Dysmenorrhea outcomes do not significant differ between in-person visits only and a combination of in-person and telemedicine visits for low-dose pill prescriptions, according to a recent study published in Telemedicine Reports.
Takeaways
- Dysmenorrhea management outcomes with low-dose pill prescriptions showed no significant difference between a combination of telemedicine and in-person consultations vs in-person only.
- Relaxation of telemedicine restrictions during the COVID-19 pandemic led to increased use in obstetrics and gynecology, including the prescription of low-dose pills for dysmenorrhea.
- