LAS VEGAS -- A texting-based intervention, where women texted in their blood pressure measurements versus coming in for a postpartum office visit, virtually eliminated racial disparities in postpartum care, a researcher said here.
There was a significant interaction between postpartum blood pressure measurement by race and follow-up method, when examining the results of a previous randomized trial that looked at a texting-based intervention versus usual care, reported Adi Hirshberg, MD, of the University of Pennsylvania (UPenn) in Philadelphia.
While there was a significant difference between the portion of non-black women versus black women who came in for an office visit (70% vs 33%, P<0.001), these disparities were eliminated in the texting arm (91% vs 93%, P=0.85, respectively), Hirshberg said at the Society for Maternal-Fetal Medicine (SMFM) annual meeting.
Several clinicians at SMFM applauded the research. One black clinician at the presentation remarked that, "we need to continue to look at alternative ways to get these patients back in, because as you pointed out, they don't come back in, regardless of the period of time. We need to bring them in sooner, and this is probably something we need to add to the package of things that we need to do to try to reach out to this population and get them back into care."
The clinician's remarks were met with actual applause from around the room.
Hirshberg gave the scope of the problem, including why these postpartum visits are so important. She said that more than half of maternal deaths occur postpartum, and around 40% occur >48 hours postpartum, adding that black women are at greater risk than non-black women, especially with hypertensive disorders of pregnancy.
A randomized trial by Hirshberg's group, which was published in BMJ Quality & Safety in 2018, found that a text-based monitoring program resulted in a significant improvement over usual care.
This was a planned secondary analysis of this randomized trial, which examined women with pregnancy-related hypertension who delivered at the Hospital of UPenn, with women either randomized to an office-based in-person blood pressure check or text-based surveillance, including twice daily text reminders to check/text blood pressure measurements. In the text message arm, blood pressure values were tracked through "Way to Health," Hirshberg said.
When the 103 women in each arm were examined by race, 71% of women in the usual care arm were black compared with 66% of women in the text arm. Black women tended to be younger (mean age 27 vs 31 for non-black women), have Medicaid insurance, have a higher BMI at delivery and be multiparous, though there was no difference in gestational age at hypertension diagnosis or preeclampsia with severe features.
A significantly higher portion of black women were discharged on oral antihypertensive medication than non-black women, and a significantly higher portion were breastfeeding.
Overall, when comparing the texting arm to usual care, there was a significant difference in blood pressure measurements obtained for both non-black (91% vs 70%, respectively, P=0.03) and black women (93% vs 33%, respectively, P<0.001).
Hirshberg said that given the positive results of this study, and that the American College of Obstetricians and Gynecologists supports alternatives to in-person assessments, this is an intervention that should be considered in different hospital systems and practice models.
Laura Riley, MD, of Weill Cornell Medical Center in New York City, also offered praise for the research at the presentation, adding that, "as a black woman, it gets really depressing to hear the bad news and not to hear any interventions." She suggested that because doctors are most interested in seeing the patient, there could also be a benefit to a telehealth, FaceTime-based intervention for this patient population, as well.
Hirshberg and co-authors disclosed no relevant relationships with industry.
Texting Succeeds for Remote HTN Care in Black Women Medpage
Digital health interventions for the prevention of cardiovascular disease: a systematic review and meta-analysis. Hirshberg said that given the positive results of this study, and that the American College of Obstetricians and Gynecologists supports alternatives to in-person assessments, this is an intervention that should be considered in different hospital systems and practice models. Kumar S, Nilsen WJ, Abernethy A,. Maddison R, Pfaeffli L, Whittaker R,. Treatment for...
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