Telehealth Care in a Pediatric and Adolescent Gynecology Clinic During the COVID-19 Pandemic

Abstract

Since the onset of the COVID-19 pandemic, healthcare systems have increased their telehealth services to meet the changing public health needs. Prior to the pandemic, telehealth was used primarily in surgical specialties for post-op visits and rural medicine. However, out of necessity, nearly all medical and surgical subspecialties incorporated this virtual technology to improve patient access in healthcare access limited time. Few studies have addressed telehealth in Pediatric and Adolescent Gynecology (PAG) to date. To describe the large-scale utilization of telehealth visits and assess patient experience and improve access to care in a large academic ambulatory gynecology PAG clinic. This retrospective, cross-sectional quality improvement study was performed by administering patient surveys and compiling aggregate data from the EPIC electronic health record (EHR) in the Division of Pediatric and Adolescent Gynecology (PAG) clinics at a single children's hospital between March 2020 and March 2021. Patient demographics, payer characteristics, visit type and purpose, and patient experience were reviewed. Wider expansion of telehealth in PAG clinics at a single institution RESULTS: : A total of 6,159 telehealth appointments were performed, involving 6 clinic sites and 9 providers. Telehealth visits comprised 50% of the total ambulatory volume (12,527). Most patients were located within the institution's state (99.5%), and the remaining called into their telehealth visits from a neighboring state. Most patients were 18 years of age or younger (73%). Video visits lasted 15-30 minutes and included routine follow-up (66.3%), new/consult (28.4%), post-op (1.6%), and urgent follow-up (0.2%). The patient population was ethnically diverse by self-identification: 61.4% White, 38.4% Hispanic, 16% Black, 4.4% Asian, 0.40% Native Hawaiian/American Indian/Alaska Native. Payor mix included self-pay (45.5%), private payer (32.2%), and Medicaid/CHIP (22.3%). Conditions seen ranged from menstrual management (71%) and routine preventative or acute gynecologic concerns (21%) to surgical evaluation for congenital anomalies, endometriosis, fertility preservation, genital concerns or pelvic masses (8%). Telehealth visits met patient expectations in 87.3% of respondents. Patient-reported opportunities for improvement included: improving set-up instructions and more consistent audio/video connections. Challenges identified by providers included: difficulty utilizing interpreters, technology limitations, and privacy constraints during HEADSS examination. This study demonstrates how a large, diverse volume of patients with PAG needs received appropriate care through a telehealth format during the COVID pandemic. Patients were satisfied with the services, but opportunities for improvement were elicited to allow for continued refining of this healthcare delivery tool in the future.