Study findings on quality domains for remote antenatal care
Quality domain | Illustrative data on where remote antenatal care works well | Illustrative data on where remote care does not work so well |
Efficient and timely Efficient—avoiding waste, in particular waste of equipment, supplies, ideas and energy Timely—reducing waits and sometimes harmful delays for both those who receive and those who give care |
‘That’s been really useful actually, to be able to take phone calls, or video calls, because I'm at a desk Monday to Friday full-time. So if I would have had to go to the hospital more(…)it would have taken more time out of my day.’ W05 ‘They don’t have to drive to the hospital, they don’t have to park, they don’t have to pay for parking, they don’t need to organise childcare. There are some considerable advantages to it.’ H01
‘Information-wise…you can do that quite quickly over the phone, whereas in person, because you have got that bit more of a rapport going, there’s more of a conversational element to it, so they kind of can go off track and things.’ H21
‘So we can be a lot more responsive to these women, by literally just picking up the phone and having that chat with them. You don’t have the practical issues, is there a clinic room available, how long is it going to take her to come in, I haven't got a clinic slot for 3 weeks’.’ M14 |
‘You have a lot more leg work to make the two (Attend Anywhere and hospital appointment system) combine…well, they don’t. I’ve got this form as I said, I have to fill in and then save it in their file and retrieve it when I need it. You know, that’s a bit of a hassle.’ H26
‘It feels like you have to do so much detective work, looking at all the different sites like their results and their records, their letters from the past, what’s happened in maternity, what happened in their past obstetric histories.’ H23
‘We always function best when we’ve had a team meeting, so like one of us will go through all the emails we’ve received, and then we’ll discuss them all, and that tends to embed it better.’ H21 |
Effective Services are based on high quality evidence, with low value care minimised |
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‘I don’t yet have the evidence I would like about the impact on women, about the acceptability from women, about whether women prefer this style.’ M08 |
Safe Care that does not cause avoidable harm |
‘If I was high risk or if I had an issue, they would have told me to come in. But for me, at least it was completely over the phone, which I was fine with, because(…)I’d had no issues that I think needed to be seen in person.’ W32 |
‘Everything’s been through the phone. It’s been – maybe because of the anxiety of it being my first pregnancy – it was really impersonal, it was really short. Because it’s over the phone it was just really brushed over.’ W29
‘(W)e look at how swollen people are, we look at the colour of their skin, how pale they are, you know, whether or not they look anaemic, whether or not they look depressed…You know, we can’t do that on the phone.’ H15 |
Accessible Care that does not present barriers to use, including obstacles related to finance, transport, or design |
‘So, in the video clinics they will have a regular appointment with the diabetes specialist nurse and the diabetes specialist dietician, and for our ladies with Type one or Type two diabetes with the consultant as well. So, we can all still have that joint decision-making but just on a video, virtual clinic rather than a face-to-face clinic.’ H14 |
‘The maternity app, if it was done properly, it would have been really useful. Some of the appointments were in there, just not all, and some of the information were there and just not all(…)It’s just half done, half completed, makes it a bit pointless sometimes.’ W30 I mean, the video calls are a bit of an issue, just because of the internet connection, and I think…I mean, I'm not 100 per cent sure but I…so I…I'm in a very rural area, I don't have broadband, I'm relying on my 4G hotspot, so that is a bit of a problem.’ W05 |
Person-centred Providing care that is respectful of and responsive to individual patient preferences, needs and values |
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‘When done remotely everything feels more formal, like a business interaction.’ W94 ‘I feel very isolated on my own, that the midwife is simply interested in this baby and not interested in the family as a unit.’ Participant W37
‘In real face-to-face kind of appointments, you get more like chitchats, which somehow sometimes reveal things that you might not have thought of.’ W30 |
Enables choice and continuity Care should be designed to respond to individual choices and preferences, with continuity of care where possible |
‘First time mums should be able to have face to face appointments(…)Second time round mums should be given the choice as to whether they want face to face or remote.’ W11
‘I think that they really need to personalise the care to the individual.’ W31 ‘It’s more about trying to develop a proper personalised understanding of that person’s circumstances and working out what’s appropriate and what’s not appropriate.’ M03 |
‘People have to feel comfortable with it, the actual using of the platforms, and, you know, there are a number of midwives that are approaching retirement age that would say they are not very digitally savvy, so it’s been difficult for them. And they have probably used the telephone more than video appointments. So, that has certainly been a problem for people’ H24 If it was a longer term thing where we were talking about bringing in remote care as part of standard maternity then that should be communicated to you right at the beginning as part of your package of care.’ W35 ‘Remote consultation doesn’t work for everyone equally. And I think that’s really, really important and if someone, you are talking to someone on the phone and they do speak little to no English, then to insist on them having all of their consultations as remote until 28 weeks I think is really stupid and does a disservice. And I think there needs to be a bit of flexibility in the system and I don’t think there is any currently.’ W15 |
Equitable Providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location and socioeconomic status |
‘Remote assessment for the right person is probably absolutely fine, whereas remote assessment for the wrong person is not going to help. And it’s knowing which person you’re talking to or about.’ M10 |
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