Clinical Applications of Telemedicine in Gynecology and Women's Health

First-trimester medication abortion via telemedicine: A retrospective cohort study

Background

Following the decriminalization of abortion in Colombia and amidst a global health crisis due to COVID-19, Profamilia implemented a telemedicine-assisted first-trimester Medication Abortion (MAB) program. This is an opportunity to reduce inequalities in access and to promote empowerment and sexual and reproductive rights. This study aims to describe socio-demographic and clinical characteristics of users and to assess its effectiveness and safety.

Study design

A retrospective cohort study.

Methods

The study analyzed data from users who received Profamilia's telemedicine abortion services between August 2021 and August 2022 (n = 3073). A descriptive analysis of their sociodemographic and clinical characteristics was performed, grouping, and comparing them according to follow-up status and abortion outcome. Effectiveness was assessed by the percentage of complete abortions without surgical intervention, and safety by the incidence of complications, potential adverse events, and potentially dangerous signs.

Results

Most of the users were less than 8 weeks gestation at the start of treatment (88.3 %), from low socioeconomic strata (84.8 %), affiliated to the subsidized healthcare system (87.6 %), with educational levels up to secondary school (81.6 %), between 18 and 35 years (87.4 %), from urban areas (97.8 %) and singles (90,8 %). 94.9 % of users had a complete abortion using medication, and 0.3 % of cases reported complications.

Conclusions

First-trimester MAB through telemedicine in the Latin American context is an effective and safe choice. Telehealth is an important strategy to expand access to safe abortion care, especially for those with limited financial means or educational backgrounds. Rural and marginalized populations need more attention to improve access.

The web-based Pleasure&Pregnancy programme in the treatment of unexplained infertility: a randomized controlled trial

STUDY QUESTION

Does offering the Pleasure&Pregnancy (P&P) programme rather than expectant management improve naturally conceived ongoing pregnancy rates in couples diagnosed with unexplained infertility?

SUMMARY ANSWER

The P&P programme had no effect on the ongoing pregnancy rates of couples with unexplained infertility.

WHAT IS KNOWN ALREADY

Underpowered studies suggested that face-to-face interventions targeting sexual health may increase pregnancy rates. The impact of an eHealth sexual health programme had yet to be evaluated by a large randomized controlled trial.

STUDY DESIGN, SIZE, DURATION

This is a nationwide multi-centre, unblinded, randomized controlled superiority trial (web-based randomization programme, 1:1 allocation ratio). This RCT intended to recruit 1164 couples within 3 years but was put on hold after having included 700 couples over 5 years (2016-2021). The web-based P&P programme contains psychosexual information and couple communication, mindfulness and sensate focus exercises aiming to help maintain or improve sexual health, mainly pleasure, and hence increase pregnancy rates. The P&P programme additionally offers information on the biology of conception and enables couples to interact online with peers and via email with coaches.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Heterosexual couples with unexplained infertility and a Hunault-prognosis of at least 30% chance of naturally conceiving a live-born child within 12 months were included, after their diagnostic work-up in 41 Dutch secondary and tertiary fertility centres. The primary outcome was an ongoing pregnancy, defined as a viable intrauterine pregnancy of at least 12 weeks duration confirmed by an ultrasound scan, conceived naturally within 6 months after randomization. Secondary outcomes were time to pregnancy, live birth, sexual health, and personal and relational well-being at baseline and after 3 and 6 months. The primary analyses were according to intention-to-treat principles. We calculated relative risks (RRs, pregnancy rates) and a risk difference (RD, pregnancy rates), Kaplan-Meier survival curves (live birth over time), and time, group, and interactive effects with mixed models analyses (sexual health and well-being).

MAIN RESULTS AND THE ROLE OF CHANCE

Totals of 352 (one withdrawal) and 348 (three withdrawals) couples were allocated to, respectively the P&P group and the expectant management group. Web-based tracking of the intervention group showed a high attrition rate (57% of couples) and limited engagement (i.e. median of 16 visits and 33 min total visitation time per couple). Intention-to-treat analyses showed that 19.4% (n = 68/351) of the P&P group and 22.6% (n = 78/345) of the expectant management group achieved a naturally conceived ongoing pregnancy (RR = 0.86; 95% CI = 0.64-1.15, RD = -3.24%; 95% CI -9.28 to 2.81). The time to pregnancy did not differ between the groups (Log rank = 0.23). Live birth occurred in 18.8% (n = 66/351) of the couples of the P&P group and 22.3% (n = 77/345) of the couples of the expectant management group (RR = 0.84; 95% CI = 0.63-1.1). Intercourse frequency decreased equally over time in both groups. Sexual pleasure, orgasm, and satisfaction of women of the P&P group improved while these outcomes remained stable in the expectant management group. Male orgasm, intercourse satisfaction, and overall satisfaction decreased over time with no differences between groups. The intervention did not affect personal and relational well-being. Non-compliance by prematurely starting medically assisted reproduction, and clinical loss to follow-up were, respectively, 15.1% and 1.4% for the complete study population. Per protocol analysis for the primary outcome did not indicate a difference between the groups. Comparing the most engaged users with the expectant management group added that coital frequency decreased less, and that male sexual desire improved in the intervention group.

