Hans van den Heuvel

Moreover, a survey amongst 89 German physicians concluded that nearly 70% considered apps for pregnancy monitoring reasonable. 21 Other reported advantages in favor of telemonitoring are the reduction of admissions and burden on hospital personnel. 18,19 Staff shortages are also demanding for a shift from hospital to home-based care. In the Netherlands, approximately 170,000 children are delivered per year, both from uncomplicated as well as complicated pregnancies. We estimated earlier that 11% of pregnant women need antenatal hospital admission because of complications, which equals to 18,700 women yearly. With use of our respondents’ results, we calculated that 1,145 to 1,865 pregnant women were monitored from home in 2018. This number roughly equals 6-10% of antenatal hospital admissions that were replaced by home- and/or telemonitoring in 2018. Although exact numbers of length of hospitalization during high-risk pregnancy are lacking, we can use these numbers to estimate the possible impact of home- and telemonitoring on admission in pregnancy. If home- or telemonitoring services in pregnancy would be used for approximately 5 days/nights per pregnant women, this would equal a reduction of 5725 to 9325 admission days otherwise spent in the hospital on ward. The number of studies on the implementation of telemonitoring using patient-recorded daily CTG is limited. Despite this limited knowledge of the effects of pregnancy telemonitoring on perinatal outcomes, patient experiences and cost-effectiveness, this study shows that its use is increasingly popular in the Netherlands. Although not mentioned by our respondents, legal concerns, such as third party control and use of data, can be a limitation in widespread use of digital health. In the Netherlands, external companies providing the devices, software and storage of patient data of telemonitoring must commit to certain certificates for data security. Evidence from clinical trials and health technology assessments will help to better estimate the exact budgetary impact, from several different (i.e. societal, insurance, hospital) perspectives. The costs involved in development, use and maintenance of the devices, as well as the way in which they are imbedded in the current practice, are also needed to calculate the added value of pregnancy telemonitoring. Our survey respondents report challenges with reimbursement, since there is no coverage for pregnancy telemonitoring in the Netherlands. Financial issues are also the main reason given by our respondents without home- or telemonitoring, especially the smaller obstetric units. Insurance companies arewell known to only cover well-researched digital health interventions with according economic evaluation. 22,23 To compare daily telemonitoring at home versus traditional hospital care for complicated pregnancies, a multi-center randomized controlled trial is currently recruiting in 6 Dutch hospitals: the HOTEL trial (HOspital admission versus TELemonitoring in high risk pregnancy). 16 This trial aims to compare both strategies with regards to perinatal outcome, patient satisfaction and cost-effectiveness. CHAPTER 9 154