1935 Telephone consultations in adolescent gynaecology during the COVID-19 pandemic: a retrospective cohort study considering impact on outpatient follow-ups

Abstract

ObjectivesIn response to the COVID-19 pandemic all paediatric and adolescent gynaecology (PAG) outpatient appointments in a tertiary teaching hospital were temporarily converted to telephone consultations.Telemedicine is a developing area with on-going research into its safety and effectiveness. The cohorts of patients attending PAG clinics have unique needs and requirements, both due to their own individual characteristics, and their presenting symptoms. There is currently a paucity of data regarding the utility of telemedicine in PAG. This study therefore aimed to review the impact on PAG outpatient follow up journey looking specifically at the patient journey from a first remote appointment by analysing number of follow ups required.MethodsA retrospective cohort study was completed of patients presenting to the general paediatric and adolescent gynaecology clinics from April 2019-April 2020 aged 11–18 years at their first appointment. Those referred to specialist PAG clinics for complex congenital gynaecology or differences of Sex Development were excluded.Patients managed pre-pandemic with their first appointment with the PAG service in person were compared to those with a telephone first appointment as part of the COVID-19 response.The first 30 patients from each clinic list who met inclusion criteria were included in the study.The electronic patient notes were reviewed with data collected on age, referring issue, number of follow ups, and whether still under PAG follow up collected. Data was collected and analysed using Excel.ResultsMedian age in both cohorts were similar;12 years old (11–17 years) face to face (f2f) and 13 years old (11–18y) in the telephone cohorts. Problems were categorised to those affecting the vulva or vagina (17/30 in telephone;21/30 f2f), menstrual concerns (15/30 telephone;14/30 f2f), or ovarian cyst (2/30 telephone;0/30 f2f).Patients with an initial telephone appointment during the pandemic had a significantly greater number of follow-up appointments compared to those with an in-person clinic appointment initially (chi-square, p = 0.044). Patients with an initial telephone appointment were significantly more likely to require follow-up compared to those seen first to face (OR 0.18 [95%CI 0.05–0.65]).Patients referred with vulval or vaginal issues (clear indication for clinical examination) were more effected by greater follow up requirements than those seen F2F first.ConclusionsPatients who had a first telephone clinic consultation were more likely to need follow-up than those seen face to face, and if follow-up was required, they had a greater number of follow up appointments than those seen first in person.In Paediatric and Adolescent Gynaecology (PAG) remote consultations are compromised by the lack of examination and reliable privacy for an adolescent to have time alone in the consultation without their parent/care-giver.The potential need for an intimate examination cannot be replicated with a remote review. It is not appropriate for video review live or review photos of an adolescent's genitals- even if technology means it can be sent securely.Whilst there is scope for the use of telemedicine for follow up consultations, further dedicated studies considering this are needed to confirm their role in the PAG setting.