How the Pandemic Has Changed Telehealth in OB/GYN
A panel discussion at the 2021 American College of Obstetrics and Gynecology’s (ACOG) Annual and Scientific Meeting, being held virtually April 30-May 2, offers insight into how the COVID-19 pandemic has changed telehealth in ob/gyn.
Although it’s been around in some capacity for the past 50 years, telehealth and its potential to transform care has become increasingly apparent over the past year, with many patients being satisfied with the care that they’ve received at such visits. A panel discussion at the annual ACOG meeting examined how telehealth had been used over the course of the year. Moderated by Nathaniel G. DeNicola, MD, MSHP, assistant professor of ob/gyn at the George Washington School of Medicine & Health Sciences in Washington, DC, the discussion looked at telehealth in low-risk obstetrics, high-risk obstetrics, and family planning.
For low-risk obstetrics, Kathryn Marko, MD, NCMP, assistant professor of ob/gyn at the George Washington School of Medicine & Health Sciences, said that previous research had shown that although telehealth interventions hadn’t improved vaccination rates and pregnancy wellness, they have shown some effectiveness in smoking cessation programs as well as promoting exclusive breastfeeding and breastfeeding continuation. Marko noted that there had been discussion about changing prenatal care before the pandemic start, but the past year has illustrated that appointments can be spaced out with certain components that require in-person care grouped together and that remote monitoring can ensure proper care along with patient satisfaction. Postpartum care can also be effectively done through telehealth, although evidence still is mixed about phone support. In high-risk pregnancies, telehealth offers a way to monitor diabetes and hypertension and there is moderate evidence that using telehealth can maintain outcomes for mother and child, even with a reduction in outpatient clinic appointments.
Curtis L. Lowery, MD, director of the University of Arkansas for Medical Sciences Institute of Digital Health & Innovation in Little Rock, said that in the postpartum period for high-risk pregnancies telehealth would offer an effective way to track hypertension in the immediate postpartum period.
For family planning, telehealth is more complicated, however. In cases of medical abortions using mifepristone where the patient received the medication after a telehealth visit, a study showed that receiving care via telehealth was not inferior to a traditional clinic visit and a majority of the cases were performed at 13 weeks or less. However, there are 19 states that will not allow for telehealth visits for a medical abortion including much of the southeast United States as well as the Midwest. Additionally, mifepristone’s risk evaluation and mitigation strategy requires it to be dispensed in person at either a clinic, medical office, or hospital. Over the past year, the requirement has been removed temporarily because of the pandemic or reinstated, but the US Food and Drug and Administration issued a letter in April 2021 that lifted the requirement during the pandemic. Contraception also poses a problem with telehealth, said Daniel A. Grossman, MD, professor of Obstetrics, Gynecology, and Reproductive Sciences at the University of California, San Francisco, with some states not allowing the use of telehealth for contraception as well as some states putting age restrictions on it. He urged further research into how telehealth could expand contraception access.