XXtra care – The Use of Telemedicine in Women’s Health
Telemedicine has become more integrated into the delivery of effective care for women’s health with a range of potential uses including (but not limited to):
– Teleconsultations to access specialists for discussion regarding a range of topics such as contraception
– Remote monitoring of maternal health before and after pregnancy, and chronic illnesses including adenomyosis and endometriosis
– Abortion care
A target of telemedicine is to coordinate and better facilitate the health of people in remote locations and this is becoming a necessary and beneficial tool for improving women’s health, particularly in maternal morbidity and mortality. There has been a number of reported successful uses of teleconsultations to conduct real-time ultrasonograms for women who live in remote locations in the US1.
In addition, remote patient monitoring has been widely reported as a tool in the monitoring of gestational diabetes2, increasing the likelihood of a safer pregnancy3-5. There is insufficient evidence to state that these interventions are superior to ‘regular’ care, however, they are well established to not cause harm, and therefore the benefits are seen in the improvement of maternal satisfaction and streamlining clinical care delivery2.
Another area of women’s health care in which telemedicine has a clear potential to have an impact on is in abortion care. Teleconsultations may be helpful for counselling and assessment, the acquisition of abortion medication, and clinical guidance throughout the process6. These services can form part of local healthcare facilities, and work alongside care offered in‐person, but they can also operate independently to overcome geographical or legal barriers to abortion access in certain locations.
A direct-to-patient telemedicine service known as ‘TelAbortion’ was found to be safe, effective, efficient, and satisfactory in the US7. The service includes a videoconference with a clinician and pre-treatment laboratory tests, as well as an ultrasound at a facility of the patient’s choice. If a patient is eligible for medical abortion, the clinician then sends the medication and instructions by mail. After taking the medication, the patient has a follow-up consult with the clinician by telephone/videoconference to evaluate the procedure’s completeness7. The use of telemedicine in abortion care at the least offers a safe option and at most a life‐saving alternative. Patient reported outcomes in this field however are not properly conducted and therefore, substantiated policy recommendations on abortion care through telemedicine is not yet possible8.
The use of telemedicine shows extreme promise in improving women’s health, especially in the areas of maternal health and abortion care, but it requires a much greater push to ensure its maximum benefit for equal healthcare for women all over the globe.
References
1. Long, M. et al., Ultrasound in Telemedicine: Its Impact in High-Risk Obstetric Health Care Delivery. Ultrasound Quarterly, 30(3):167–172.
2. Ming, W.K. et al., Telemedicine Technologies for Diabetes in Pregnancy: A Systematic Review and Meta-Analysis. J Med Internet Res. 18(11):e290.
3. Mackillop, L. et al., Development of a real-time smartphone solution for the management of women with or at high risk of gestational diabetes. J Diabetes Sci Technol. 8(6):1105–14.
4. Carral, F. et al., Web-based telemedicine system is useful for monitoring glucose control in pregnant women with diabetes. Diabetes Technol Ther. 17(5):349–54.
5. Homko, C.J. et al., Use of an Internet-based telemedicine system to manage underserved women with gestational diabetes mellitus. Diabetes Technol Ther. 9(3):297–306.
6. Endler, M. et al., Telemedicine for medical abortion: a systematic review. BJOG, doi: 10.1111/1471-0528.15684.
7. Raymond, E., et al, TelAbortion: evaluation of a direct to patient telemedicine abortion Service in the United States. Contraception, S0010-7824(19)30176-3.
8. Fok, W.K. et al., Abortion through telemedicine. Curr Opin Obstet Gynecol, 30(6):394-399.