Patient Perceptions, Opinions and Satisfaction of Telehealth With Remote Blood Pressure Monitoring Postpartum

Abstract Background: We conducted a post participation process evaluation of participant experiences with in-home remote patient monitoring via telehealth for blood pressure monitoring of women with postpartum hypertension. In collaboration with expert opinion, we developed a self-administered questionnaire to investigate patient factors we hypothesized to be relevant influencing participant perceptions. Factors included type of hypertension, medication, maternal demographics, and infant discharge rates. 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. Study participants received the survey at the 6-week study endpoint. Results: 60% of participants 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.

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

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03632-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Nicole A. Thomas ◽

Anna Drewry ◽

Susan Racine Passmore ◽

Nadia Assad ◽

Kara K. Hoppe

Keyword(s):

Blood Pressure ◽

Patient Monitoring ◽

Blood Pressure Monitoring ◽

Study Endpoint ◽

Free Text ◽

Remote Patient Monitoring ◽

Pressure Monitoring ◽

Link Type ◽

Remote Patient

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.

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Does Daily Self-Weighing Contribute to Postpartum Weight Loss? A Secondary Analysis of Daily Postpartum Weights among Women with Hypertensive Disorders of Pregnancy

American Journal of Perinatology ◽

10.1055/s-0041-1727217 ◽

2021 ◽

Author(s):

Ali N. Lohr ◽

Kara K. Hoppe ◽

Chaoqun C. Mei ◽

Kathleen M. Antony

Keyword(s):

Blood Pressure ◽

Weight Loss ◽

Blood Pressure Monitoring ◽

Controlled Trial ◽

Secondary Analysis ◽

Postpartum Women ◽

Pressure Monitoring ◽

Postpartum Weight ◽

The Impact

Objective This study was aimed to examine the impact of daily self-weighing via remote monitoring on postpartum weight loss. Study Design This was a secondary analysis of a nonrandomized controlled trial comprised of postpartum women with diagnosed hypertensive-related disorders in pregnancy who received a tablet device linked to Bluetooth-enabled equipment including a scale and blood pressure cuff. In addition to blood pressure monitoring, participants were instructed to perform daily self-weighing. The primary outcome of this study was to determine whether postpartum women who performed daily self-weighing lost more weight than those who did not, with a 42-day endpoint based on a 6-week postpartum visit weight. Results Overall, 214 women participated in this program and 214 received usual care. Median weight loss for women participating in the remote blood pressure monitoring system was 23.0 (interquartile range [IQR]: 17–30) pounds versus 23.0 (IQR: 17–29) pounds among controls. Weight loss did not vary by prepregnancy obesity (median: 20 pounds [IQR: 17–28 pounds] for nonobese and 23 [IQR: 17–30] pounds for women with obesity, p = 0.16). Women who weighed themselves more than half of follow-up days lost a median of 24 pounds (IQR: 17–30 pounds) compared with 20.5 pounds (IQR: 14–29 pounds), p = 0.06. Women who weighed themselves more than half of follow-up days lost a mean of 11.4% (standard deviation [SD] = 0.41%) of body weight compared with 9.1% (SD = 0.74%; p = 0.01). The amount of weight loss in the telehealth group was correlated with the number of daily weights performed (Pearson's correlation coefficient 0.164, p = 0.025). Postpartum weight loss for daily self-weighing participants was most notable in the first 2 weeks with ongoing weight loss up to the 42-day (6-week) endpoint of this secondary analysis. Conclusion Daily self-weighing alone may be insufficient to promote postpartum weight loss. However, there was a slight trend toward more weight loss with more frequent weighing. Key Points

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Role of Ambulatory Blood Pressure Monitoring in Predicting Adverse Maternofetal Events in Pregnancy

Indian Journal of Cardiovascular Disease in Women WINCARS ◽

10.1055/s-0040-1708576 ◽

2021 ◽

Author(s):

Satish Kumar Rao Vavilala ◽

Indrani Garre ◽

Sumalatha Beeram

Keyword(s):

