How lessons learned during Covid-19 are helping Cheshire & Merseyside address equity and equality in maternity care
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Remote Pregnancy Monitoring for High Risk Pregnancies
Co-designed with an active clinical lead, care teams and patient representatives, the Graphnet myMaternity app enables pregnant women to be regularly and safely monitored remotely.
An app for high-risk pregnancy monitoring
Our easy-to-use app allows the woman to quickly record key findings using an NHS login, such as blood pressure and blood sugar against personalised observation thresholds set by her clinical team. Her observations and accompanying comments are fed in real-time to a clinician’s caseload and monitoring view for review and action if needed.
Digital safety netting and triage advises next steps on data input, including a link to contact the monitoring team). The app provides a complete history of recordings and advice from the care team. All information is recorded within the Graphnet Shared Care record with the pregnant woman receiving advice from the care team via a Shared Care record e form.
In addition to this, any authorised user can access a caseload dashboard which shows RAG status of patients enrolled at cohort level, they are then able to access the patient’s record and a pregnancy monitoring tile within the Shared Care record listing all recordings.
High-risk pregnancy monitoring use case
In Greater Manchester, women identified as being at risk of pre-eclampsia are provided with free blood pressure monitors and an app to record their readings at home, without needing to attend hospital or clinic as frequently.
Women with diabetes can access their treatment plan via the app and record their blood sugar readings in a quick and intuitive way.
Women receive immediate, tailored advice from their clinical team based upon their readings. The readings and comments can then be accessed by their midwives who can monitor them in real-time and start additional treatment and personalise their blood pressure thresholds if necessary.
The app and clinical portal content was co-designed and reviewed with the help of the local care teams and highly engaged patients. The project is part of part of Health Innovation Manchester’s work in improving the detection of pre-eclampsia through adoption and spread of Placental Growth Factor (PlGF) - based testing.
Benefits of remote pregnancy monitoring
- No need to attend hospital or clinic
- Used to detect pre-eclampsia
- Observations and comments entered in the app are available immediately in the clinical portal
- Personalised observation thresholds are determined and managed by the clinical teams
- Complex clinical rules determine which parameters to use and actions to take, so the woman receives timely and accurate advice
- Relevant information and contact details are activated by clinicians based on type of monitoring and booking location
- Medication notes for hypertension and diabetes are shared with the woman via the app
Equity and equality in maternity care
The Cheshire and Merseyside Women’s Health and Maternity Partnership have been pioneers of health equity in pregnancy.
This is as a result of a partnership programme bringing together a cross-section of organisations in the NHS aiming to improve women's health and maternity experiences. The programme focused on addressing health inequalities in terms of outcomes, access, and services since it was established in 2015. However, Covid-19 threw the issue into even sharper focus. It proved to be a catalyst for accelerated change that is now embedded across the integrated care system.
There are significant stark health inequalities across the local ICS footprint which covers 2.5 million people. As an example, Liverpool and Knowsley are in the top three of the most deprived in the country. Pregnancy brings magnifies those healthcare inequalities.
Initially, one of the barriers for Cheshire and Merseyside was the lack of detailed data and information about the women that were coming forward for the covid vaccine, along with those that were hesitant about receiving it.
Cheshire & Merseyside held no definitive data about the number of women who were coming forward for the vaccine, or even those who weren't. The ICS couldn't report on where these women were living, what their ethnicity was and why some of them were hesitant about getting the vaccine. With that in mind they started to look at how a pregnancy dashboard could be developed that would allow tracking of data using NHS numbers and help focus on interventions.
It was clear that there could also be additional benefits, such as cutting down on duplication of records from both primary care and out in the community and reducing the amount of workforce time and effort that was going into manually looking at records.
The Cheshire and Merseyside pregnancy dashboard
The Cheshire and Merseyside Women’s Health and Maternity Partnership worked with their population health intelligence colleagues at CIPHA (the Combined Intelligence for Population Health Action) and Graphnet to develop an interactive pregnancy dashboard. The data that flowed into the dashboard gave Cheshire and Merseyside a clear picture of how many women were coming forward to be vaccinated, which stage of gestation they were in, age, ethnicity, any long-term conditions and the socioeconomic factors in terms of where they lived.
This provided a rich pool of intelligence and highlighted priority actions. Cheshire & Merseyside then took that data and worked collaboratively across the system – not just with health but with communities, including through their own community engagement team who have many connections with local groups and leaders.
What became apparent was that much of the success around vaccination uptake amongst pregnant women was related to how they were being communicated to – the language, the promotion of it. This rapidly influenced how to engage with people.
They also quickly started to understand some of the other health issues that they needed to look at. They tapped into the experience of their team, including the many multi-lingual employees that were well connected with local communities to try and address those areas. When going out into the community, they found that people began to engage about other factors that were encroaching on their lives – there were many discussions around poverty, debt and domestic violence. This allowed Cheshire & Merseyside to then signpost them to other organisations to help and support.
The Cheshire and Merseyside Women’s Health and Maternity Partnership used this data and interaction with local communities to take the vaccination to their citizens. That included a roving vaccination bus, which attracted hundreds of people.
In terms of health equity, in December 2021, Cheshire and Merseyside had a vaccination rate of 56.4% amongst pregnant women, which had increased to 70.8% by December 2022. Putting that into perspective, the year before the figure had been zero.
