COVID-19 creates opportunity for rural women’s health

Dr. Johnna Nynas, an obstetrician and gynecologist at Sanford Health in Bemidji, spoke about her hospital moving to virtual visits last year.

“We started laying the foundation stone a few years ago,” said Nynas. “We considered implementing a virtual visitation option that would give patients some devices to monitor their pregnancies at home, including a blood pressure cuff and then a doppler so they could hear their baby at home. But what really got us to the top and accelerated the timeline was the COVID pandemic. “

Technical and legal challenges related to the interface between patients at home and their medical records. But with the outbreak of the pandemic, Nynas said, “there were rapid changes in Congress that made it much easier for health organizations to initiate telemedicine”.

This gave doctors the ability to remotely contact patients when clinically appropriate. “That really drove it, and we are now on the ground under our feet,” she said. “I think our first visits were in March 2020. We have been doing this for a year now.”

Sanford’s virtual prenatal care model allows some flexibility in patient planning, but there are still core visits where patients are seen in person, Nynas said. Even during the height of the pandemic, when most people were advised to stay home, they always offered personalized attention to patients who faced a technological barrier or whose pregnancies were too complicated to monitor remotely.

Still, over the past 15 months, Nynas said, “Probably about a third of my patients have received some form of remote care.”

Nynas interacts with a patient at Sanford Health in Bemidji. Over the past year, she said, about a third of her patients have made at least one prenatal visit in some way remotely. (Courtesy Sanford Health, September 27, 2019, filed May 19, 2021)

Well received

Nynas said that the adoption of telemedicine technology among patients has been excellent. “Like any new program, it is not without its challenges,” she admitted. “But for something that we got directly involved in, things are actually going extremely well.”

The benefits, she said, include putting some of the responsibility for data collection on the patient.

“I think that gives patients a degree of ownership within the process,” she said. “For example, sometimes it’s very easy to come to the hospital or clinic and step on a scale and ignore the number, but when you step on the scale and look at the number and have to repeat it to someone else, it means something other. Just like they measure their blood pressure and listen to their babies. I think the patients are very committed. “

From a vendor perspective, Nynas values ​​the insights that virtual visits give her into the private lives of patients.

“The patient’s clinical picture doesn’t stop with the symptoms that he shares with you at the bedside,” she said. “We know that social determinants of health are a big problem, especially for women who live in rural areas.”

For example, if an expectant mother tells her that she is having trouble getting a good night’s sleep, Nynas may say, “It looks like you have a busy house with your four children doing homework and distance learning.”

“I understand this so much better that I can see this in real time than just hearing about it in passing,” she said.

Improving rural access

The feedback from patients is positive.

“My patients really like the flexibility,” said Nynas. “It’s not exactly the same as having your provider there, but some of the comments are: It feels a lot more personable than they expected. It doesn’t feel as cold or distant as you would expect, even though we’re talking on a computer screen. “

She said it helped that in recent years, especially during the pandemic, everyone has adapted quickly to new technology – using FaceTime to video chat with family, learn about Google Classroom, and attend work meetings via Zoom .

Rural patients in particular benefited from this, said Nynas. While many rural maternity hospitals have closed in recent years, she said, “We are seeing patients move on to get to prenatal care.” Meanwhile, “there is very good data that women who have to travel more than 50 kilometers in one direction to access prenatal care do not get as good results as those who do not have to travel that far.”

Nynas explained that telemedicine visits provide a way to assess a patient and their baby in real time, without the stress, expense and travel time, “so that they can have as efficient and complete prenatal care as someone in the field lives. ”

Nynas reads test results to a patient with a colleague in the obstetrics department at Sanford Health in Bemidji. (Courtesy Sanford Health, September 27, 2019, filed May 19, 2021)

There are still barriers that need to be addressed, such as broadband and cellular access in rural areas and for low-income families. And there are days when the technology doesn’t work as well as it does on others and doctors have to be content with phone calls.

Still, Nynas said, virtual visits are likely to continue even after COVID-19 clears from public awareness.

“One of the reasons I got into rural practice is because I grew up in a rural area in Minnesota,” she said. “I’ve seen this distance from the hospital, this distance from medical providers, really have an impact on the health of my family and the people I grew up with.”

After specializing as an OB / GYN, she said, “The inequality became very, very evident right away. Rural women suffer from higher maternal morbidity and mortality and higher infant morbidity and mortality. It has to do with the early detection of disease, and distance is a big factor in that. “

The discrepancy is real. Nynas cited shocking statistics: 23 percent of American women live in rural areas, but only 6% of gynecologists practice in rural areas. “This is the challenge we face,” she said.

The benefits of prenatal care are real even for women whose pregnancies are considered low risk. “It’s better to connect to prenatal care and get that care when and how you can,” said Nynas, “because no prenatal care is definitely correlated with poorer outcomes.”

At the same time, the cost of running a labor and delivery unit with fewer deliveries increases the gap between rural patients and the care they need. “This is where it can be very helpful to offer services remotely,” she said.

Sanford Health recently announced plans to create a virtual hospital connecting patients in rural hospitals and clinics with specialized care not available in rural areas. Using a “hub-and-spoke” model, Nynas said, “this can be a really effective way to ensure that patients receive comprehensive care and that any emerging or urgent medical problem is identified and addressed in good time before it is addressed Life will. or death situation. “

She said she expects more and more high-risk conditions to be treated safely remotely as the healthcare industry continues to use telemedicine technology.

“I don’t think this will go away anytime soon,” said Nynas. “I think it will continue to grow and we will find more and more ways to use this for the benefit of our patients.”

source https://dailyhealthynews.ca/covid-19-creates-opportunity-for-rural-womens-health/