Key Clinical Issue

Does telehealth allow for the effective delivery of preventive services for women, and how can it best be used to address these needs?

Evidence-Based Answer

Telehealth interventions alone had similar outcomes compared with in-person visits for women presenting for care related to contraception and interpersonal violence (IPV). (Strength of recommendation [SOR]: B, inconsistent or limited-quality patient-oriented evidence.) Telehealth interventions used to supplement usual care resulted in similar outcomes for contraceptive use at six months and had similar rates of sexually transmitted infections (STIs) and pregnancy. (SOR: B, inconsistent or limited-quality patient-oriented outcomes.) Outcomes related to abortion rates were unclear. There were no studies addressing telehealth services for family planning or STI counseling. There is insufficient evidence for factors related to health equity and health care access or potential harms.^1,2

Practice Pointers

Research conducted before the COVID-19 pandemic suggests women are more likely than men to choose telehealth, even when the overall uptake of telemedicine is low.³ This may be because the time savings and virtual convenience are particularly attractive to caregivers, a role traditionally filled by women.³ The number of clinics reporting telehealth capabilities increased with the start of the COVID-19 pandemic, thereby presenting new opportunities for health care delivery, including preventive services.⁴

Research on telehealth effectiveness and acceptability has been proliferating. An Agency for Healthcare Research and Quality (AHRQ) review published before the COVID-19 pandemic found that telehealth visits improved clinical outcomes for wound care, psychiatry, and some chronic conditions. They may increase patient satisfaction, reduce costs, and decrease health care use.⁵

The most recent AHRQ review included 16 studies evaluating the effectiveness of telehealth for women's preventive services, specifically contraceptive care and IPV. Two studies assessed telehealth as a supplement to in-person visits, and 14 studies compared in-person consultations with telehealth alone.

There was enough evidence to assess the effectiveness of telehealth on clinical outcomes for some women's health preventive services. In assessing telehealth interventions for contraceptive care, two studies concluded that the rates of STIs were similar between the in-person consultation group and the group that received care supplemented with telephone counseling, although the strength of evidence is low. Based on one study, continuation of oral contraceptives and long-acting reversible contraception was similar among these two groups with low strength of evidence. Pregnancy rates were similar between the two groups with low strength of evidence. There was insufficient evidence to support conclusions about abortion rates in the groups. No studies compared the effectiveness of telehealth alone with in-person consultations alone.

In assessing telehealth interventions related to IPV, six studies found no differences between women randomized to telehealth compared with usual care in relation to the clinical outcomes of repeat episodes of IPV, depressive symptoms, posttraumatic stress disorder, fear of partner, coercive control, self-efficacy, and safety behaviors. The strength of evidence for these outcomes is rated as low because of a lack of consistency in the nature and type of telehealth intervention across studies.

There were no studies evaluating the effectiveness of telehealth in the delivery of STI counseling or family planning, defined as preconception counseling or birth spacing. An American Academy of Family Physicians position paper on preconception care does not offer recommendations about telemedicine care.⁶ Effectiveness of tele-health for medical abortion consultation was not included in the AHRQ review, although abortion rates were a patient-centered outcome of some of the included studies. No studies addressed tele-health outcomes related to health care access, health equity, or health disparities. There were insufficient data for harms related to IPV care via telehealth, and harms were not addressed in any studies of contraceptive care.

Based on limited evidence, telehealth interventions for contraceptive care and IPV have similar clinical outcomes as in-person care. The most effective approaches for delivering these telehealth services remain unclear, as does the impact of telehealth on women in marginalized and underserved communities.