LIMITATIONS, REASONS FOR CAUTION

The intended sample size of 1164 was not reached because of a slow recruitment rate. The achieved sample size was, however, large enough to exclude an improvement of more than 8% of the P&P programme on our primary outcome.

WIDER IMPLICATIONS OF THE FINDINGS

The P&P programme should not be offered to increase natural pregnancy rates but may be considered to improve sexual health. The attrition from and limited engagement with the P&P programme is in line with research on other eHealth programmes and underlines the importance of a user experience study.

STUDY FUNDING/COMPETING INTEREST(S)

Funded by The Netherlands Organisation for Health Research and Development (ZonMw, reference: 843001605) and Flanders Research Foundation. C.B.L. is editor-in-chief of Human Reproduction. H.W.L. received royalties or licences from Prometheus Publishers Springer Media Thieme Verlag. J.B. received support from MercK for attending the ESHRE course 'The ESHRE guideline on ovarian stimulation, do we have agreement?' J.v.D. reports consulting fees and lecture payments from Ferring, not related to the presented work, and support for attending ESHRE from Goodlife and for attending NFI Riga from Merck. A.H. reports consulting fees by Ferring Pharmaceutical company, The Netherlands, paid to institution UMCG, not related to the presented work. H.V. reports consulting fees from Ferring Pharmaceutical company, The Netherlands, and he is a member of the ESHRE guideline development group unexplained infertility and Chair of the Dutch guideline on unexplained infertility (unpaid). M.G. declares unrestricted research and educational grants from Ferring not related to the presented work, paid to their institution VU Medical Centre. The other authors have no conflicts to declare.

TRIAL REGISTRATION NUMBER

NTR5709.

TRIAL REGISTRATION DATE

4 February 2016.

DATE OF FIRST PATIENT’S ENROLMENT

27 June 2016.

Telemedicine for Preoperative Assessment, Surgical Appointments, and Preoperative Education in Gynecological Day Surgery: An Prospective Observational Analysis

Background

This study investigates the differences in the cost, time, pre-operative education and patient satisfaction levels of patients requiring a second hysteroscopic surgery using a full-service model of remote preoperative assessment, surgical appointments, and preoperative education.

Methods

Forty-one patients who were proficient in the use of telemedicine platforms, planned to undergo a second hysteroscopic surgery, and selected either telemedicine (N=21) or face-to-face (N=20) models for their preoperative assessments, surgical appointments, and preoperative education were included. The data were analyzed using the Mann-Whitney U-test and Fisher's exact test.

Results

No significant demographic differences were observed between patients who used telemedicine and those who did not. The telemedicine group demonstrated significantly lower median travel time (40 min vs 205 min, P < 0.01), time spent in hospital (60 min vs 155 min, P < 0.01), meal time (0 min vs 60 min, P < 0.01), and total time spent (108 min vs 415 min, P < 0.01). Similarly, the telemedicine group had significantly lower median travel expenses (40 yuan vs 300 yuan, P < 0.01) and meal expenses (0 yuan vs 135 yuan, P < 0.01), and overall, total expenses (255 yuan vs 837 yuan, P < 0.01). 95.2% of the telemedicine group completely understood the preoperative education, compared to 100% who completely understood in the face-to-face group (P = 1.00). All patients in the telemedicine group were very satisfied compared to 80% in the face-to-face group (P = 1.00).

Conclusion

Telemedicine may be a feasible and advantageous method for preoperative assessment, surgical appointments, and preoperative education in gynecological day surgery. The application of telemedicine has demonstrated notable time and cost efficiency with high patient satisfaction levels. Future research should explore the full potential of telemedicine in this setting and for other surgical procedures.

Telemedicine for the provision of medication abortion to pregnant people at up to twelve weeks of pregnancy: a systematic literature review and meta-analysis

BACKGROUND

Telemedicine represents an important strategy to facilitate access to medication abortion (MAB) procedures, reduces distance barriers and expands coverage to underserved communities. The aim is evaluating the self-managed MAB (provided through telemedicine as the sole intervention or in comparison to in-person care) in pregnant people at up to 12 weeks of pregnancy.

METHODS

A literature search was conducted using electronic databases: MEDLINE, Embase, Cochrane (Central Register of Controlled Trials and Database of Systematic Reviews), LILACS, SciELO, and Google Scholar. The search was based on the Population, Intervention, Comparison, Outcome, and Study Design (PICOS) framework, and was not restricted to any years of publication, and studies could be published in English or Spanish. Study screening and selection, risk of bias assessment, and data extraction were performed by peer reviewers. Risk of bias was evaluated with RoB 2.0 and ROBIS-I. A narrative and descriptive synthesis of the results was conducted. Meta-analyses with random-effects models were performed using Review Manager version 5.4 to calculate pooled risk differences, along with their individual 95% confidence intervals. The rate of evidence certainty was based on GRADE recommendations.

