背景:在产科护理模式中整合远程医疗对于为可能的感染暴发做好准备非常重要,这些感染暴发需要社交距离并限制面对面咨询。为确保产科远程健康在香港成功实施,了解和解决孕妇的担忧至关重要。
目的:本研究旨在评估孕妇的态度,关注,以及对香港远程医疗产科诊所服务的看法。
方法:我们于2021年11月至2022年8月在玛丽医院进行了一项前瞻性横断面问卷调查研究。利用5分评分量表,问卷旨在捕捉孕妇的偏好,期望,可行性感知,以及与远程医疗诊所服务有关的隐私问题。我们使用了统计分析,包括卡方检验和多项逻辑回归,比较问卷的回答,并调查怀孕和对远程医疗诊所的态度之间的关系。
结果:该研究包括分布在不同妊娠阶段的664名参与者:在18孕周之前的269名(40.5%),在24至31周之间有198(29.8%),和197(29.7%)交货后。其中,49.8%(329/664)赞成面对面咨询,而不是远程医疗诊所,只有7.3%(48/664)的人认为相反。此外,24.2%(161/664)同意应开设远程保健诊所进行产科服务。然而,对远程医疗诊所的总体偏好是<20%的常规产前检查(81/664,12.2%)和解决与怀孕相关的问题,如阴道出血(76/664,11.5%),阴道分泌物(128/664,19.4%),胎动减少(64/664,9.7%),子宫收缩(62/664,9.4%),和怀疑羊水渗漏(54/664,8.2%)。相反,76.4%(507/664)更喜欢远程医疗诊所,而不是当面访问产前教育讲座,产前和产后锻炼,解决母乳喂养问题。参与者对远程医疗诊所的任务更满意,例如解释怀孕检查结果(418/664,63.1%),在家自行使用小便试纸(373/664,56.4%),病史记录(341/664,51.5%),和使用电子机器自我监测血压(282/664,42.8%)。%).在产后期间,与妊娠18周前相比,更多的参与者同意远程医疗诊所可以作为评估阴道出血等身体症状的一种选择(aOR2.105,95%CI1.448-3.059),胎动减少(aOR1.575,95%CI1.058-2.345),子宫收缩(aOR2.906,95%CI1.945-4.342),疑似羊水渗漏(aOR2.609,95%CI1.721-3.954),发烧(aOR1.526,95%CI1.109-2.100),和流感样症状(aOR1.412,95%CI1.030-1.936)。他们对测量联合基底高度也更有信心,安排进一步调查,并通过远程医疗诊所与医生进行诊断。远程医疗诊所的主要感知公共卫生优势是较短的旅行和等待时间(526/664,79.2%),而主要关注的是错误诊断和治疗的法律问题(511/664,77.4%)。
结论:面对面咨询仍然是参与者的首选咨询方式。然而,远程健康诊所可以替代不需要体检或联系的服务。随着妊娠的进行和分娩后,人们对远程医疗的接受度和信心增加。执行更严格的法律和准则可以促进远程保健诊所的实施,并增加孕妇对使用远程保健诊所进行产科护理的信心。
Integrating telehealth in an obstetric care model is important to prepare for possible infection outbreaks that require social distancing and limit in-person consultations. To ensure the successful implementation of obstetric telehealth in Hong Kong, it is essential to understand and address pregnant women\'s concerns.
This study aimed to assess pregnant women\'s attitudes, concerns, and perceptions regarding telehealth obstetric clinic services in Hong Kong.
We conducted a prospective cross-sectional questionnaire study at Queen Mary Hospital between November 2021 and August 2022. Utilizing a 5-point rating scale, the questionnaire aimed to capture pregnant women\'s preferences, expectations, feasibility perceptions, and privacy concerns related to telehealth clinic services. We used statistical analyses, including chi-square tests and multinomial logistic regression, to compare questionnaire responses and investigate the association between advancing gestation and attitudes toward telehealth clinics.
The study included 664 participants distributed across different pregnancy stages: 269 (40.5%) before 18 gestational weeks, 198 (29.8%) between 24 and 31 weeks, and 197 (29.7%) after delivery. Among them, 49.8% (329/664) favored face-to-face consultations over telehealth clinics, and only 7.3% (48/664) believed the opposite. Additionally, 24.2% (161/664) agreed that telehealth clinics should be launched for obstetric services. However, the overall preference for telehealth clinics was <20% for routine prenatal checkups (81/664, 12.2%) and addressing pregnancy-related concerns, such as vaginal bleeding (76/664, 11.5%), vaginal discharge (128/664, 19.4%), reduced fetal movement (64/664, 9.7%), uterine contractions (62/664, 9.4%), and suspected leakage of amniotic fluid (54/664, 8.2%). Conversely, 76.4% (507/664) preferred telehealth clinics to in-person visits for prenatal education talks, prenatal and postpartum exercise, and addressing breastfeeding problems. Participants were more comfortable with telehealth clinic tasks for tasks like explaining pregnancy exam results (418/664, 63.1%), self-administering urinary dipsticks at home (373/664, 56.4%), medical history-taking (341/664, 51.5%), and self-monitoring blood pressure using an electronic machine (282/664, 42.8%). %). During the postpartum period, compared to before 18 weeks of gestation, significantly more participants agreed that telehealth clinics could be an option for assessing physical symptoms such as vaginal bleeding (aOR 2.105, 95% CI 1.448-3.059), reduced fetal movement (aOR 1.575, 95% CI 1.058-2.345), uterine contractions (aOR 2.906, 95% CI 1.945-4.342), suspected leakage of amniotic fluid (aOR 2.609, 95% CI 1.721-3.954), fever (aOR 1.526, 95% CI 1.109-2.100), and flu-like symptoms (aOR 1.412, 95% CI 1.030-1.936). They were also more confident with measuring the symphysis-fundal height, arranging further investigations, and making diagnoses with the doctor via the telehealth clinic. The main perceived public health advantage of telehealth clinics was the shorter traveling and waiting time (526/664, 79.2%), while the main concern was legal issues from wrong diagnosis and treatment (511/664, 77.4%).
Face-to-face consultation remained the preferred mode of consultation among the participants. However, telehealth clinics could be an alternative for services that do not require physical examination or contact. An increased acceptance of and confidence in telehealth was found with advancing gestation and after delivery. Enforcing stricter laws and guidelines could facilitate the implementation of telehealth clinics and increase confidence in their use among pregnant women for obstetric care.