Implementation of home-based telemonitoring and teleconsultations for obstetrics: A cross-sectional survey of current practice in the United Kingdom.

OBJECTIVE

The requirement for regular maternal-fetal monitoring and clinical consultations has increased in recent years, placing a strain on obstetric services. In recent years, technology advancements have enabled the development of remote monitoring and teleconsultation strategies, aiming to provide care in the home setting. This cross-sectional survey seeks to understand the current state of home-based monitoring and teleconsultations across the United Kingdom (UK).

METHODS

A web-based survey was distributed to an obstetric representative in all UK National Healthcare Service (NHS) trusts. Survey questions consisted of multiple-choice and open questions surrounding four domains: (1) demographics, (2) home-based antenatal monitoring, (3) obstetric teleconsultations, and (4) advantages and disadvantages of home-based monitoring and teleconsultations.

RESULTS

In total, 76 out of 145 (52.4%; 95% confidence interval [CI], 44.0-60.8 response rate) UK NHS trusts completed the survey. Any form of home monitoring and obstetric teleconsultations were provided in 61.8% (95% CI, 50.0-72.8) (47/76) and 68.4% (95% CI, 56.7-78.6) (52/76) of UK trusts, respectively. Secondary analysis demonstrated that remote monitoring was significantly more likely to be used in teaching versus non-teaching NHS trusts (P = 0.03). Blood pressure monitoring (45/47, 95.8%; 95% CI, 85.5-99.5) and chronic hypertension (41/47, 87.2%; 95% CI, 74.3-95.2) were the most common device and condition to use home monitoring, respectively. Teleconsultations were utilized most frequently for patients complicated with gestational diabetes (34/52, 65.4%; 95% CI, 50.9-78.0) and delivered via a telephone call (51/52, 98.1%; 95% CI, 89.7-100). High cost and lack of clinical support were cited as the most common implementation barriers by respondents not currently using these strategies. Patient convenience (42/76, 55.3%; 95% CI, 43.4-66.7 and 44/76, 57.9%; 95% CI, 46.0-69.1) and reduced hospital burden (38/76, 50%; 95% CI, 38.3-61.7 and 22/76, 28.9%; 95% CI, 19.1-40.5) were common advantages for home monitoring and teleconsultations, respectively. Compliance issues (23/76, 30.3%; 95% CI, 20.2-41.9 and 15/76, 19.7%; 95% CI, 11.5-30.5) and digital resource requirements (15/76, 19.7%; 95% CI, 11.5-30.5, and 18/76, 23.7%; 95% CI, 14.7-34.8) were frequently cited difficulties for both home monitoring and teleconsultations, respectively.

CONCLUSION

This study describes the current state of remote monitoring and obstetric teleconsultation implementation across the UK, with survey respondents primarily derived from English maternity services. National frameworks are emerging and are vital to inform future digital standardization.