Patient perceptions, opinions and satisfaction of telehealth with remote blood pressure monitoring postpartum

Thomas et al. BMC Pregnancy and Childbirth https://doi.org/10.1186/s12884-021-03632-9 (2021) 21:153 ORIGINAL RESEARCH Open Access Patient perceptions, opinions and satisfaction of telehealth with remote blood pressure monitoring postpartum Nicole A. Thomas1*, Anna Drewry2, Susan Racine Passmore3, Nadia Assad4 and Kara K. Hoppe2 Abstract Background: Our aim was to conduct a post participation survey of respondent experiences with in-home remote patient monitoring via telehealth for blood pressure monitoring of women with postpartum hypertension. We hypothesized that the in-home remote patient monitoring application will be implemented with strong fidelity and have positive patient acceptability. Methods: This analysis was a planned secondary analysis of a non-randomized controlled trial of telehealth with remote blood pressure patient monitoring for postpartum hypertension compared to standard outpatient monitoring in women with a hypertension-related diagnosis during pregnancy. In collaboration with survey experts, we developed a 41-item web-based survey to assess 1) perception of quality of care received, 2) ease of use/ease to learn the telehealth program, 3) effective orientation of equipment, 4) level of perceived security/privacy utilizing telehealth and 5) problems encountered. The survey included multiple question formats including Likert scale responses, dichotomous Yes/No responses, and free text. We performed a descriptive analysis on all responses and then performed regression analysis on a subset of questions most relevant to the domains of interest. The qualitative data collected through open ended responses was analyzed to determine relevant categories. Intervention participants who completed the study received the survey at the 6-week study endpoint. Results: Sixty six percent of respondents completed the survey. The majority of women found the technology fit easily into their lifestyle. Privacy concerns were minimal and factors that influenced this included age, BMI, marital status, and readmissions. 95% of women preferred remote care for postpartum follow-up, in which hypertensive type, medication use and ethnicity were found to be significant factors in influencing location of follow-up. Most women were satisfied with the devices, but rates varied by hypertensive type, infant discharge rates and BMI. Conclusions: Postpartum women perceived the telehealth remote intervention was a safe, easy to use method that represented an acceptable burden of care and an overall satisfying method for postpartum blood pressure monitoring. Trial registration: ClinicalTrials.gov identification number: NCT03111095 Date of registration: April 12, 2017. Keywords: Postpartum hypertension, Remote patient monitoring, Telehealth, Participant satisfaction, Qualitative evaluation * Correspondence: 1 University of Wisconsin-Madison, School of Nursing, Signe Skott Cooper Hall, 701 Highland Avenue, Madison, WI 53705, USA Full list of author information is available at the end of the article © The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Thomas et al. BMC Pregnancy and Childbirth (2021) 21:153 Background Hypertensive disorders are one of the most common complications of pregnancy in the United States. Approximately 10% of pregnancies are affected nationwide [1–3]. While guidelines for antepartum and intrapartum management of hypertension are numerous, recommendations for monitoring for hypertension in the postpartum period have just started to emerge over the past decades despite the fact that hypertensive disorders are one of the leading reasons for postpartum readmission, morbidity and mortality [3]. Blood pressure (BP) decreases within 48 h following delivery and increases 3–6 days postpartum [1, 4, 5]. The American College of Obstetrics and Gynecology (ACOG) suggests that obstetric providers monitor the BPs of women with gestational hypertension, preeclampsia or superimposed preeclampsia inpatient, or that equivalent outpatient surveillance be performed for the immediate 72 h postpartum and again at 7–10 days postpartum or earlier in women with symptoms [1]. Of note, 50 to 70% of women do not follow up postpartum [6–8]. To address this gap we developed a telehealth with remote monitoring intervention devised for daily home BP monitoring. All data was transmitted to clinical providers on a daily basis [6]. We conducted a single-site non-randomized controlled trial of telehealth with remote monitoring and linked interventions for management of postpartum hypertension. The intervention was associated with reduced hospital readmissions compared to standard care (1 [0.5%] vs. 8 [3.7%], adjusted relative risk 0.12; 95% confidence interval (CI): 0.01–0.96) [9]. After providing informed consent, postpartum women prior to hospital discharge were assigned to and dispensed a remote monitoring unit that securely transmitted individual data to a central monitoring platform via Bluetooth technology leveraged by Honeywell (now Resideo) Lifestream Clinical Monitoring solution. To increase equitable utilization of services among intervention participants, all necessary equipment was provided and telehealth services was capable via wi-fi, internet, or cellular data. Equipment dispensed to each intervention participant included a Genesis Touch tablet, automatic blood pressure cuff, scale and pulse oximeter. Prior to hospital discharge the participants were trained on use of equipment and were requested to submit biometric data daily. Registered nurses trained in the research protocol assessed participant data daily and used nurse-driven BP algorithms for initiation, titration and cessation of anti-hypertensive medication as indicated [6]. ACOG defines telehealth as “technology-enhanced health care framework that includes services such as virtual visits, remote patient monitoring, and mobile health care.” [7] This technology has been used for blood Page 2 of 11 press (...truncated)