Navigating Women's Health Utilization in a Changing Landscape | AMCP Nexus 2024
A series of posters presented at AMCP Nexus 2024 highlighted the evolving landscape of women's health, focusing on the use of medications for preterm birth prevention and the adoption of telehealth for prenatal consultations.
A series of posters presented at AMCP Nexus 2024 focused on 2 key areas: the utilization of medications for preterm birth (PTB) prevention and the adoption of telehealth for prenatal consultations. These presentations offered insights into how women’s health trends have evolved before, during, and after the COVID-19 pandemic.
Pregnant woman utilizing telehealth services / peopleimages.com - stock.adobe.com
There is an unmet need for further research and development of new medications to address PTB, according to one poster presented at the meeting.1
Intramuscular 17a-hydroxyprogesterone caproate (17-OHPC) was the sole FDA-approved medication to decrease the risk of PTB in pregnant women with a history of spontaneous preterm delivery. However, in late 2019, the FDA held a committee meeting to review the results of the PROLONG trial that had failed to confirm the efficacy of 17-OHPC in preventing PTB.
In 2023, the FDA made the final decision to revoke approval for generic 17-OHPC. This action was predicted to lead to an increase in the administration of compounded 17-OHPC. Additionally, the American College of Obstetricians and Gynecologists recommends vaginal progesterone as another potential option for PTB prevention.
Investigators aimed to track the usage patterns of generic 17-OHPC, compounded 17-OHPC, and vaginal progesterone among pregnant women at high risk of PTB between 2016 and 2023.
The study population consisted of pregnant women who gave birth to live children. These women had continuous medical and drug coverage for at least 6 months, with an allowable gap of 45 days between the start of their pregnancy and the delivery date. Additionally, they had a documented history of PTB.
Pregnancy outcomes and duration were determined using a validated algorithm. The dispensing of generic 17-OHPC, compounded 17-OHPC, and vaginal progesterone was identified using National Drug Code numbers.
The study analyzed 5412 live births to individuals with a history of PTB. The proportion of pregnancies receiving generic 17-OHPC rose from 16.5% in 2016 to 27.6% in 2018 but subsequently declined to 15.0% in 2019, 8.7% in 2020, 5.6% in 2021, and 2.4% in 2023.
The use of compounded 17-OHPC reached its highest point in 2019 at 13.8% but dropped dramatically from 2020 (8.2%) to 2023 (1.1%).
The use of vaginal progesterone remained consistently low, fluctuating between 2.2% and 4.0% from 2016 to 2023. In 2023, 93.7% of pregnant women with a history of PTB did not receive any form of progesterone.
Following the publication of the PROLONG trial, obstetric health care providers decreased the prescribing of generic and compounded 17-OHPC to women at risk of PTB. However, the use of vaginal progesterone remained relatively unchanged in this group. A substantial proportion of at-risk pregnancies did not receive any form of progesterone for PTB prevention.
“Given the important public health impact of PTB, there is an opportunity to update clinical guidelines and to invest in research and development for new medicines for PTB prevention,” wrote investigators.
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Telehealth use for prenatal care significantly increased during the early COVID-19 pandemic, primarily using real-time video, and while usage declined slightly later, it remained substantially higher than pre-pandemic levels, according to a second poster presented at the meeting.2
Telehealth offers comparable health outcomes to traditional care, boosts patient satisfaction, and increases engagement. The American College of Obstetricians and Gynecologists supports telehealth to reduce maternal risks. Knowing this, investigators sought to describe telehealth use trends for prenatal care from 2018 to 2024.
The current study analyzed administrative data from a large national health plan to examine prenatal care encounters between 2018 and 2024. Prenatal care encounters were defined as visits with a primary diagnosis of pregnancy supervision.
Investigators classified each prenatal care encounter as in-person or telehealth, specifying the telehealth modality (video or phone), based on procedure, place of service codes, and modifiers. To analyze usage trends, they calculated monthly telehealth rates using the total number of pregnant people as denominators and the number with at least one telehealth encounter as numerators.
The study identified 14,321,649 prenatal care encounters, including 44,143 telehealth visits. Of these, 37,982 were video calls, 4081 were phone calls, and 646 used remote monitoring.
Telehealth use for prenatal care remained at 0.1% from January 2018 to February 2020. During the early COVID-19 pandemic, it surged to 2.4% in March, 6.9% in April, 5.7% in May, and 4.5% in June of 2020. After the second year of the pandemic, the monthly rate gradually declined to 3.8% in March 2021, 3.5% in March 2022, 3.1% in March 2023, and 2.6% in March 2024.
“Policymakers, payers, professional societies, and providers should assess and modify barriers and facilitators for telehealth utilization to improve access to prenatal care services during this digital age,” wrote investigators.
READ MORE: Women's Health Resource Center
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