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Centres have employed new policies and care models, such as telemedicine, aiming to decrease the risk of COVID-19 transmission while continuing to deliver quality care.
In March 2020, The Ottawa Hospital (TOH) implemented a hybrid model of antenatal care with fewer in-person visits and new safety restrictions. Currently, little is known about the effects of these changes on patient experience.
Therefore, we conducted a survey to explore patient satisfaction with antenatal care delivered at our tertiary centre during the first two waves of the pandemic. We analyzed the following 5 quality of care domains: access to care, telemedicine, communication, safety of care, and overall patient satisfaction.
The online survey (SurveyMonkey) consisted of 14 multiple-choice and Likert-scale questions based on the validated Patient Satisfaction Questionnaire Short Form framework.
Patients were recruited between April and October 2020 via flyers posted in TOH antenatal clinics and on the hospital’s Facebook page. Participation was voluntary and non-compensated. Data were analyzed using descriptive statistics and Pearson χ2 test as applicable. Statistical significance was set at P < 0.05.
We had 101 respondents with 99 consistently answering all questions, yielding a 98.0% completion rate. Participant demographics accurately reflect our centre’s population (supplemental table; online Appendix). Regarding each domain of quality, we found the following (Figure):
1.
Access to care: The majority deemed online or phone check-in and follow-up scheduling to be positive or neutral changes. Some viewed wait times for ultrasounds and to see the doctor as negative changes, but most considered these positive or neutral.
2.
Telemedicine: Most respondents were satisfied (57.5%) or neutral (27.5%) with telemedicine and viewed prenatal phone visits as a positive or neutral change. Only 17.8% believed additional ultrasounds would have improved their care.
3.
Communication: The majority of patients (84.8%) affirmed that new COVID-19 policies were communicated timely and effectively by the health care team. Interestingly, 71.0% of low-risk clinic patients felt this was done timely and effectively compared to 90.0% of high-risk clinic patients (P = 0.02).
4.
Safety of care: Screening all patients at the hospital entrance, facility cleanliness, and accessibility of hand sanitizer were considered positive changes by respondents. However, opinions varied regarding the number of providers in the room. We found no significant difference in the perception of safety based on the gestational age of respondents. When examining willingness to self-isolate for 14 days before admission, responses were split (50.5% did self-isolate, 49.5% did not).
5.
Overall satisfaction: 81.0% of respondents felt safe and protected by new policies instituted during the pandemic. However, overall prenatal care experience varied, as 37.9% felt their experience had been negatively impacted by the pandemic and 38.9% did not; 23.2% were neutral. Notably, the majority of participants who felt negatively impacted were primigravida.
Figure 1Obstetric patients’ (n=101) perceptions about new antenatal care policies instituted at The Ottawa Hospital during the COVID-19 pandemic.
The findings of our study provide significant insight into the antenatal care experience of obstetric patients at TOH during the pandemic. To our knowledge, this is the first Canadian study that explores patient satisfaction with prenatal care during the COVID-19 pandemic. Our results suggest that telemedicine and hybrid models can be adopted in hospitals without affecting the quality or safety of care, even among high-risk obstetric patients. We also found that social media and the hospital website can be versatile tools to offer patients quick access to updated information. Positive responses regarding hospital COVID-19 policies were consistently observed throughout different age, parity, and model of care groups.
The COVID-19 pandemic has led to many changes in the way we deliver antenatal care. Despite some negative impacts by new COVID-19 policies, the majority of pregnant patients at TOH felt safe and protected during their antenatal care experience.
Acknowledgements
The authors would like to acknowledge Sandra Dunn for her review of and feedback on an early version of the manuscript
Ethics
The Ottawa Health Science Network Research Ethics Board (OHSN-REB) deemed this study exempt from review with the following statement: “our review of the proposal indicates that your project falls within the context of quality initiative, quality improvement, quality assurance, and/or program evaluation. Consequently, as per the Tri-Council Policy Statement 2, Article 2.5, we have determined that the proposal is not ‘human subject research’; therefore, review by the OHSN-REB is not required”.
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