Effects of the COVID-19 Pandemic and Telehealth on Antenatal Screening and Services, Including for Mental Health and Domestic Violence: An Australian Mixed-Methods Study.

Autor:	Henry A; Discipline of Women's Health, School of Clinical Medicine, UNSW Medicine and Health, University of New South Wales (NSW), Sydney, NSW, Australia.; Department of Women's and Children's Health, St George Hospital, Sydney, NSW, Australia.; The George Institute for Global Health, UNSW Medicine and Health, Sydney, NSW, Australia., Yang J; Discipline of Women's Health, School of Clinical Medicine, UNSW Medicine and Health, University of New South Wales (NSW), Sydney, NSW, Australia., Grattan S; The George Institute for Global Health, UNSW Medicine and Health, Sydney, NSW, Australia., Roberts L; Department of Women's and Children's Health, St George Hospital, Sydney, NSW, Australia.; St George and Sutherland Clinical School, UNSW Medicine and Health, University of New South Wales, Sydney, NSW, Australia., Lainchbury A; Royal Hospital for Women, Randwick, NSW, Australia., Shanthosh J; The George Institute for Global Health, UNSW Medicine and Health, Sydney, NSW, Australia.; Australian Human Rights Institute, UNSW Sydney, Kensington, NSW, Australia., Cullen P; School of Population Health, UNSW Sydney, Kensington, NSW, Australia.; Ngarruwan Ngadju, First Peoples Health and Wellbeing Research Centre, Australian Health Services Research Institute, University of Wollongong, Wollongong, NSW, Australia., Everitt L; Department of Women's and Children's Health, St George Hospital, Sydney, NSW, Australia.; School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia.
Jazyk:	angličtina
Zdroj:	Frontiers in global women's health [Front Glob Womens Health] 2022 Jun 22; Vol. 3, pp. 819953. Date of Electronic Publication: 2022 Jun 22 (Print Publication: 2022).
DOI:	10.3389/fgwh.2022.819953
Abstrakt:	Introduction: Australian antenatal care includes specific screening and service provision for domestic and family violence (DFV) and mental health. However, the COVID-19 pandemic resulted in major care changes, including greatly expanded telehealth. Given difficulties in a safe assessment and management of disclosures via telehealth, DFV and mental health service provision might be substantially impacted. This study therefore aimed to assess COVID-19 effects on DFV and mental health screening, as well as broader service provision from the perspective of local maternity service providers. Methods: Mixed-methods study of staff surveys and interviews of staff directly involved in pregnancy care (doctors, midwives, and allied health) in three Sydney (Australia) maternity units, from October 2020 to March 2021. Surveys and interviews interrogated perceived effects of the COVID-19 pandemic on delivery (ensuring required services occurred), timeliness, and quality of (a) overall maternity care and (b) DFV and mental health screening and care; and also advantages and disadvantages of telehealth. Surveys were descriptively analyzed. Interviews were conducted online, recorded, and transcribed verbatim prior to thematic analysis. Results: In total, 17 interviews were conducted and 109 survey responses were received. Breakdown of survey respondents was 67% of midwives, 21% of doctors, and 10% of allied health. Over half of survey respondents felt the pandemic had a negative effect on delivery, timeliness, and quality of overall pregnancy care, and DFV and mental health screening and management. Perceived telehealth positives included convenience for women (73%) and reducing women's travel times (69%). Negative features included no physical examination (90%), difficulty regarding non-verbal cues (84%), difficulty if interpreter required (71%), and unsure if safe to ask some questions (62%). About 50% felt telehealth should continue post-pandemic, but for <25% of visits. Those perceived suitable for telehealth were low-risk and multiparous women, whereas those unsuited were high-risk pregnancy, non-English speaking, and/or mental health/psychosocial/DFV concerns. "Change to delivery of care" was the central interview theme, with subthemes of impact on mental health/DFV screening, telehealth (both positive and negative), staff impact (e.g., continuity of care disruption), and perceived impact on women and partners. Discussion: While telehealth may have an ongoing, post-pandemic role in Australian maternity care, staff believe that this should be limited in scope, mostly for low-risk pregnancies. Women with high risk due to physical health or mental health, DFV, and/or other social concerns were considered unsuited to telehealth. Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2022 Henry, Yang, Grattan, Roberts, Lainchbury, Shanthosh, Cullen and Everitt.)
Databáze:	MEDLINE
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