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SARAH E. STUMBAR, MD, MPH, AND SUZANNE MINOR, MD, Florida International University Herbert Wertheim College of Medicine, Miami, Florida

Am Fam Physician. 2023;107(5):535-538

 This clinical content conforms to AAFP criteria for CME.

Author disclosure: No relevant financial relationships.

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

Preventive serviceOutcomeInterventionComparisonNumber of studies (participants)Overall effectStrength of evidence
Family planning———No studies——
ContraceptionContraceptive useSupplemental telephone counseling; structured telephone supportFour-month supply of OCs and condoms and in-person counseling; general advice for follow-up as needed2 RCTs (n = 1,724)Similar rates of OC continuation and condom use at three, six, and 12 months; similar rates of long-acting reversible contraception use at six months●○○
Sexually transmitted infection ratesSupplemental telephone counselingFour-month supply of OCs and condoms and in-person counseling1 RCT (n = 1,155)Similar rates of sexually transmitted infections●○○
Pregnancy ratesSupplemental telephone counselingFour-month supply of OCs and condoms and in-person counseling1 RCT (n = 1,155)Similar pregnancy rates●○○
Abortion ratesStructured telephone supportGeneral advice for follow-up as needed1 RCT (n = 569)Similar rates of abortion in both groups of post abortion patients at one year; reduction of subsequent abortion in both groups within two years○○○
Sexually transmitted infection counseling———No studies——
Interpersonal violenceInterpersonal violence ratesInteractive online toolsNoninteractive online tools2 RCTs (n = 1,132)No difference in repeat interpersonal violence between interactive vs. noninteractive online tools in two RCTs●○○
Depression scoresIn-person interviews, followed by phone calls; interactive online toolsReferral; noninteractive online tools5 RCTs (n = 2,322)Telehealth is at least as effective as usual care alternatives for improving measures of depression●○○
Posttraumatic stress disorder scoresInteractive online toolsNoninteractive online tools2 RCTs (n = 1,182)No difference in posttraumatic stress disorder symptoms between interactive vs. noninteractive online tools●○○
Fear, coercive controlInteractive online toolsNoninteractive online tools2 RCTs (n = 884)No difference between interactive vs. noninteractive online tools●○○
Self-efficacyInteractive online tools; computerized encounters; in-person interviews followed by telephone callsNoninteractive online tools; in-person encounters; referral3 RCTs (n = 919)Telehealth is at least as effective as usual care alternatives for improving self-efficacy scores●○○
Safety behaviorsTelephone calls; computerized encounters; in-person interviews followed by telephone callsUsual care; in-person encounters; referral4 RCTs (n = 1,175)Telehealth is at least as effective as usual care for increasing safety behaviors●○○
HarmsInteractive online toolNoninteractive online tool1 RCT (n = 231)No difference in patient-reported anxiety using a tailored, online safety tool vs. a static version○○○
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The Agency for Healthcare Research and Quality (AHRQ) conducts the Effective Health Care Program as part of its mission to produce evidence to improve health care and to make sure the evidence is understood and used. A key clinical question based on the AHRQ Effective Health Care Program systematic review of the literature is presented, followed by an evidence-based answer based on the review. AHRQ’s summary is accompanied by an interpretation by an AFP author that will help guide clinicians in making treatment decisions.

This series is coordinated by Joanna Drowos, DO, MPH, MBA, contributing editor. A collection of Implementing AHRQ Effective Health Care Reviews published in AFP is available at https://www.aafp.org/afp/ahrq.

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