A Mobile Prenatal Care App to Reduce In-Person Visits: Prospective Controlled Trial

Abstract

Background: Risk-appropriate prenatal care has been asserted as a way for the cost-effective delivery of prenatal care. A virtual care model for prenatal care has the potential to provide patient-tailored, risk-appropriate prenatal educational content and may facilitate vital sign and weight monitoring between visits. Previous studies have demonstrated a safe reduction in the frequency of in-person prenatal care visits among low-risk patients but have noted a reduction in patient satisfaction.

Objective: The primary objective of this study was to test the effectiveness of a mobile prenatal care app to facilitate a reduced in-person visit schedule for low-risk pregnancies while maintaining patient and provider satisfaction.

Methods: This controlled trial compared a control group receiving usual care with an experimental group receiving usual prenatal care and using a mobile prenatal care app. The experimental group had a planned reduction in the frequency of in-person office visits, whereas the control group had the usual number of visits. The trial was conducted at 2 diverse outpatient obstetric (OB) practices that are part of a single academic center in Washington, DC, United States. Women were eligible for enrollment if they presented to care in the first trimester, were aged between 18 and 40 years, had a confirmed desired pregnancy, were not considered high-risk, and had an iOS or Android smartphone that they used regularly. We measured the effectiveness of a virtual care platform for prenatal care via the following measured outcomes: the number of in-person OB visits during pregnancy and patient satisfaction with prenatal care.

Results: A total of 88 patients were enrolled in the study, 47 in the experimental group and 41 in the control group. For patients in the experimental group, the average number of in-person OB visits during pregnancy was 7.8 and the average number in the control group was 10.2 (P=.01). There was no statistical difference in patient satisfaction (P>.05) or provider satisfaction (P>.05) in either group.

Conclusions: The use of a mobile prenatal care app was associated with reduced in-person visits, and there was no reduction in patient or provider satisfaction.

Trial registration: ClinicalTrials.gov NCT02914301; https://ichgcp.net/clinical-trials-registry/NCT02914301 (Archived by WebCite at http://www.webcitation.org/76S55M517).

Keywords: controlled clinical trial; mobile applications; mobile health; patient monitoring; patient safety; patient satisfaction; prenatal care; technological innovations.

Conflict of interest statement

Conflicts of Interest: JO and ACM declare a competing interest and hold a position in Babyscripts. KIM and NDG are unpaid consultants. JAB holds stock in the company 1EQ, and was employed by 1EQ at the time of the study. The remaining authors declare no conflicts of interest.

©Kathryn I Marko, Nihar Ganju, Jill M Krapf, Nancy D Gaba, James A Brown, Joshua J Benham, Julia Oh, Lorna M Richards, Andrew C Meltzer. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 01.05.2019.

Figures

Figure 1

CONSORT flow diagram.

Figure 2

Total number of prenatal clinical visits per group. Babyscripts (Brx) versus controls. P value is based on Wilcoxon ranked-sum test.

Figure 3

Survey data for patient satisfaction with overall prenatal care between Babyscripts (Brx) and control groups. For each time point, Brx and control patients are given a survey. The total numeric scores for all questions at that time point is calculated. All numeric scores are then normalized to 1 to standardize between different numbers of survey questions. SOC: standard of care.