Endometriosis Clinical and Surgical Care During the COVID-19 Pandemic: A Comparison of Virtual-Only Care to Virtual and In-Person Care Combined.

Abstract

Objective: Endometriosis is a chronic and inflammatory condition that affects approximately 10% of the reproductive-age population. During the COVID-19 pandemic, there was a shift towards virtual care for endometriosis. Our aim was to evaluate the diagnostic and treatment outcomes of virtual-only care, compared to those who had both virtual and in-person visits.

Design: Retrospective descriptive analysis of registry data.

Setting: This study was conducted in British Columbia, Canada, at a tertiary referral center for endometriosis and pelvic pain.

Participants: In this cohort (n=389), we examined patients who received an initial virtual assessment followed by virtual care alone (Virtual Only group, n=203) and those who had an initial virtual assessment followed by an in-person physical exam (Physical Exam group, n=186).

Interventions: Virtual care at the center during the Covid-19 pandemic.

Results: The Physical Exam group was more likely to have surgery compared to the Virtual Only group (45.7% vs. 16%, p<.001). At the time of surgery, the groups did not differ based on type of surgery (e.g. excision of endometriosis and/or hysterectomy), endometriosis anatomic findings (e.g. stage and anatomic subtype), surgical complexity or surgical complications. At baseline, the two groups did not differ in their pain, mental health or quality of life scores. At one-year follow-up, the two groups did not differ in these outcome measures.

Conclusion: There was a lower rate of surgery, but no differences in surgical findings or complications, nor in one-year outcomes, after virtual only care for endometriosis compared to patients that had a virtual visit and then underwent a physical exam. These results support a hybrid model, where a virtual visit is the first contact and serves as a triage tool to determine whether a patient is appropriate for virtual only care or would benefit from a physical exam. Future research could incorporate population-based administrative data or qualitative approaches to understanding patient experiences and physician perspectives on virtual care for the treatment of endometriosis.