Oregon Health & Science University researchers have found that replacing or supplementing in-person care with telehealth generally results in similar, and sometimes better, clinical outcomes compared with in-person care.
In particular, the study, published in the Journal of General Internal Medicine, found comparable outcomes for services related to contraception and intimate partner violence, demonstrating that telehealth, even for sensitive preventive services like family planning, can still meet the needs of patients.
"We know that telehealth can be a valuable tool to increase access and availability of care and services, especially to those who face barriers to receiving traditional care," said Amy G. Cantor, M.D., M.P.H., associate professor of medical informatics and clinical epidemiology, family medicine and obstetrics and gynecology in the OHSU School of Medicine. "These findings are encouraging because they provide valuable insight for us to create more effective design and delivery of telehealth services, and hopefully provide higher quality care to women who need it."
Recent research has found that telehealth may improve maternal care, prompting OHSU experts to explore the approach in other areas of women's health care.
Traditionally, preventive services for women are either integrated into regular in-person visits or offered when the opportunity arises during the management of other existing health conditions. This research investigated telehealth for care related to contraception and intimate partner violence, or IPV. Telehealth services offered for contraception care can include screening, counseling, provision of care and follow-up, and for IPV can include screening, diagnosis, treatment and referrals.
Although telehealth was rapidly expanded across different care settings in response to the COVID-19 pandemic, there is a lack of data supporting telehealth delivery of specific preventive services for women, as well as how to best mobilize telehealth to address women's health care needs — particularly for those who are geographically isolated or in marginalized or underserved communities. OHSU researchers aimed to both evaluate the effectiveness of telehealth for a specific subset of women's preventive services compared with in-person care, and to inform future efforts by policymakers, researchers and clinicians.
Cantor's team of researchers conducted a comprehensive comparative analysis of several clinical trials, including eight randomized controlled trials; one nonrandomized trial; and seven observational studies, which included more than 10,000 women receiving services for contraception or IPV.
Researchers analyzed the trials and found that when telehealth-delivered care was used to supplement or replace in-person services, clinical outcomes and patient satisfaction were similar, and sometimes better, compared with in-person care. Specifically, there were similar rates of contraceptive use, sexually transmitted infections and pregnancy in studies looking at contraception. There were also similar rates of IPV-related outcomes, including depression and posttraumatic stress disorder, compared with in-person care. Cantor said these results have positive implications for clinicians, who can feel confident that leveraging telehealth for certain preventive services will still meet the needs of their patients.
Although these findings are encouraging, Cantor hopes that future research will focus on how outcomes differ among populations who face significant health disparities. Looking forward, she also notes that research must consider the barriers to broader telehealth implementation, including limitations in internet access and varying levels of digital literacy.
"We still have questions around the potential barriers and disadvantages telehealth may pose in delivering care to certain underserved populations," Cantor said. "Developing telehealth approaches that are inclusive, accessible and sustainable is crucial to reduce disparities and improve health outcomes for women everywhere."
This work received financial support from the Agency for Healthcare Research and Quality (AHRQ), Contract No. 75Q80120D00006.
