(1007) Provider Perspectives on Telemedicine in Tailored Prenatal Care: Barriers and Facilitators Post-COVID-19

Telemedicine is a key care delivery option in the new American College of Obstetricians and Gynecologists’ Clinical Consensus Document: Tailored Prenatal Care. Telemedicine care can improve access to prenatal care services; however, practices may require support to implement it. We describe providers’ perspectives of barriers and facilitators of adopting one aspect of tailored prenatal care: telemedicine. 

Study Design:
We conducted semi-structured interviews with 30 clinically active ( >20% clinical FTE) maternity care professionals at three academic sites. Interviews were transcribed, imported into MaxQDA, and iteratively coded using the Consolidated Framework for Implementation Research (CFIR), which provides a structured approach to identifying barriers and facilitators of implementing evidence-based interventions. Findings were organized by tailored care components and then CFIR domain to summarize barriers and facilitators of tailored prenatal care adoption.

Results:
The most cited drivers of telemedicine implementation were in the outer setting, inner setting, and individual domains. Outer setting facilitators included COVID-19 and social distancing requirements, which accelerated adoption of telehealth. Barriers included inequitable access to technology (e.g., broadband internet, home devices). Inner setting barriers were logistical: lack of private space for virtual visits, difficulties coordinating care with interpreters or other support services, and workflow challenges with support staff. At the individual level, barriers to telemedicine included provider discomfort with telehealth platforms and inconsistent patient access to home monitoring tools (e.g. blood pressure cuffs).

Conclusion:

While telemedicine is promising for overcoming barriers to care, providers and health systems face multilevel barriers to implementation. A combination of local strategies, including workflow optimization and support staff, and policy-level strategies, including payment reform, are needed to support access to virtual care for all patients.