A guide for urogynecologic patient care utilizing telemedicine during the COVID-19 pandemic: review of existing evidence

Abstract

Introduction and hypothesis The COVID-19 pandemic and the desire to "flatten the curve" of transmission have significantly affected the way providers care for patients. Female Pelvic Medicine and Reconstructive Surgeons (FPMRS) must provide high quality of care through remote access such as telemedicine. No clear guidelines exist on the use of telemedicine in FPMRS. Using expedited literature review methodology, we provide guidance regarding management of common outpatient urogynecology scenarios during the pandemic. Methods We grouped FPMRS conditions into those in which virtual management differs from direct in-person visits and conditions in which treatment would emphasize behavioral and conservative counseling but not deviate from current management paradigms. We conducted expedited literature review on four topics (telemedicine in FPMRS, pessary management, urinary tract infections, urinary retention) and addressed four other topics (urinary incontinence, prolapse, fecal incontinence, defecatory dysfunction) based on existing systematic reviews and guidelines. We further compiled expert consensus regarding management of FPMRS patients in the virtual setting, scenarios when in-person visits are necessary, symptoms that should alert providers, and specific considerations for FPMRS patients with suspected or confirmed COVID-19. Results Behavioral, medical, and conservative management will be valuable as first-line virtual treatments. Certain situations will require different treatments in the virtual setting while others will require an in-person visit despite the risks of COVID-19 transmission.Conclusions We have presented guidance for treating FPMRS conditions via telemedicine based on rapid literature review and expert consensus and presented it in a format that can be actively referenced.

Clinical Assessment Service (CAS) – a novel approach to expand access to secondary care in gynaecology during the COVID-19 pandemic: a single-institution intervention study

“…16 This study adds further evidence that telemedicine plays an important role in reviewing patients referred as first attendance, provided there are robust pathways that streamline patients to the correct consultation. 16 Although there are many advantages of virtual clinics, careful planning is sought when care is provided to vulnerable groups such as those at a higher risk of domestic violence, depression and sexually transmitted infections. 17 Prioritising hospital appointments for ethnic minorities should be considered as social distancing requirements can further exacerbate an already underlying racial and minority disparities in care and health outcomes.…”

Clinical Assessment Service (CAS) – a novel approach to expand access to secondary care in gynaecology during the COVID-19 pandemic: a single-institution intervention study

“…16 This study adds further evidence that telemedicine plays an important role in reviewing patients referred as first attendance, provided there are robust pathways that streamline patients to the correct consultation. 16 Although there are many advantages of virtual clinics, careful planning is sought when care is provided to vulnerable groups such as those at a higher risk of domestic violence, depression and sexually transmitted infections. 17 Prioritising hospital appointments for ethnic minorities should be considered as social distancing requirements can further exacerbate an already underlying racial and minority disparities in care and health outcomes.…”

Systematic review on telemedicine platforms in lockdown periods: Lessons learned from the COVID-19 pandemic

“…Synchronous virtual meetings that happen in real time, live, and reciprocal modes use noninteractive and store-forward technologies to data transmission between two sides of communication. [ 50 69 ] In the current study, the results indicated that real-time interaction modalities, for example, online chatting, telephonic communication, VOIP, and video conference technologies[ 7 17 27 37 39 40 41 42 43 44 45 47 48 49 51 52 54 55 56 61 62 66 ] offer immediate and easy-to-use ways of providing care remotely during the current pandemic than store-forward services such as E-mail, fax, forums, file transfer technologies, and prerecorded multimedia. [ 17 27 34 37 40 41 44 45 52 61 ] However, some studies suggested the use of combined approach during the COVID-19 pandemic.…”

“…[ 50 69 ] In the current study, the results indicated that real-time interaction modalities, for example, online chatting, telephonic communication, VOIP, and video conference technologies[ 7 17 27 37 39 40 41 42 43 44 45 47 48 49 51 52 54 55 56 61 62 66 ] offer immediate and easy-to-use ways of providing care remotely during the current pandemic than store-forward services such as E-mail, fax, forums, file transfer technologies, and prerecorded multimedia. [ 17 27 34 37 40 41 44 45 52 61 ] However, some studies suggested the use of combined approach during the COVID-19 pandemic. [ 17 37 39 41 51 ] Telemedicine data exchange templates contain different content ranges from plain text, text-numerical, and even image transfer via real-time technologies[ 40 41 43 45 48 49 51 56 62 66 ] and nonreal-time platforms;[ 17 27 34 37 40 41 44 45 61 ] synchronous[ 37 39 41 42 43 45 47 48 …”

In Reply:

“…Based on the randomized nature of our trial, participants with varied abilities to contract their pelvic floor muscles were likely included and equally randomized. Furthermore, our Discussion highlights an article by Grimes et al 5 that emphasizes the valuable contribution of telemedicine to first-line conservative treatment of UI, even in the absence of a physical examination.…”

Clinical Assessment Service (CAS) – a novel approach to expand access to secondary care in gynaecology during the COVID-19 pandemic: a single-institution intervention study

