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Telehealth sexual and reproductive health care during the COVID‐19 pandemic

Yan Cheng, Clare Boerma, Lucy Peck, Jessica R Botfield, Jane Estoesta and Kevin McGeechan
Med J Aust || doi: 10.5694/mja2.51219
Published online: 6 September 2021

It is increasingly recognised that telehealth services reduce waiting times and increase patient satisfaction.1,2,3 In response to the coronavirus disease 2019 (COVID‐19) epidemic, Medicare Benefits Schedule (MBS) rebates for telehealth services (telephone and video consultations) were introduced in March 2020.4 From 20 July 2020, however, primary care rebates were largely restricted to patients who had attended the treating service during the preceding year.5

We investigated the characteristics of patients who used Family Planning NSW (FPNSW; https://www.fpnsw.org.au) telehealth services during 2020, and explored patients’ and clinicians’ experiences with these services. FPNSW, a provider of sexual and reproductive health care, introduced telephone consultations in April 2020 alongside face‐to‐face care. To compare service provision before and during the COVID‐19 pandemic, we reviewed MBS‐subsidised FPNSW consultations during the period 1 April – 30 September in 2019 and 2020. Associations between patient characteristics and telehealth use were examined in logistic regression analyses conducted in SAS 9.4.

We also invited patients (new patients, 1 April – 18 July 2020; returning patients, 1–30 September 2020) and clinicians who used or provided FPNSW telehealth services during the study period to participate in semi‐structured interviews. The interviews were recorded, transcribed, and de‐identified before analysis; NVivo 11 (QSR International) was used for coding and to support thematic analysis. The Family Planning NSW Ethics Committee provided ethics approval (R2020‐04).

Of 4681 patients who had MBS‐subsidised FPNSW consultations during April‒September 2020, 1148 used telehealth only (25%), 2686 face‐to‐face consultations only (57%), and 847 both telehealth and face‐to‐face consultations (18%). During April‒September 2019, 5351 patients had had MBS‐subsidised FPNSW face‐to‐face consultations. Between 1 April and 18 July 2020, 867 new patients used MBS‐subsidised FPNSW services, 424 of whom had telehealth consultations (49%). The demographic characteristics of telehealth and face‐to‐face service users were similar during April‒September 2020, except that larger proportions of people aged 16–19 years, English‐speaking patients, and students used telehealth services. For patients who had telehealth consultations only, the most frequent reasons for presentation were contraception (37%), gynaecological problems (34%), medical abortion (10%), and sexually transmissible disease (13%) (Box).

All 23 interviewed patients (12 existing, 11 new patients) reported positive experiences with telehealth, related to convenience, improved consultation efficiency, and accessibility. The six interviewed clinicians similarly noted that telehealth improved access to time‐critical services (eg, abortion) and for people with disabilities and those living in remote locations. Fourteen of 15 patients under 30 years of age reported feeling more comfortable discussing sexual and reproductive health in telehealth consultations. However, two patients preferred face‐to‐face consultations for sensitive topics, and five believed that quality of care was better in face‐to‐face consultations. Both patients and clinicians felt that body language and facial expressions made communication in face‐to‐face consultations superior. One patient from a culturally diverse background commented that language barriers could make using telehealth services difficult. Patients suggested that video conferencing and removing restrictions on MBS rebates would improve telehealth services and increase access to sexual and reproductive health care.

Our findings indicate that telehealth (provided by telephone) can improve access to sexual and reproductive health services. Its advantages include convenience, accessibility, and patient comfort, particularly for younger people. Using visual technology for telehealth consultations would need to take privacy concerns into consideration.7 Integrating telehealth into health care was acceptable to both clinicians and patients. Removing restrictions on MBS rebates for telehealth consultations would enhance access to sexual and reproductive health services in Australia.

 

Box – Patient and clinical service characteristics for 4681 patients who attended Family Planning New South Wales clinics, 1 April – 30 September 2020

 


Consultation type


Characteristic

Telehealth only

Face‐to‐face only

Both telehealth and face‐to‐face


Number of patients

1148

2686

847

Age group (years)

 

 

 

 16–19

141 (12%)

205 (8%)

73 (9%)

 20–29

502 (44%)

1009 (38%)

379 (45%)

 30–39

236 (21%)

717 (27%)

204 (24%)

 40–49

144 (13%)

447 (17%)

124 (15%)

 50 or more

113 (10%)

273 (10%)

58 (7%)

 Missing data

12

35

9

Sex

 

 

 

 Women

1079 (94%)

2482 (92%)

826 (98%)

 Men

68 (6%)

198 (7%)

19 (2%)

 Intersex/other

1 (< 1%)

6 (< 1%)

2 (< 1%)

Aboriginal or Torres Strait Islander

 

 

 

 Yes

49 (4%)

123 (5%)

35 (4%)

 No

1099 (96%)

2563 (95%)

812 (96%)

People with disability

 

 

 

 Yes

46 (4%)

102 (4%)

33 (4%)

 No

1102 (96%)

2584 (96%)

814 (96%)

Area of remoteness index6

 

 

 

 Major cities

945 (83%)

2153 (81%)

724 (86%)

 Inner regional

15 (1%)

46 (2%)

18 (2%)

 More remote

178 (16%)

473 (18%)

100 (12%)

 Missing data

10

14

5

English‐speaking

 

 

 

 Yes

1035 (90%)

2231 (83%)

740 (87%)

 No

113 (10%)

455 (17%)

107 (13%)

Education level

 

 

 

 University

431 (40%)

1004 (39%)

324 (40%)

 Trade certificate

192 (18%)

485 (19%)

156 (19%)

 School certificate

415 (38%)

966 (38%)

313 (38%)

 No school certificate

51 (5%)

110 (4%)

25 (3%)

 Missing data

59

121

29

Work status

 

 

 

 Full/part‐time

578 (51%)

1530 (58%)

464 (55%)

 Not in paid employment

250 (22%)

558 (21%)

172 (21%)

 Student

303 (27%)

543 (21%)

202 (24%)

 Missing data

17

55

9

Number of visits

 

 

 

 One

952 (83%)

2177 (81%)

2 (< 1%)

 Two

155 (14%)

431 (16%)

486 (57%)

 Three or more

41 (4%)

78 (3%)

359 (42%)

Main reason for presentation

 

 

 

 Contraception

427 (37%)

1560 (58%)

489 (58%)

 Gynaecological problems*

395 (34%)

877 (33%)

406 (48%)

 Sexually transmissible disease

148 (13%)

167 (6%)

82 (10%)

 Medical termination of pregnancy

118 (10%)

109 (4%)

107 (13%)

 Pregnancy/fertility

78 (7%)

82 (3%)

45 (5%)


 *  Including abnormal menstrual bleeding, menopause, pelvic pain, vulval or vaginal symptoms.  †  Including screening, infection treatment.

 

Received 25 February 2021, accepted 11 June 2021

  • Yan Cheng1
  • Clare Boerma1
  • Lucy Peck1,2
  • Jessica R Botfield1
  • Jane Estoesta1
  • Kevin McGeechan1,2

  • 1 Family Planning NSW, Sydney, NSW
  • 2 The University of Sydney, Sydney, NSW

Correspondence: wendyc@fpnsw.org.au

Acknowledgements: 

We thank the patients and clinicians who participated in this study and contributed their perspectives on telehealth.

Competing interests:

Family Planning NSW (FPNSW) provides Medicare Benefits Schedule‐subsidised telehealth services for sexual and reproductive health care.

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