Hans van den Heuvel

Possible disadvantages of home-monitoring and telemonitoring for the patient include the possibility of a delay in providing help in case of an emergency or acute problem, because the patient is not physically present in the hospital. Technical issues and insecurity regarding the devices are also mentioned (Textbox 1). Text ox 1: Advantages and disadvantages of home- and telemonitoring for patients, as addressed by 57 respondents . Advantages n (%) Improved patient comfort 40 (70) Reduced (emotional) burden of admission 35 (61) Reduced stress/more rest 25 (44) Better patient autonomy 21 (37) Higher patient satisfaction 8 (14) Higher patient safety 7 (12) Reduced over-medicalization during pregnancy 2 (4) Disadvantages n (%) Possible delay in providing help during emergencies or acute problems 38 (67) No direct communication with the consulting gynecologist 18 (31) Patients’ inability to conduct CTGa at home 13 (23) Technical issues 17 (30) Inability to follow instructions 12 (21) Respondents reported a number of perceived benefits of home- and telemonitoring for the healthcare provider, the most important being the reduction of admissions, which in turn may reduce health care costs (45 of all 57 respondents, 79%) and less burden on the hospital personnel (46%). Most mentioned disadvantages of home- and telemonitoring for clinicians are: costs and reimbursement (66%), impossibility of direct patient assessment (32%) and specific for the home monitoring: lack of sufficient obstetric personnel to make home visits (38%). Number of high-risk pregnant women managed from home In all 19 home monitoring centers combined, respondents reported a minimum of 745 to a maximum of 1140 patients with a singleton pregnancy were monitored with home visits in 2018 in the Netherlands. The telemonitoring centers responded that, in their 17 centers combined, a minimum of 400 to a maximum of 725 patients with a singleton pregnancy were monitored with remote monitoring devices in 2018 in the Netherlands. Altogether, in 2018 in the Netherlands, 1145 to 1865 women with a complicated pregnancy were managed at home with home-monitoring and telemonitoring, as an alternative to hospital admission. CHAPTER 9 152