“…16 This study adds further evidence that telemedicine plays an important role in reviewing patients referred as first attendance, provided there are robust pathways that streamline patients to the correct consultation. 16 Although there are many advantages of virtual clinics, careful planning is sought when care is provided to vulnerable groups such as those at a higher risk of domestic violence, depression and sexually transmitted infections. 17 Prioritising hospital appointments for ethnic minorities should be considered as social distancing requirements can further exacerbate an already underlying racial and minority disparities in care and health outcomes.…”

Systematic review on telemedicine platforms in lockdown periods: Lessons learned from the COVID-19 pandemic

“…Synchronous virtual meetings that happen in real time, live, and reciprocal modes use noninteractive and store-forward technologies to data transmission between two sides of communication. [ 50 69 ] In the current study, the results indicated that real-time interaction modalities, for example, online chatting, telephonic communication, VOIP, and video conference technologies[ 7 17 27 37 39 40 41 42 43 44 45 47 48 49 51 52 54 55 56 61 62 66 ] offer immediate and easy-to-use ways of providing care remotely during the current pandemic than store-forward services such as E-mail, fax, forums, file transfer technologies, and prerecorded multimedia. [ 17 27 34 37 40 41 44 45 52 61 ] However, some studies suggested the use of combined approach during the COVID-19 pandemic.…”

“…[ 50 69 ] In the current study, the results indicated that real-time interaction modalities, for example, online chatting, telephonic communication, VOIP, and video conference technologies[ 7 17 27 37 39 40 41 42 43 44 45 47 48 49 51 52 54 55 56 61 62 66 ] offer immediate and easy-to-use ways of providing care remotely during the current pandemic than store-forward services such as E-mail, fax, forums, file transfer technologies, and prerecorded multimedia. [ 17 27 34 37 40 41 44 45 52 61 ] However, some studies suggested the use of combined approach during the COVID-19 pandemic. [ 17 37 39 41 51 ] Telemedicine data exchange templates contain different content ranges from plain text, text-numerical, and even image transfer via real-time technologies[ 40 41 43 45 48 49 51 56 62 66 ] and nonreal-time platforms;[ 17 27 34 37 40 41 44 45 61 ] synchronous[ 37 39 41 42 43 45 47 48 …”

In Reply:

“…Based on the randomized nature of our trial, participants with varied abilities to contract their pelvic floor muscles were likely included and equally randomized. Furthermore, our Discussion highlights an article by Grimes et al 5 that emphasizes the valuable contribution of telemedicine to first-line conservative treatment of UI, even in the absence of a physical examination.…”

Clinical Assessment Service (CAS) – a novel approach to expand access to secondary care in gynaecology during the COVID-19 pandemic: a single-institution intervention study

“…16 This study adds further evidence that telemedicine plays an important role in reviewing patients referred as first attendance, provided there are robust pathways that streamline patients to the correct consultation. 16 Although there are many advantages of virtual clinics, careful planning is sought when care is provided to vulnerable groups such as those at a higher risk of domestic violence, depression and sexually transmitted infections. 17 Prioritising hospital appointments for ethnic minorities should be considered as social distancing requirements can further exacerbate an already underlying racial and minority disparities in care and health outcomes.…”

Systematic review on telemedicine platforms in lockdown periods: Lessons learned from the COVID-19 pandemic

“…Synchronous virtual meetings that happen in real time, live, and reciprocal modes use noninteractive and store-forward technologies to data transmission between two sides of communication. [ 50 69 ] In the current study, the results indicated that real-time interaction modalities, for example, online chatting, telephonic communication, VOIP, and video conference technologies[ 7 17 27 37 39 40 41 42 43 44 45 47 48 49 51 52 54 55 56 61 62 66 ] offer immediate and easy-to-use ways of providing care remotely during the current pandemic than store-forward services such as E-mail, fax, forums, file transfer technologies, and prerecorded multimedia. [ 17 27 34 37 40 41 44 45 52 61 ] However, some studies suggested the use of combined approach during the COVID-19 pandemic.…”

“…[ 50 69 ] In the current study, the results indicated that real-time interaction modalities, for example, online chatting, telephonic communication, VOIP, and video conference technologies[ 7 17 27 37 39 40 41 42 43 44 45 47 48 49 51 52 54 55 56 61 62 66 ] offer immediate and easy-to-use ways of providing care remotely during the current pandemic than store-forward services such as E-mail, fax, forums, file transfer technologies, and prerecorded multimedia. [ 17 27 34 37 40 41 44 45 52 61 ] However, some studies suggested the use of combined approach during the COVID-19 pandemic. [ 17 37 39 41 51 ] Telemedicine data exchange templates contain different content ranges from plain text, text-numerical, and even image transfer via real-time technologies[ 40 41 43 45 48 49 51 56 62 66 ] and nonreal-time platforms;[ 17 27 34 37 40 41 44 45 61 ] synchronous[ 37 39 41 42 43 45 47 48 …”

In Reply:

“…Based on the randomized nature of our trial, participants with varied abilities to contract their pelvic floor muscles were likely included and equally randomized. Furthermore, our Discussion highlights an article by Grimes et al 5 that emphasizes the valuable contribution of telemedicine to first-line conservative treatment of UI, even in the absence of a physical examination.…”