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Telehealth Interventions to Improve Obstetric and Gynecologic Health Outcomes: A Systematic Review
Nathaniel DeNicola1, Daniel Grossman, Kathryn Marko
1Departments of Obstetrics and Gynecology, George Washington University, Washington, DC, the University of Pennsylvania, Philadelphia, Pennsylvania, the Mayo Clinic, Rochester, Minnesota, the Uniformed Services University of the Health Sciences, Bethesda, Maryland, and the University of Arkansas for Medical Sciences, Little Rock, Arkansas; the Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, California; the Center for Health Research, Kaiser Permanente, Northwest, Portland, Oregon; and the American College of Obstetricians and Gynecologists, Washington, District of Columbia.
Objective:
To systematically review the effectiveness of telehealth interventions for improving obstetric and gynecologic health outcomes.
Data Sources:
We conducted a comprehensive search for primary literature in ClinicalTrials.gov, Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, EMBASE, PubMed, and MEDLINE.
Methods Of Study Selection:
Qualifying primary studies had a comparison group, were conducted in countries ranked very high on the United Nations Human Development Index, published in English, and evaluated obstetric and gynecologic health outcomes. Cochrane Collaboration's tool and ROBINS-I tool were used for assessing risk of bias. Summary of evidence tables were created using the United States Preventive Services Task Force Summary of Evidence Table for Evidence Reviews.
Tabulation, Integration, Results:
Of the 3,926 published abstracts identified, 47 met criteria for inclusion and included 31,967 participants. Telehealth interventions overall improved obstetric outcomes related to smoking cessation and breastfeeding. Telehealth interventions decreased the need for high-risk obstetric monitoring office visits while maintaining maternal and fetal outcomes. One study found reductions in diagnosed preeclampsia among women with gestational hypertension. Telehealth interventions were effective for continuation of oral and injectable contraception; one text-based study found increased oral contraception rates at 6 months. Telehealth provision of medication abortion services had similar clinical outcomes compared with in-person care and improved access to early abortion. Few studies suggested utility for telehealth to improve notification of sexually transmitted infection test results and app-based intervention to improve urinary incontinence symptoms.
Conclusion:
Telehealth interventions were associated with improvements in obstetric outcomes, perinatal smoking cessation, breastfeeding, early access to medical abortion services, and schedule optimization for high-risk obstetrics. Further well-designed studies are needed to examine these interventions and others to generate evidence that can inform decisions about implementation of newer telehealth technologies into obstetrics and gynecology practice.
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