Blood Pressure ◽

Logistic Regression ◽

Standard Deviation ◽

Ambulatory Blood Pressure ◽

Blood Pressure Monitoring ◽

Statistical Significance ◽

Binary Logistic Regression ◽

Pressure Monitoring ◽

In Pregnancy

Abstract Aims To correlate the relationship between the ambulatory blood pressure parameters and the occurrence of the antenatal and postnatal adverse maternofetal events in pregnancy. Methods Observational study designed for 50 pregnant patients who had an appointment to the obstetrics with abnormal blood pressure (BP) measurements and for whom ambulatory blood pressure monitoring (ABPM) was studied between January 2019 and June 2019. Data about age, personal history, obstetrics, family, body mass index (BMI), weight gain in pregnancy, values of blood pressure in the appointment, values recorded in ABPM, delivery and newborn, pregnancy and postpartum events, and follow-up of woman and child. Data were analyzed using descriptive and inferential statistics with Minitab 17.0 for Windows. Results Patients demographic data, clinical history, and laboratory results, including the ABPM parameters, were compiled. Antenatal complications occurred in 22 patients (44%), and postpartum complications were found in 41 patients (82%) whose ABPM values were deranged. Antenatal complications were studied using the binary logistic regression analysis for calculating the role each factor played in the development of hypertension. In the sample studied, mean age was 24.980 with a standard deviation of 4.876 (p = 0.003; minimum age of 19 years and maximum age of 38 years), mean weight of patient was 63.71 with a standard deviation of 63.71 (p = 0.001), mean gravida was 1.780 with a standard deviation of 0.910 (p = 0.034), mean gestation weeks at presentation was 33.000 weeks with a standard deviation of 4.086 (p = 0.041), mean birth weight was 2.226 with a standard deviation of 0.797 (p = 0.000), mean maximum diastole was 109.22 with a standard deviation of 16.53 (p = 0.002), mean day maximum systole was 187.2 with a standard deviation of 203.5 (p = 0.009), mean day minimum diastole was 63.50 with a standard deviation of 12.99 (p = 0.013), all of which had statistical significance. It is found that the nighttime diastolic blood pressure (DBP) and daytime maximum systolic blood pressure (SBP) were the best predictors of adverse events. Among antenatal complications (ANC), the most common complication is intrauterine growth restriction (IUGR), noted in (n = 19, 86.36%) preterm delivery (n = 17, 77.27%) among the 17 babies who were delivered preterm; 12 (70.5%) needed neonatal intensive care unit (NICU) care of which 4 (25%) babies died because of prematurity; intrauterine death (IUD) was noted in 7 (31.81%) patients and eclampsia was seen in 5 (22.72%). Nondippers proðle had a worse survival rate at follow-up until delivery compared with those with a dipper proðle. Postnatal complications were seen in 41 patients; among them, 13 patients (31.7%) had abnormal fundus examination, 15 patients (36.58%) required usage of antihypertensive beyond first postpartum, 9 patients (21.95%) required blood transfusion for severe bleeding in the form of postpartum hemorrhage. Binary logistic regression for systolic dippers versus nondippers shows statistical significance in age (p = 0.023), weight (p = 0.038), and para (p = 0.045) (Table 3). Binary logistic regression for diastolic dippers versus nondippers shows statistical significance in age (p = 0.039), weight (p = 0.020), birth weight (p = 0.010), maximum heart rate (p = 0.043), and ANC (p = 0.007) Adverse events occurred most commonly in nondippers. Systole nondippers is noted in (n = 41, 82%). Dippers is noted in (n = 9, 18%), Diastole nondippers is noted in (n = 39, 78%) Dippers is noted in (n = 11, 22%). Conclusion ABPM recorded blood pressure is very precise. ABPM is the advised method for both diagnostic and therapeutic monitoring of hypertensive pregnancy diseases, mainly in situations like whitecoat hypertension, masked hypertension, nocturnal hypertension, and nondipping profile. In patients with high-risk pregnancy, elderly primigravida, and precious pregnancy, who have a high-risk of developing pregnancy-induced hypertension (PIH) and related complications, early use of ABPM predicts adverse maternofetal events, which when intervened at an earlier date can prevent antenatal and postnatal complications.

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