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Prev Med ; 151: 106569, 2021 10.
Article in English | MEDLINE | ID: covidwho-1294321


The expeditious diagnosis and treatment of high-grade cervical precancers are fundamental to cervical cancer prevention. However, during the COVID-19 pandemic healthcare systems have at times restricted in-person visits to those deemed urgent. Professional societies provided some guidance to clinicians regarding ways in which traditional cervical cancer screening might be modified, but many gaps remained. To address these gaps, leaders of screening programs at an academic medical center and an urban safety net hospital in California formed a rapid-action committee to provide guidance to its practitioners. Patients were divided into 6 categories corresponding to various stages in the screening process and ranked by risk of underlying high-grade cervical precancer and cancer. Tiers corresponding to the intensity of the local pandemic were constructed, and clinical delays were lengthened for the lowest-risk patients as tiers escalated. The final product was a management grid designed to escalate and de-escalate with changes in the local epidemiology of the COVID-19 pandemic. While this effort resulted in substantial delays in clinical screening services as mandated by the healthcare systems, the population effects of delaying on both cervical cancer outcomes as well as the beneficial effects related to decreasing transmission of severe acute respiratory coronavirus 2 have yet to be elucidated.

COVID-19 , Uterine Cervical Neoplasms , Academic Medical Centers , California , Early Detection of Cancer , Female , Humans , Pandemics , SARS-CoV-2 , Safety-net Providers , Uterine Cervical Neoplasms/diagnosis
Obstet Gynecol ; 137(3): 487-492, 2021 03 01.
Article in English | MEDLINE | ID: covidwho-1066431


The use of telemedicine in U.S. perinatal care has drastically increased during the coronavirus disease 2019 (COVID-19) pandemic, and will likely continue given the national focus on high-value, patient-centered care. If implemented in an equitable manner, telemedicine has the potential to reduce disparities in care access and related outcomes that stem from systemic racism, implicit biases and other forms of discrimination within our health care system. In this commentary, we address implementation factors that should be considered to ensure that disparities are not widened as telemedicine becomes more integrated into care delivery.

COVID-19/prevention & control , Delivery of Health Care/standards , Healthcare Disparities , Perinatal Care/methods , Telemedicine/economics , COVID-19/epidemiology , Female , Health Policy , Humans , Patient Acceptance of Health Care , Pregnancy , United States