ABSTRACT
Objective: During the COVID-19 pandemic, institutions turned to telehealth as the primary method of postpartum care delivery. We aimed to determine the impact of telehealth on the completion of postpartum care goals. Study Design: We compared a 14-week period, March-June 2019, before implementation of telehealth to the same calendar months post-implementation during 2020. Patients with a postpartum visit (PPV) scheduled at our institution during the study period were included. Our primary outcome was attendance to the PPV. Secondary outcomes included completion of postpartum depression (PPD) screening, contraception selection, breastfeeding status at PPV, completion of postpartum 2-hour glucose tolerance test (GTT) for women with gestational diabetes, and cardiology follow-up when recommended. Multivariable logistic regression with backward elimination was used to control for confounders. Results: Of the 1,579 patients meeting inclusion criteria, 780 were in the pre-telehealth group and 799 were in the post-telehealth group. Subjects in the post-telehealth group were 90% more likely to attend a PPV compared to those in the pre-telehealth group, even when controlling for race, prenatal care provider, parity, gestational age at delivery, and insurance status (82.9% vs. 72.4%, p < 0.001;aOR 1.90, 95% CI [1.47-2.46]). Patients in the post-telehealth group were also more likely to get screened for PPD (86.3% vs. 65.1%, p < 0.001). While subjects were as likely to choose a contraceptive method at the PPV, those in the post-telehealth group were less likely to choose long-acting reversible contraception (LARC) or permanent sterilization (26.2% vs. 33.2%, p=0.03). There was no difference in breastfeeding status at the PPV, completion rate of postpartum 2-hour GTT, or attendance to cardiology follow-up appointments between groups. Conclusion: Availability of telehealth during the COVID-19 pandemic is associated with increased PPV attendance and PPD screening. However, the availability of telehealth was also associated with a decrease in the utilization of LARC or permanent sterilization. [Formula presented]
ABSTRACT
Objective: During the COVID-19 pandemic, institutions turned to telehealth as the primary method of postpartum care delivery. We aimed to understand the patient experience around telehealth for delivery of postpartum care using a qualitative approach. Study Design: We performed individual, semi-structured patient interviews (n=25) within two weeks of a scheduled telehealth postpartum visit (PPV) at our institution. Interviews were performed by phone from 10/1/2020-1/1/2021, more than 6 months into the COVID-19 pandemic. Transcriptions were analyzed using grounded theory and coded with a systematic approach. Results: Overall, participants reported mixed preferences for the modality of the postpartum visit (in-person vs. telehealth). Those in favor of telehealth focused on its convenience and flexibility. When performed via video and audio rather than audio alone, participants felt telehealth well-simulated in-person engagement. Participants also reported similar experiences by modality regarding contraceptive planning. On the other hand, several participants raised concerns about the limitations of telehealth for physical examination, such as providing patient reassurance regarding healing after delivery. Reported facilitators to telehealth were lack of need for childcare or transportation to an in-person encounter, minimized disruption to maternal-newborn routine, and prioritizing safety during the COVID-19 pandemic. Reported barriers also included the need for childcare during the telehealth encounter, as well as difficulty finding a private space for the visit, scheduling and logistic challenges, privacy concerns, and technological difficulties. Conclusion: Telehealth is becoming an increasingly utilized modality of PPVs in the United States. In this qualitative analysis, we characterize patients’ experiences with telehealth postpartum care, and identify areas of patient concern. Future work should determine how best to provide reassurance regarding postpartum healing to further optimize telehealth for postpartum care. [Formula presented]
ABSTRACT
Introduction/Background*The aim of the present study was to assess the impact of postponed screening examinations and lockdown measures on gynecological and breast cancer detection rate throughout the year 2020 in a gynecological oncological center in Austria.MethodologyData of 889 patients with either newly diagnosed gynecological or breast cancer between January 2019 and December 2020 were collected. Clinical parameters including symptoms, performance status, comorbidities and referral status were compared in patients, who were newly diagnosed with cancer in the period of the first lockdown from March 2020 – April 2020 and the second lockdown from November 2020 – December 2020 and compared to the same period in 2019.Result(s)*Our results showed a strong decline in newly diagnosed cancers during the lockdown periods: -45% in gynecological cancer and -52% in breast cancer compared to the same period in 2019. Compared to the analogue period of 2019, breast cancer patients reported significantly more tumor-associated symptoms (55% versus 31%, p=0.013) during and in between (48% versus 32%, p=0.022) the lockdowns. During the lockdown periods breast cancer patients were diagnosed with a significantly higher tumor-stage (T2-T4;p=0.047).Conclusion*Both lockdowns led to a strong decrease in newly diagnosed gynecological and breast cancers. Treatment delays in potentially curable disease could lead to inferior clinical outcomes, with the risk of missing the optimal treatment window. As the COVID-19 pandemic will be a challenge for some time to come, new strategies in patient care are needed to optimize cancer screening and management during the pandemic.
ABSTRACT
A nationwide lockdown was declared on March 16 in Austria due to coronavirus disease 2019 (COVID-19) outbreak, requiring citizens to remain in their homes except for necessary reasons. The lockdown resulted not only in socialdistancing and reduction of commercial activity, but also in severe restrictions in the health care system. Regularmedical services and outpatient care were nearly shut down to prevent the spread of the virus and to increase thetotal hospital capacities. Thus, patients faced barriers to attend preventive checkups, such as mammography, screening for cervical cancer, or to consult the general practitioner. As a gynecologic department with a largeoncologic subunit, we noticed significantly fewer tumor diagnoses presenting at our department since the lockdown.This phenomenon forced us to perform this retrospective study on newly diagnosed gynecologic and breast cancersbefore and during the COVID-19 pandemic. A retrospective analysis of newly diagnosed gynecologic and breastcancers presented at the University Hospital Innsbruck from January to May 2019 and from January to May 2020was performed. Descriptive statistics and analysis of the clinical data stratified by the year of diagnosis wereperformed using SPSS software and Mann-Whitney U test. Our results showed a slight increase of newly diagnosedcancers in January and February 2020 as compared to 2019 (+13%) and a strong decline in newly diagnosedtumors since the lockdown: -45% in March 2020 vs. March 2019, -63% in April 2020 vs. April 2019, and -44% in May 2020 vs. May 2019. Around two third of patients diagnosed during the pandemic consulted the specialist due totumor symptoms, while before the pandemic less than 50% of patients presented with symptoms. The ratio of breastand vulvar cancer was significantly higher during the pandemic (71 vs. 61% and 3 vs. 1.9%, respectively;p=0.043), but significantly fewer cervical cancers were diagnosed (4.4 vs. 8.9%;p=0.043). Patients with other malignant, rheumatic, or metabolic disease were rarely diagnosed with a new cancer in 2020 as compared to 2019 (7.5 vs.12%;0.7 vs. 3.7% and 6.7 vs. 12%, respectively;p=0.014). A better performance status was observed in patientspresented in 2020 as compared to 2019 (p=0.011). In a country with maximum intensive care bed occupancy of26% during the COVID-19 pandemic, the accessibility of the health care services was severely impaired andpreventive care and early cancer detection was restricted, leading to an increase in undetected or postponed tumordiagnoses. The aim of our work is to raise awareness of this issue. It is not clear whether these undetected caseswill lead to potential months of life lost;however, decreased accessibility of the medical services and postponeddiagnosis of potentially curable cancers are clearly a step backwards in our health care system and will probablyimpair cancer treatment outcomes. Thus, new strategies to manage early cancer detection are needed to optimizecancer care in a time of pandemic in the future.