Obstetricians' experiences with remote monitoring programs for hypertensive disorders

Despite widespread use in primary care, remote patient monitoring (RPM) in obstetrics for hypertensive disorders in pregnancy remain limited. Little is known about the specific modalities, perceived impact, and integration of RPM into standard practice in obstetrics.

To explore obstetricians' experiences with RPM for hypertensive disorders in the perinatal period and barriers in implementation, and to identify promising practices to overcome these barriers.

This qualitative study, conducted from September to October 2024, involved semi-structured interviews with 20 obstetricians across the United States, who represented different practice settings and RPM program models. We developed a qualitative codebook and conducted thematic analysis informed by the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework.

Five key themes emerged from interviews: (1) Barriers to Engagement; (2) Perceptions of Clinical Benefit; (3) Financial Hurdles in RPM Utilization; (4) Navigating Workflow and Data Challenges; and (5) Liability Concerns in RPM. RPM programs varied substantially in their eligibility criteria, timing within the perinatal period, data transfer methods, staffing models, and workflow. The major barriers included financial constraints (eg, insurance coverage and equipment costs), complex workflows, liability concerns related to 24/7 monitoring and response, and patient-level barriers (eg, technology literacy, language, and anxiety). Obstetricians used several strategies to overcome these challenges, including having patients bring their cuffs to the office to validate accuracy, assigning dedicated staff or partnering with a vendor to streamline workflows, coupling RPM with additional services like pregnancy education to improve adherence, and training staff so not all issues (eg, medication titration) require escalation to obstetricians. Despite the challenges, participants generally valued RPM and observed benefits in both clinical outcomes and patient engagement.

These findings highlight the need for context-specific approaches to enhance the accessibility and effectiveness of RPM for managing hypertensive disorders in the perinatal period.