Synchronous Care Research Articles

O03Safety and effectiveness of synchronous and asynchronous telehealth medication abortion provided by us virtual clinics

<h3>Objectives</h3> In 2021, new virtual clinics proliferated, offering remote-only telehealth abortion care with synchronous (phone or video) or asynchronous (messaging) communication and mailed pills. However, few large US studies have evaluated their safety and effectiveness. <h3>Methods</h3> We evaluated the safety and effectiveness of medication abortions provided by three virtual clinics operating in 21 states. We reviewed electronic health records for consecutive patients served between April 2021 and January 2022 and also invited the patients to participate in longitudinal surveys. We used multivariable mixed-effects models to estimate effectiveness and safety rates. <h3>Results</h3> Among the 6,134 included medication abortion patients, 73% received asynchronous services. Among the 5,036 (82%) abortion patients with follow-up data, 18 (0.44%, 95% CI: 0.36%-0.52%) had abortions that were followed by a serious adverse event. Abortion outcomes were confirmed for 4,106 (67%) cases, among whom 114 (2.8%, 95% CI: 2.3%-3.3%) required additional intervention to complete the abortion and 7 (0.21%, 95% CI: 0.06%-0.37%) were diagnosed with ectopic pregnancies. Rates of effectiveness (3.0% vs. 2.1%, p=0.187) and serious adverse events (0.44% vs. 0.44%, p=0.991) were similar between asynchronous and synchronous care. Among the 1,592 survey participants, 29 (2%) reported they would have had to continue the pregnancy had they not had access to telehealth abortion. Among survey participants, 47 received medications but did not take them, and among those, 36 still had the pills. <h3>Conclusions</h3> This real-world evidence shows that telehealth medication abortion care is safe and effective. Telehealth can increase access to this vital service while maintaining patient safety.

A Literature Review Comparing Clinicians' Approaches and Skills to In-Person, Synchronous, and Asynchronous Care: Moving Toward Competencies to Ensure Quality Care

Introduction: Research is increasing on asynchronous technologies used by specialist clinicians and primary care, including e-mail, text, e-consultation, and store-and-forward (asynchronous) options. Studies typically describe interventions and care outcomes rather than development of clinical skills for using technology. Methods: This article attempts to compare clinicians' approaches to, and skills for, asynchronous technologies versus in-person and synchronous (i.e., video) care. Literature from technology, health care, pedagogy, and business were searched from 2000 to 2019 for title words, including synchronous (e.g., video, telemental or behavioral health, telepsychiatry), asynchronous (e.g., app, e-consultation, e-mail, text, sensor in a wearable device), education, clinical, and consultation. Results: From a total of 4,812 potential references, two authors (D.M.H., J.T.) found 4,622 eligible for full text review and found 381 articles directly relevant to the concept areas in combination for full text review. However, exclusion criteria subtracted 305, leaving a total of 76 articles. While in-person and synchronous care are similar in many ways, the clinical approach to asynchronous care has many differences. As asynchronous technologies and models of care are feasible and effective, often for consultation, an outline of patient, primary care provider, and specialist clinician goals and skills are presented. Few studies specifically discuss skills or competencies for asynchronous care, but components from published clinical informatics, video, social media, and mobile health competencies were organized into Accreditation Council of Graduate Medical Education domains. Conclusions: Further implementation of science research is needed for asynchronous technology interventions, as well as clinician competencies using asynchronous technologies, to ensure optimal outcomes for patients in health care.