RESULTS

21 articles published between 2011 and 2022 met the inclusion criteria. Among them, 20 were observational studies, and 1 was a randomized clinical trial. Regarding the risk of bias, 5 studies had a serious risk, 15 had a moderate risk, and 1 had an undetermined risk. In terms of the type of intervention, 7 compared telemedicine to standard care. The meta-analysis of effectiveness revealed no statistically significant differences between the two modalities of care (RD = 0.01; 95%CI 0.00, 0.02). Our meta-analyses show that there were no significant differences in the occurrence of adverse events or in patient satisfaction when comparing the two methods of healthcare delivery.

CONCLUSION

Telemedicine is an effective and viable alternative for MAB, similar to standard care. The occurrence of complications was low in both forms of healthcare delivery. Telemedicine services are an opportunity to expand access to safe abortion services.

Use of telemedicine to obtain contraception among young adults: Inequities by health insurance

OBJECTIVES

The objective of this study was to describe the use of telemedicine for contraception in a sample of young adults and examine differences by health insurance coverage.

STUDY DESIGN

We analyzed survey data collected from May 2020 to July 2022 from individuals at risk of pregnancy aged 18 to 29 recruited at 29 community colleges in California and Texas. We used multivariable mixed-effects logistic regression models with random effects for site and individual to compare the use of telemedicine to obtain contraception by insurance status, sociodemographic characteristics, and state.

RESULTS

Our analytic sample included 6465 observations from 1630 individuals. Participants reported using a contraceptive method obtained through telemedicine in just 6% of observations. Uninsured participants were significantly less likely than those privately insured to use contraception obtained through telemedicine (adjusted odds ratio [aOR], 0.54; 95% confidence interval [CI], 0.31-0.97), as were participants who did not know their insurance status (aOR, 0.54; 95% CI, 0.29-0.99). Texas participants were less likely to use contraception obtained via telemedicine than those in California (aOR, 0.42; CI: 0.25-0.69).

CONCLUSIONS

Few young people in this study obtained contraception through telemedicine, and insurance was crucial for access in both states.

IMPLICATIONS

Although telemedicine holds promise for increasing contraceptive access, we found that few young adults were using it, particularly among the uninsured. Efforts are needed to improve young adults' access to telemedicine for contraception and address insurance disparities.

Defining practices suitable for care via teleconsultation in gynaecological and obstetrical care: a French Delphi survey

OBJECTIVE

Delineate the scope of teleconsultation services that can be effectively performed to provide women with comprehensive gynaecological and obstetrical care.

DESIGN

Based on the literature and experts' insights, we identified a list of gynaecological and obstetrical care practices suitable for teleconsultation. A three-round Delphi consensus survey was then conducted online among a panel of French experts. Experts using a 9-point Likert scale assessed the relevance of each teleconsultation practice in four key domains: prevention, gynaecology and antenatal and postnatal care. Consensus was determined by applying a dual-criteria approach: the median score on a 9-point Likert scale and the percentage of votes either below 5 or 5 and higher.

SETTING

The study was conducted at a national level in France and involved multiple healthcare centres and professionals from various geographical locations.

PARTICIPANTS

The panel comprised 22 French experts with 19 healthcare professionals, including 12 midwives, 3 obstetricians-gynaecologists, 4 general practitioners and 3 healthcare system users. Participants were selected to include diverse practice settings encompassing hospital and private practices in both rural and urban areas.

PRIMARY AND SECONDARY OUTCOME MEASURES

The study's primary outcome was the identification of gynaecological and obstetrical care practices suitable for teleconsultation. Secondary outcomes included the level of professional consensus on these practices.

RESULTS

In total, 71 practices were included in the Delphi survey. The practices approved for teleconsultation were distributed as follows: 92% in prevention (n=12/13), 55% in gynaecology (n=18/33), 31% in prenatal care (n=5/16) and 12% in postnatal care (n=1/9). Lastly, 10 practices remained under discussion: 7 in gynaecology, 2 in prenatal care and 1 in postnatal care.

CONCLUSIONS

Our consensus survey highlights both the advantages and limitations of teleconsultations for women's gynaecological and obstetrical care, emphasising the need for careful consideration and tailored implementation.

Healthcare and research priorities for women with polycystic ovary syndrome in the UK National Health Service: A modified Delphi method

OBJECTIVE

Polycystic ovary syndrome (PCOS) is a chronic lifelong condition affecting up to 20% of women worldwide. There is limited input from affected women to guide the provision of healthcare services and future research needs. Our objective was to scope the healthcare and research priorities of women with PCOS in the United Kingdom.

DESIGN

A three-staged modified Delphi method, consisting of two questionnaires and a consensus meeting involving lay representatives and healthcare professionals.

PATIENTS AND MEASUREMENTS

Lay patient representatives of women with PCOS. Participants were asked to identify and rank healthcare and research priorities for their importance.

RESULTS

Six hundred and twenty-four lay participants took part in our Delphi method. Over 98% were diagnosed with PCOS (614/624, 98.4%). More than half experienced difficulties to receive a PCOS diagnosis (375/624, 60%), and the majority found it difficult to access specialised PCOS health services in the NHS (594/624, 95%). The top two healthcare priorities included better education for health professionals on the diagnosis and management of PCOS (238/273, 87.1%) and the need to set up specialist PCOS services (234/273, 85.7%). The top two research priorities focused on identifying better treatments for irregular periods (233/273, 85.3%) followed by better tests for early PCOS diagnosis (230/273, 84.2%).

