[Obstet Gynecol. 2023]Reduced Compared With Traditional Schedules for Routine Antenatal Visits: A Systematic Review.Balk EM, Danilack VA, Bhuma MR, Cao W, Adam GP, Konnyu KJ, Peahl AF. Obstet Gynecol. 2023 Jul 1; 142(1):8-18. Epub 2023 Jun 7.
- Changes to Prenatal Care Visit Frequency and Telehealth: A Systematic Review of Qualitative Evidence.[Obstet Gynecol. 2023]Changes to Prenatal Care Visit Frequency and Telehealth: A Systematic Review of Qualitative Evidence.Konnyu KJ, Danilack VA, Adam GP, Friedman Peahl A, Cao W, Balk EM. Obstet Gynecol. 2023 Feb 1; 141(2):299-323. Epub 2023 Jan 4.
- Televisits Compared With In-Person Visits for Routine Antenatal Care: A Systematic Review.[Obstet Gynecol. 2023]Televisits Compared With In-Person Visits for Routine Antenatal Care: A Systematic Review.Balk EM, Danilack VA, Cao W, Bhuma MR, Adam GP, Konnyu KJ, Peahl AF. Obstet Gynecol. 2023 Jul 1; 142(1):19-29. Epub 2023 Jun 7.
- Review Who should provide routine antenatal care for low-risk women, and how often? A systematic review of randomised controlled trials. WHO Antenatal Care Trial Research Group.[Paediatr Perinat Epidemiol. 1998]Review Who should provide routine antenatal care for low-risk women, and how often? A systematic review of randomised controlled trials. WHO Antenatal Care Trial Research Group.Khan-Neelofur D, Gülmezoglu M, Villar J. Paediatr Perinat Epidemiol. 1998 Oct; 12 Suppl 2:7-26.
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