ACOG seeks to transform century-old prenatal care approach

Key takeaways:

• ACOG updated its prenatal care guidance to emphasize a more patient-centered approach.
• The guidance recommends that providers tailor the frequency of visits based on individual medical and social needs.

ACOG recently published new prenatal guidance that recommends screening patients for social drivers of health and adjusting care based on their individual needs, including the frequency of visits and care modalities.

Traditionally, prenatal care has been delivered during 12 to 14 in-person visits, regardless of a patient’s risk factors, according to a press release from the organization. The current care model has been used for nearly a century, but emerging evidence indicates a need for change, Christopher Zahn, MD, FACOG, chief of clinical practice and health equity and quality at ACOG, said in the release.

“Research has shown that the standard 12 to 14 visits do not ensure that patients receive the recommended prenatal care. In fact, 23% of patients don’t go to their first prenatal care appointment until after the first trimester, and almost half do not receive all the recommended services on time,” Zahn said. “In order to improve access and outcomes, we have to adjust the system and meet patients where they are.”

According to the guidance, average or low-risk patients may benefit from fewer in-person visits and alternative care modalities, like telehealth.

The guidance was developed by an independent panel of experts in maternity care, public health, pediatrics and equity, as well as patient representatives, according to the press release. Healio spoke with Alex Friedman Peahl, MD, MSc, FACOG, a co-author of the guidance and assistant professor of OB/GYN at the University of Michigan, to learn more about the recommendations and the biggest take-home message for providers.

Healio: The guidance recommends providers screen for social drivers of health, including race, ethnicity, gender identity, education and employment. What tools can clinicians use to screen for social drivers of health? How will the results help guide treatment plans?

Peahl: Clinicians may select screening tools for social and structural drivers of health from the resources identified in the clinical consensus, including the ACOG Committee Opinion 11, Addressing Social and Structural Determinants of Health, the SIREN Network website, or tools used within their health system.

Clinicians can address unmet social needs through assistance (connecting patients to resources) and adjustment (modifying care delivery to be more accessible). Clinicians should connect patients to resources through the health system and community, for example, providing ride vouchers for transportation barriers. Clinicians may also adjust care to be more accessible, particularly for patients with unmet needs. For example, using a targeted visit schedule or telemedicine for patients with transportation barriers.

Healio: The guidance states that providers may tailor the frequency of visits based on individual medical and social needs. Is there a minimum number of visits in which a pregnant patient should be seen? Or a maximum amount of time between visits?

Peahl: The tailored prenatal care guideline provides two sample schedules for prenatal care: the targeted and traditional visit schedule. For a patient who has their initial prenatal visit in the first trimester and gives birth at 39 weeks, this includes eight to nine visits for the targeted schedule, and 12 to 14 visits for the traditional schedule. Visit timing is based on evidence-based services for a healthy pregnancy like laboratory tests and immunizations. Patients are also given the option of doing some visits through telemedicine if no in-person services are required.

Healio: Now that the guidance is public, what are the next steps toward implementing it? What policies are needed before it can be fully adopted in practice?

Peahl: ACOG is developing an implementation resource website with resources for patients, clinicians, health systems and policymakers. These tools include videos and handouts for patients, a CME-eligible presentation for clinicians and shared decision-making grids to help patients and clinicians collaborate on finding the best care plan for each individual patient. Some state-level policy changes have helped support tailored prenatal care such as legislative guarantees for access to home blood pressure monitors for all birthing people and payment parity for telemedicine services. More resources will be built out here.

Healio: What is the biggest takeaway of this new guidance for OB/GYNs and other maternal care professionals?

Peahl: Tailored care does not mean less care. It means ensuring patients receive the right care in the right place at the right time. This individualization can improve access, patient experience and pregnancy outcomes, while also improving clinics’ operational efficiency.

References:

For more information:

Alex Friedman Peahl, MD, MSc, FACOG, can be reached at: alexfrie@med.umich.edu.