CONCLUSIONS

We identified 13 healthcare and 14 research priorities that reflect the current health needs of women with PCOS in the United Kingdom. Adopting these priorities in future healthcare and research planning will help to optimise the health of women with PCOS and increase patient satisfaction.

Data protection concerns are a statistically significant reason for refusal: Exploratory study of the patient perspective on telemedicine services based on 735 gynecological surgery patients

Objective

Internet-based healthcare is a crucial facet of telemedicine. Here, we examine telemedicine methods in perioperative care for gynecological surgery from a patient's perspective. We aim to understand the patients' needs during perioperative gynecological care and suggest how to optimize telemedicine services based on these insights.

Methods

The data were gathered via self-report questionnaires from patients who came in for preparatory consultations for gynecological surgery from May to November 2022. This process involved questioning 735 women about their past usage of internet-based services, personal information, and their views on telemedicine services. The study, which assured full anonymity, had voluntary participation.

Results

This participant pool consisted of 735 females. Around half (n = 365, 49.66%) were preparing for outpatient surgery, while a significant number (n = 322, 43.81%) were slated for inpatient surgery. Statistically, data protection concerns were the only significant factor influencing consent to telemedicine. While nonsignificant results were found for individuals with minimal concerns (b = 0.08; odds ratio [OR] = 1.09, p = 0.791), markedly significant results (p < 0.001) emerged for those expressing more concerns with b = 1.45 and OR = 4.28. This suggests that the likelihood of refusing consent to telemedicine is 4.28 times higher for those with significant data protection concerns compared with those with no concerns.

Conclusion

The patient's perspective on telemedicine services for gynecological surgery is influenced by several factors. These include the patient's age, computer skills, travel distance, occupation, education level, severity of the disease, satisfaction with previous treatments, treatment location, and referral method. Of these, concerns about data security significantly impact patient satisfaction. Hence, it is critical to prioritize this factor when offering telemedical services to meet patients' needs.

Comparison of interpersonal quality of contraceptive counseling delivered via telehealth versus in person

OBJECTIVES

This study aimed to compare the interpersonal quality of contraceptive counseling between telehealth and in-person visits.

STUDY DESIGN

Patients at a single Title X-funded clinic selected their preferred counseling modality (in person or telehealth via video or telephone) when scheduling an appointment for contraception. After counseling, we invited patients to complete a survey and recorded their desired contraceptive method. We assessed the quality of counseling using the Interpersonal Quality in Family Planning scale. We reviewed the electronic medical record to identify any subsequent clinician visit. We performed between-group comparisons using Mann-Whitney U, χ2, and Fisher exact tests.

RESULTS

From March 2021 to June 2022, 360 patients were eligible to participate, and 296 (82%) completed the survey and were included in the analysis; 150 (51%) completed counseling in person, and 146 (49%) completed counseling via telehealth. In the telehealth group, 102 (70%) chose telephone, and 44 (30%) chose video. Respondent characteristics were similar between groups. The majority of respondents in both groups reported high quality of counseling, defined as a top score on the Interpersonal Quality in Family Planning scale (75.0% telehealth respondents and 80.0% in person, p = 0.30). Compared to respondents completing in-person counseling, telehealth respondents were less likely to have a subsequent clinician visit (89.0% versus 100.0%, p < 0.001).

CONCLUSIONS

The majority of respondents reported high-quality contraceptive counseling without significant difference between the modalities. However, respondents choosing telehealth were less likely to have a subsequent clinician visit. Given the higher uptake of telephone compared to video, telehealth via telephone may be more accessible or acceptable to some patients.

IMPLICATIONS

Contraceptive counseling via telehealth has similar high interpersonal quality when compared to traditional, in-person visits. However, barriers may exist for patients who choose telehealth contraceptive counseling to access subsequent in-person care. Utilization of telehealth for contraceptive visits may provide opportunities for more equitable health care and to expand contraceptive access.

Demand-oriented design of telemedical services in gynecologic oncology

BACKGROUND

The medical field is in the midst of a massive expansion in telemedical services. However, it is not possible to say to what extent telemedical offerings can be designed to meet needs in the German healthcare system. This study provides insights into demand-oriented care using telemedical services for gynecological patients.

METHODS

A total of 262 patients who received systemic therapy for gynecological oncology were surveyed anonymously using a questionnaire regarding their acceptance of telemedicine from February 2021 to April 2021.

RESULTS

Insufficient computer skills were associated with less acceptance of telemedicine treatment by gynecological oncology patients and presented a barrier. However, the patient's level of education was not related to the level of acceptance. Long travel distances from medical facilities and some types of patient occupations significantly increased the acceptance of telemedicine services. A high level of education, on the other hand, was not associated with the approval of telemedical approaches. Long journeys and work commitments increased the acceptance of telemedical visits.

CONCLUSIONS

The results of this study show that the factors investigated have an influence on the acceptance of telemedical offerings by patients. Barriers such as insufficient computer skills must be taken into account when implementing telemedicine services. Telemedicine can provide physical and economic relief for patients if telemedical planning is tailored to their needs.

