Abstract
Introduction
Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy.
Current approaches to GDM management and education are labor intensive and costly.
Telemedicine offers a potential solution to reduce the time and cost burden of prenatal
care for women with GDM.
Methods
We assessed the acceptability of a telemedicine intervention to transmit patients’
weight, blood pressure, and blood glucose measurements from wireless devices to health
care providers, and to alternate “virtual office visits” with office-based prenatal
visits. We administered surveys to 70 Kaiser Permanente Southern California members
with GDM to assess preferences for modalities of GDM care delivery and to understand
perceptions of telemedicine. We subsequently conducted 10 qualitative interviews among
women with GDM to elicit perceptions about confidence and comfort with receiving care
telephonically and safety concerns. Data were coded and categorized using analytic
induction.
Results
Training on these devices would increase participants’ confidence in using the equipment.
Continuity of care was perceived as an important factor in facilitating confidence
with near universal preference for having virtual visits with the same clinician.
Most participants were not concerned with the safety of their baby or themselves during
the weeks without an office visit. One participant expressed an unwillingness to participate
in the intervention because of a perceived association between having a high-risk
pregnancy and an increased risk of pregnancy loss.
Conclusions
As telemedicine becomes increasingly common in health care, feedback from end users
will be essential in tailoring, communicating about, and supporting the uptake and
success of such programs.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Women's Health IssuesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Overview of maternal morbidity during hospitalization for labor and delivery in the United States: 1993–1997 and 2001–2005.Obstetrics and Gynecology. 2009; 113: 1075-1081
- Qualitative data analysis for health services research: Developing taxonomy, themes, and theory.Health Services Research. 2007; 42: 1758-1772
- Gestational diabetes mellitus: Risks and management during and after pregnancy.Nature Reviews Endocrinology. 2012; 8: 639-649
- Increasing prevalence of gestational diabetes mellitus (GDM) over time and by birth cohort: Kaiser Permanente of Colorado GDM Screening Program.Diabetes Care. 2005; 28: 579-584
- The effect of telemedicine on outcome and quality of life in pregnant women with diabetes.Journal of Telemedicine and Telecare. 2009; 15: 238-242
- Future risk of diabetes in mother and child after gestational diabetes mellitus.International Journal of Gynaecology and Obstetrics. 2009; 104: S25-S26
- Risk of development of diabetes mellitus after diagnosis of gestational diabetes.CMAJ. 2008; 179: 229-234
- Referral to telephonic nurse management improves outcomes in women with gestational diabetes.American Journal of Obstetrics and Gynecology. 2012; 206: 491.e1-491.e5
- Tele-mum: A feasibility study for a randomized controlled trial exploring the potential for telemedicine in the diabetes care of those with gestational diabetes.Diabetes Technology and Therapeutics. 2015; 17: 880-888
- Disparities in the risk of gestational diabetes by race-ethnicity and country of birth.Paediatric and Perinatal Epidemiology. 2010; 24: 441-448
- Acceptability and user satisfaction of a smartphone-based, interactive blood glucose management system in women with gestational diabetes mellitus.Journal of Diabetes Science and Technology. 2015; 9: 111-115
- Gestational diabetes mellitus.Obstetrics and Gynecology. 2011; 118: 1379-1393
- Trends in the prevalence of preexisting diabetes and gestational diabetes mellitus among a racially/ethnically diverse population of pregnant women, 1999–2005.Diabetes Care. 2008; 31: 899-904
- The use of telemedicine in obstetrics: A review of the literature.Obstetrical & Gynecological Survey. 2011; 66: 170-178
- Alteration of endothelial function markers in women with gestational diabetes and their fetuses.Journal of Maternal, Fetal, and Neonatal Medicine. 2013; 26: 507-512
- Telemedicine interventions for gestational diabetes mellitus: A systematic review and meta-analysis.Diabetes Research and Clinical Practice. 2015; 110: 1-9
- The prevalence of gestational diabetes in advanced economies.Journal of Perinatal Medicine. 2012; 40: 511-520
- Gestational diabetes and future risk of diabetes.Journal of Clinical Medicine Research. 2013; 5: 92-96
Biography
Teresa N. Harrison, SM, is a Senior Research Project Manager in the Department of Research & Evaluation at Kaiser Permanente Southern California. Her research interests include reproductive health, medication adherence, and population-based outreach interventions.
Biography
David A. Sacks, MD, is an Associate Investigator with the Department of Research & Evaluation at Kaiser Permanente Southern California and Adjunct Clinical Professor in Maternal-Fetal Medicine at the Keck School of Medicine. His primary research interest is diabetes in pregnancy.
Biography
Carly Parry, PhD, MSW, MA, is Senior Program Officer, the Patient-Centered Outcomes Research Institute, Washington, DC. She leads a national transitional care initiative, with expertise in behavioral, mixed methods, and health services research in cancer, chronic illness, and transitional care.
Biography
Mayra Macias, MS, is a Research Associate in the Department of Research & Evaluation at Kaiser Permanente Southern California. She is responsible for coordinating and supporting multiple studies in the fields of gestational diabetes, palliative care, and care transitions.
Biography
Deborah S. Ling Grant, PhD, MPH, MBA, is a Research Project Manager with the Department of Research & Evaluation, Kaiser Permanente Southern California. Her research interests include behavioral therapy for child traumatic stress, substance abuse, health policy, comparative effectiveness, and outcomes research.
Biography
Jean M. Lawrence, ScD, MPH, MSSA, is a Senior Research Scientist with the Department of Research & Evaluation, Kaiser Permanente Southern California. Her research focuses on gestational diabetes, pregnancy complications and outcomes, and diabetes diagnosed in childhood and young adulthood.
Article info
Publication history
Published online: January 30, 2017
Accepted:
December 16,
2016
Received in revised form:
December 3,
2016
Received:
August 29,
2016
Footnotes
Funding Statement: This work was supported in part by funding from the Care Improvement Research Team in the Department of Research and Evaluation, Kaiser Permanente Southern California. The authors have no conflicts of interest to disclose.
Data Access and Responsibility: Dr. Lawrence had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Identification
Copyright
© 2016 Jacobs Institute of Women's Health. Published by Elsevier Inc.
