Effectiveness of Telehealth for Women’s Preventive Services [Internet]

Excerpt

Objectives: To evaluate the effectiveness, use, and implementation of telehealth for women’s preventive services for reproductive healthcare and interpersonal violence (IPV), and to evaluate patient preferences and engagement for telehealth, particularly in the context of the coronavirus (COVID-19) pandemic.

Data sources: Ovid MEDLINE^®, CINAHL^®, Embase^®, and Cochrane CENTRAL databases (July 1, 2016, to March 4, 2022); manual review of reference lists; suggestions from stakeholders; and responses to a Federal Register Notice.

Review methods: Eligible abstracts and full-text articles of telehealth interventions were independently dual reviewed for inclusion using predefined criteria. Dual review was used for data abstraction, study-level risk of bias assessment, and strength of evidence (SOE) rating using established methods. Meta-analysis was not conducted due to heterogeneity of studies and limited available data.

Results: Searches identified 5,704 unique records. Eight randomized controlled trials, one nonrandomized trial, and seven observational studies, involving 10,731 participants, met inclusion criteria. Of these, nine evaluated IPV services and seven evaluated contraceptive care, the only reproductive health service studied. Risk of bias was low in one study, moderate in nine trials and five observational studies, and high in one study. Telehealth interventions were intended to replace usual care in 14 studies and supplement care in 2 studies. Delivery modes included telephone (5 studies), online modules (5 studies), and mobile applications (1 study), and was unclear or undefined in five studies. There were no differences between telehealth interventions to supplement contraceptive care and comparators for rates of contraceptive use, sexually transmitted infection, and pregnancy (low SOE); evidence was insufficient for abortion rates. There were no differences between telehealth IPV services versus comparators for outcomes measuring repeat IPV, depression, post-traumatic stress disorder, fear of partner, coercive control, self-efficacy, and safety behaviors (low SOE). The COVID-19 pandemic increased telehealth utilization. Barriers to telehealth interventions included limited internet access and digital literacy among English-speaking IPV survivors, and technical challenges and confidentiality concerns for contraceptive care. Telehealth use was facilitated by strategies to ensure safety of individuals who receive IPV services. Evidence was insufficient to evaluate access, health equity, or harms outcomes.

Conclusions: Limited evidence suggests that telehealth interventions for contraceptive care and IPV services result in equivalent clinical and patient-reported outcomes as in-person care. Uncertainty remains regarding the most effective approaches for delivering these services, and how to best mobilize telehealth, particularly for women facing barriers to healthcare.