"Check Your Vulva"-A Patient Education and Virtual Vulva Care Pilot Project

OBJECTIVE

The aim of the study is to identify whether vulvar self-examination learned from a web site could lead to a self-identification of vulvar lesions and the feasibility of virtual vulvar care with patient submitted photos.

MATERIALS AND METHODS

The study used a prospective cohort design in a tertiary academic hospital over a 1-year period. Eligible participants who self-identified a vulvar lesion/skin changes were invited to send vulvar photos through a secure patient portal and schedule a phone consult to discuss diagnosis/management. Clinical data, photo interpretability, and patient satisfaction measures were collected. Self-referral patients versus vulva clinic waitlist patients were analyzed separately.

RESULTS

Few people were interested in submitting vulvar photos online. Twenty-eight participants directly contacted the study, 8 consented, and 6 sent in vulvar photos. Forty four of 476 on the waitlist consented but only 24 of 44 sent in photos (5% of waitlist patients). The median time for a virtual assessment was 7 days for study participants while it was 18 months for the in-person usual care pathway. Most patient submitted photos were assessable. However, 60% participants needed help from another person to take the photos. More than 90% of patients required an in-person visit for their vulvar condition/concerns. While most patients were happy with the virtual process, 58% rated their satisfaction with the ease of taking photos of the genital region as "fair" or "poor."

CONCLUSIONS

Virtual care with photos/phone calls might be feasible, although most patients are unlikely to participate. Because of patient discomfort, unease with taking photos, and patient privacy concerns, vulvar care should continue to be in-person for most new consults.

Role of telemedicine in obstetrics and gynecology: an experience at tertiary care center

BACKGROUND

The telemedicine/telehealth is well established and rapidly evolving innovation in modern practice of medicine. It is used in nearly every aspect of obstetrics and gynecology. Telehealth intervention may reduce the need for in-person visits amongst high-risk obstetric patients. It is an effective innovation for chronic gynecological conditions.

RESEARCH DESIGN AND METHODS

This was a prospective, observational study where the online platform 'e-Sanjeevani' was used. It was a health care worker to doctor (specialist) consultation regarding the patient. After an interaction, provisional diagnosis and management plan was made, and an electronic prescription for the same was generated and printed at the patient's end.

RESULTS

A total of 3219 patients were attended in 10 months. The majority of the cases had a gynecological problem (71.5%), with menstrual irregularity being the commonest. Among pregnant patients, consultations for early pregnancy complications were made in 29% of the cases. 5.8% were referred because of some surgical intervention.

CONCLUSION

Non-emergency patients who can be managed medically can be prevented from unnecessary visits to the hospital and managed through teleconsultation, which decreases the burden of patient load at the tertiary center.

Mental health in women undergoing gynecological surgery at risk of infertility

Surgery for benign gynecologic conditions may lead to infertility complications. In a cross-sectional study we investigated depressive and anxiety symptoms, Quality of Life (QoL), and coping strategies in women with benign gynecologic conditions undergoing surgical treatment (G1, N = 45) compared with women that did not need surgery (G2, N = 43), through the Patient's Health Questionnaire, the Short Form Health Survey-12 items, the Self-Rating Anxiety State, and the Brief COPE. Statistical analyses showed that women in G1 had significant higher depressive (p=.04) and anxiety (p=.03) symptoms, and lower QoL (p=.01), than did those in G2. Moreover, women with more depressive or anxiety symptoms in both groups were more likely to present maladaptive coping modalities. A careful evaluation of the mental health of women undergoing gynecological surgery at risk of infertility should be included in the care for benign gynecologic conditions, in order to prevent psychosocial distress and alleviate the burden on QoL.

Perceived Access to Contraception via Telemedicine Among Young Adults: Inequities by Food and Housing Insecurity

BACKGROUND

Telemedicine expanded rapidly during the COVID-19 pandemic, including for contraceptive services. Data are needed to understand whether young people can access telemedicine for contraception, especially in underserved populations.

OBJECTIVE

To compare young people's perceived access to telemedicine visits for contraception during the COVID-19 pandemic by food and housing insecurity.

DESIGN

Supplementary study to a cluster randomized controlled trial in 25 community colleges in California and Texas. Online surveys were administered May 2020 to April 2021. Mixed-effects logistic regression models with random effects for site were used to examine differences in access to contraception through telemedicine by food and housing insecurity status, controlling for key sociodemographic characteristics, including race/ethnicity, non-English primary language, health insurance status, and state of residence, and contraceptive method used.

PARTICIPANTS

1,414 individuals assigned female at birth aged 18-28.

MAIN MEASURES

Survey measures were used to capture how difficult it would be for a participant to have a telemedicine visit (phone or video) for contraception.

KEY RESULTS

Twenty-nine percent of participants were food insecure, and 15% were housing insecure. Nearly a quarter (24%) stated that it would be difficult to have a phone or video visit for contraception. After accounting for sociodemographic factors and type of method used, food insecure (adjusted odds ratio [aOR], 2.17; 95% confidence interval [CI], 1.62-2.91) and housing insecure (aOR, 1.62; 95% CI, 1.13-2.33) participants were significantly more likely to report that it would be difficult to use telemedicine for contraception during the pandemic.

