Telehealth contraceptive care in 2018: A quality improvement study of barriers to access and patient satisfaction.

OBJECTIVE: The primary aim of this project was to facilitate access to contraception at the University of Wisconsin-Madison campus by offering telehealth as an alternative option to an in-person contraception visit. The secondary aim was to assess patient feedback regarding telehealth contraception encounters and generate descriptive statistics of the 366 unique telehealth patients. STUDY DESIGN: We implemented this quality improvement project from August 20, 2018, through December 31, 2018, at the University Health Services (UHS) Women's Health Clinic at the University of Wisconsin-Madison. Patients completed a health history form online and scheduled a 15-minute phone call appointment with a provider. Providers addressed concerns, contraindications, screening recommendations and prescribe a patient selected contraceptive method over the phone or scheduled a LARC appointment. After the telehealth encounter, we invited patients to complete a confidential electronic patient satisfaction survey. RESULTS: In the fall of 2018, there were 3413 contraception visits, 371 (11%) of which were telehealth encounters, an overall 7.8% increase in total Women's Health visits compared to the same time period in the previous year. The response rate of the satisfaction survey was 41%, with 97% of respondents reporting being very satisfied or satisfied with the telehealth option. CONCLUSIONS: Offering telehealth as an option for contraceptive visits improved capacity by increasing the total number of available appointments, including both in-person and telehealth visits. Additionally, telehealth may reduce barriers to reproductive health care with high patient satisfaction assessed prior to pandemic restrictions. IMPLICATIONS: This study supports telehealth as an option for health systems to improve capacity by increasing the total number of available appointments, as well as reducing barriers to reproductive health care. Our patients found value in telehealth for contraceptive appointments prior to the major shift to telehealth with the onset of the pandemic, suggesting that this value may likely remain in the post-pandemic future.

The Healthy Moms Study: the efficacy of brief alcohol intervention in postpartum women.

BACKGROUND: The prevention and treatment of alcohol use disorders among women of reproductive age have been well described. However, there is limited information on women specifically during the postpartum period. This period in a woman's life is a time of transition and it provides an ideal opportunity for primary care providers to intervene. PURPOSE: The goal of this report was to present the results of a brief alcohol intervention conducted in 34 obstetrical practices with women seeking routine postpartum care. METHODS: A randomized clinical trial was conducted from 2002 to 2005 in a diverse sample of women located in 15 Wisconsin counties. This report presents 6-month follow-up data. RESULTS: A total of 8,706 women were screened for high-risk alcohol use during routine postpartum care with 997 (12%) of these women testing positive for at-risk drinking. A total of 235 women met inclusion criteria and were randomized to either "usual care" or "brief intervention." The 4-session intervention was delivered by outpatient obstetrical nurses and research staff. The mean age of the women in the sample was 28, 19.3% were from minority groups, 60.8% were married, 53.2% reported current tobacco use, and 17.9% had used marijuana in the previous 30 days. At the 6 month follow-up appointment, there were significant reductions in mean number of total drinks in the previous 28 days (p < 0.013), number of drinking days (p < 0.024) and heavy drinking days (p < 0.019). In addition to a statistical difference between groups, there was a 19% difference in the mean number of drinks and number of drinking days, and a 36% difference in the number of heavy drinking days in favor of the intervention group. CONCLUSION: The findings of the Healthy Moms Trial support the implementation of brief alcohol intervention during the postpartum period.

S.O.S! I'm short of breath!

BACKGROUND: There are various causes of shortness of breath in a young, pregnant woman. The importance of entertaining a broad differential diagnosis is highlighted in this case. CASE: A young, pregnant African-American woman presented in her third trimester with acute onset of shortness of breath. A team approach by different medical specialties and systematic workup eventually helped us reach the diagnosis and provide optimal management. CONCLUSION: This case raises intriguing questions about diagnosis and management of a common symptom in a pregnant woman.

College blues and hues.

BACKGROUND: Vulvar ulcerations are an entity that practicing gynecologists frequently encounter in daily practice. CASE: A 21-year-old nulliparous college student presented with a 3-day history of itching to the genital area with associated tenderness and sore bumps. She was initially treated for vulvovaginal candidiasis and instructed to return several days later for follow-up. Repeat examination revealed multiple coalescent and necrotic-appearing ulcerations confined to the labia minora, vagina, and posterior fourchette. All of the lesions eventually resolved. CONCLUSION: This case reminds us to broaden our differential diagnosis when considering causes of genital tract ulcerations in reproductive-aged females.