CONCLUSIONS

Underserved patients are those who could benefit most from the expansion of telemedicine services, yet our findings show that young people experiencing basic needs insecurity perceive the greatest difficulty accessing these services for essential reproductive care.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03519685.

The covid-19 pandemic and the usability of telehealth in a midlife women's health integrated care program

BACKGROUND

Telehealth has emerged as an alternative to conventional, face-to-face visits, and the COVID pandemic has hastened its introduction. Telephone appointments make use of an easy-to-use and accessible technology.

AIM

To investigate the usability of telephone-based telehealth in a women's health outpatient clinic and whether this may be affected by the severity of the COVID pandemic.

METHOD

A telephone survey was prepared to explore two usability domains: interaction quality (4 items) and satisfaction, preference and future use (6 items). Women were selected from two periods during the COVID pandemic when the infection rates were high and low.

RESULTS

The survey was completed by 106 women (60 when the prevalence of COVID was high, mean age 53.58 years, and 46 when it was low, mean age 48.59 years) out of the 153 women who had a telephone appointment. The severity of the COVID pandemic showed an effect on responses. Women were less enthusiastic about using the telephone during the period of low COVID prevalence, as shown by lower scores on 3 of the 4 items of the first domain [I had enough time; I would have understood better in person; I would have expressed myself better in person (p < 0.001 for comparison between groups on each of the 3 items)], and on 4 of the 6 items in the second domain [satisfied with quality of care (p < 0.001), or with the information received (p = 0.018); use of telephone in future (p < 0.001); preference to try other technologies in future (p < 0.001)]. Overall, women expressed a preference for in-person visits regardless of COVID prevalence rates.

CONCLUSION

Telephone calls were a feasible alternative to face-to-face visits in a women's health outpatient clinic, but the pandemic pressure modified usability parameters. Respondents preferred in-person visits at any pandemic stage.

Telehealth as a potential tool for outreach among women in Puerto Rico

BACKGROUND

Access to the full spectrum of healthcare should be available to all individuals. After the revocation of the constitutional right to abortion, women have fewer alternatives to unplanned pregnancy. Telehealth provides an additional option for such pregnancies through its remote provision of services. This could benefit women of all social strata. However, data regarding telehealth among underserved populations are limited.

OBJECTIVE

This study aimed to evaluate the use of contraception, awareness of abortion services, and receptiveness to telehealth among women in Puerto Rico, a Spanish-speaking minority population.

STUDY DESIGN

This was a cross-sectional study of women living in Puerto Rico aged between 21 and 65 years. Data were collected with a self-administered survey via SurveyMonkey from March to December of 2021. Recruitment was done through social media and at the gynecology clinics of the University of Puerto Rico, Medical Sciences Campus and San Juan City Hospital. Analysis was done with Stata, version 14.2. Chi-square and Cochran-Armitage tests were used to evaluate the unadjusted relationship between variables. A P value ≤.05 was considered statistically significant.

RESULTS

A total of 286 women were recruited. Of these, 73.3% (189/258) were sexually active, 89.1% (229/257) were heterosexual, and 62.7% (163/260) were not using contraception. In addition, 63.3% (157/248) knew about emergency contraception, yet 42.4% (103/243) were unaware of any sources of access to it; 76.6% (197/257) were unaware of nearby abortion services. A higher education level was associated with knowing about emergency contraception (P<.05) and awareness of sources of access to it (P<.05). However, no significant association was found between a higher education level and awareness of nearby abortion services (P=.799). Regarding telehealth, 65.2% (176/270) were willing to use the service for future gynecologic visits, yet only 18.9% (51/269) were offered telehealth services. No association was found between previous telehealth experiences and willingness to use telehealth for future gynecologic visits (P=.325).

CONCLUSION

The lack of contraceptive use and unawareness of nearby abortion services place women at increased risk of unplanned pregnancy and unsafe practices. The gap between knowledge about and access to emergency contraception also calls for action. Telehealth may be of benefit given that most women showed interest in using it, and could be used for educating and providing women in Puerto Rico with contraception and medical abortions, further increasing their access to reproductive healthcare. Clarifying misconceptions and instructing women about safe practices is essential to our role as physicians. Ensuring women's access to adequate services is also vital for upholding their rights to healthcare.

Virtual postoperative visits following robotic gynecologic surgery: a study of patient satisfaction, safety, and feasibility

Since the onset of the COVID-19 pandemic the use of telehealth has burgeoned. Numerous surgical specialties have already adopted the use of virtual postoperative visits, but there is data lacking in both robotics and gynecology. In this single-institution prospective cohort study we sought to evaluate the patient satisfaction, feasibility and safety of postoperative telehealth visits following robotic gynecologic surgery. Thirty-three patients undergoing robotic gynecologic procedures participated in a postoperative telehealth visit approximately 2 weeks following surgery, of which 27 completed a survey which assessed participant satisfaction with the telehealth visit, overall health-related quality of life following surgery, exposure to telehealth visits, and social determinants of health. The mean satisfaction score was just below 'excellent'. Only 2 participants (6.3%) required an in-person visit. Postoperative telehealth visit satisfaction score was significantly associated only with BMI (Pearson r = 0.45, p = 0.018). These data suggest that telehealth visits following robotic gynecologic procedures appear to be safe and feasible, and are associated with a high level of patient satisfaction.

Use of telehealth: Evidence from French teleconsultation for women's healthcare, prior and during COVID-19 pandemic

Prior to the COVID-19 pandemic, French healthcare practitioners seldom used teleconsultations in France. COVID-19 has brought with it a great need for the use of teleconsultation and other interventions using digital technology. The study’s objective was to identify how French healthcare practitioners used teleconsultation for obstetrics and gynecology care services before and during COVID-19. Our study used a survey of French healthcare practitioners specializing in obstetrics and gynecology from 1 March 2020, to 31 April 2020. We first described the global picture of the teleconsultation context prior to COVID-19 and then during the first lockdown measures. For both contexts, we set up three aspects: 1- teleconsultation regarding providers’ ability; 2- teleconsultation with regards to its technological features; and 3- teleconsultation for which type of healthcare. Second, we mobilized logit models to study the determinant factors of teleconsultation use as well as what drives provider satisfaction with teleconsultation practice. We show the central role of training, and the importance of some main digital technology benefits, namely improving public health, responding to patients’ requests, and facilitating healthcare access. We also exhibit the importance of the limitations specifically related to the lack of convenience in digital technology use and the lack of trust in the digital service provided. Our results guide policy makers on suppliers’ motivation and needs for teleconsultation adoption. These results highlight the conditions for efficient use of teleconsultation.

The role of telemedicine in minimally invasive gynecologic surgery

PURPOSE OF REVIEW

Telemedicine has been available for decades but has had minimal use in the USA prior to the COVID-19 pandemic. We aim to educate readers on the benefits of telemedicine and provide insight from our experience to optimize care in this setting.

RECENT FINDINGS

The COVID-19 pandemic ushered in a massive increase in use of telemedicine, offering several advantages with comparable clinical outcomes.

SUMMARY

This review summarizes the recent vast expansion of telemedicine, describes the benefits specific to minimally invasive gynecologic surgery, and offers practical suggestions for maintaining a successful practice that incorporates both in-person and virtual experiences for patients, anticipating continued use of telemedicine beyond the end of the current public health emergency.

Satisfaction with new patient telehealth visits for reproductive endocrinology patients in the era of COVID-19

PURPOSE

To study patient satisfaction with new patient telehealth visits in a reproductive endocrinology and infertility (REI) office.

METHODS

A cross-sectional study in a university-based fertility clinic was completed including all new patients seen via telehealth between March 1, 2021, and August 19, 2021. Primary outcomes were perceived patient satisfaction, access, and preferences to telehealth visits.

RESULTS

A total of 351 participants were contacted, 61.8% (n = 217) agreed to participate in the study, and 28.8% (n = 101) completed the survey. There were no significant differences in age, BMI, distance from clinic, or length of infertility with response to survey. Ninety-three percent of responders would use telehealth services again and were satisfied with the telehealth system. Telehealth improved access to healthcare for 88% and travel time for 96%. The median distance from clinic was 24 miles, and there was no significance difference in preference for telehealth visits over in person visits (p = 0.696).

CONCLUSIONS

In the era of COVID-19, healthcare implementation has dramatically changed with a drastic increase in telehealth services. Based on our survey, majority of patients were satisfied with telehealth visits and believed it saved travel time while improving access to REI care. Despite no differences in patient preference for in person versus telehealth depending on their distance from clinic, this is reassuring because patients are satisfied with telehealth for reasons other than distance from clinic.

Telemedicine in prenatal care

Telemedicine, as a health service provided remotely, is increasingly becoming a common part of health care. Telemedicine is defined as "an umbrella term for health activities, services and systems operated remotely through information and communication technologies to promote global health, prevention and health care, as well as education, health management and health research". It also describes telemedicine as "the provision of services where distance is a critical factor, using information and communication technologies to exchange valid information for the diagnosis, treatment and prevention of disease and injury, for research and evaluation, and for the continuing education of healthcare providers to improve the health of individuals and communities". Both definitions imply that two of the hallmarks of telemedicine include the use of communication and information technologies to overcome distance as a critical factor, a factor that is well known to us, not least from the recent months of the COVID-19 pandemic. Distance medicine can thus act as a tool for improving access to health care and also complement health care itself in a very appropriate way.

Telemedicine in post-molar follow-up: is it a useful tool?

Background

Telemonitoring is an alternative to in-person appointments and overcomes geographic distance barriers.

Objective

The primary objective of this study was to evaluate adherence to post-molar follow-up using both WhatsApp and in-person appointments compared with standard care. The secondary objective was to evaluate the rate of completion of post-molar follow-up of complete moles, considering 6 and 3 months of duration.

Methods

This retrospective cohort study was conducted at the Gestational Trophoblastic Disease Center, São Paulo Hospital. Patients with complete or partial mole treatment between January 1, 2009 and December 31, 2018 were included in two groups: group 1 (patients from 2009 to 2013) and group 2 (from 2014 to 2018), before and after telemonitoring implementation, respectively. Complete follow-up was considered if after the first normal human chorionic gonadotropin (hCG) level (<5 mIU/mL), the patient was followed up for an additional 30 days (partial mole) or 180 days (complete mole). Loss to post-molar follow-up with positive hCG was also evaluated. Statistical analysis was performed using Pearson’s Χ2 test, 5% significance level (p=0.05), and R version 4.0.2.

Results

A total of 308 patients were included in the study, 92 of them were assessed in group 1 and 216 patients in group 2. There was no difference between the rates of complete follow-up after telemonitoring implementation (complete mole: 42/72=58.3% group 1 vs 85/163=52.1% group 2; p=0.38; partial mole: 16/20=80% group 1 vs 37/53=69.8 group 2; p=0.3), and no increase of loss to post-molar follow-up with positive hCG (8/92=8.7% group 1 vs 14/216=6.5% group 2; p=0.49). The shortening of follow-up of complete moles to 90 days increased the rate of complete post-molar follow-up (from 127/235=54.0% to 189/235=80.4%, p<0.001).

Conclusions

The association of telemonitoring with in-person appointments could have had an advantage in post-molar follow-up since it did not reduce adherence to hormonal surveillance. Shortening post-molar follow-up after complete mole to 90 days after the first normal hCG level increased the rate of complete post-molar follow-up.

Assessment of Saudi Women's Adherence and Experience with Venous Thromboembolism Prophylaxis after Cesarean Section Delivery Using Telemedicine Technology

Background

Telemedicine technology is widely used especially after the COVID-19 pandemic. It can be used to give medical advice as well as follow up with the patients at home in the outpatient setting. Low molecular weight heparin, such as enoxaparin, decreases the risk of venous thromboembolism after cesarean delivery.

Objective

assessing postcesarean women's adherence and experience to enoxaparin thromboprophylaxis regimens in the outpatient setting via telephone calls.

Methods

prospective cohort study was conducted in the Maternity and Children Hospital (MCH). Postcesarean women were interviewed at the postnatal ward in the MCH. The participants were followed up for 10 days of the delivery to assess their adherence to and experience with enoxaparin thromboprophylaxis. Suboptimal adherence was defined as the missing of one or more doses of enoxaparin.

Results

170 women participated in this study. The majority of them (78.8%) were fully adherent to enoxaparin while 21.2% missed at least one dose. The most-reported causes for suboptimal adherence were perceived lack of necessity (44.4%), forget to take the injection (30.6%), feeling of high load going to the primary care unit to take injection (27.8%), and fear of injection (11.1%).

Conclusion

Telemedicine technology could be used to assess patients' adherence. The study results showed that the majority of participants were fully adherent to postcesarean enoxaparin but more than 20% of the participants were suboptimal adherent. Proper patient education techniques could influence patients' adherence and potentially decrease the risk of DVT in those populations.

Barriers and facilitators affecting presentation in women with early versus advanced stage cervical cancer

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Structural and intrapersonal barriers to cervical cancer care persist but differ between early and advanced stage patients.

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Barriers in the early stage group were lack of knowledge, competing priorities, lack of insurance, and embarrassment.

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Barriers in the advanced stage group were lack of knowledge/risk, competing priorities, avoidance, fear of the healthcare system.

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Innovative methods to increase access to care and engagement with the healthcare system are needed.

Background

This study was performed to evaluate the barriers and facilitators associated with patient presentation for early stage (ES) versus advanced stage (AS) cervical cancer (CC).

Methods

A mixed-method approach was used to collect quantitative (i.e., demographics and medical/screening histories) and qualitative data (individual interviews assessing patients’ perceptions regarding their general health, HPV and CC screening, and barriers and facilitators to CC care). Two separate investigators coded the interviews for major themes that occurred with an agreement that 50% or more of the themes would be included.

Results

Twenty-five women agreed to participate in the study with 80% completing the interview. Patients with ES disease were classified as Stage IA1-Stage IB3; patients with Stage IIA-IVB disease were classified with AS disease. Frequent barriers in the ES group were lack of knowledge, competing priorities, feeling healthy, lack of time or health insurance, and being embarrassed/uncomfortable. Frequent barriers in the AS group were lack of knowledge, competing priorities, avoidance/procrastination, fear of the healthcare system or finding something wrong, and lack of perceived risk to CC. Facilitators for ES included understanding the importance of the Pap test, having an abnormal Pap test, and knowing someone with CC. Having abnormal symptoms was the only facilitator for AS patients.

Conclusions

Structural and intrapersonal barriers to CC care persist but differ between ES and AS patients. Multi-level interventions are needed to address the wide array of issues that women highlighted in this study including potential innovative methods to increase access to care and engagement with the healthcare system.

The role of telemedicine in gynecologic healthcare: A narrative review

ABSTRACT

This article offers a comprehensive narrative literature review on telemedicine use in gynecologic healthcare analyzing current telemedicine integration in the field and outlining innovative and best practices. Telemedicine use in contraceptive care, sexually transmitted infections, acute and chronic gynecologic conditions, and education are discussed. NPs are in a unique position to offer these services to patients in need of women's healthcare services. Barriers, facilitators, clinical implications, and future research are addressed.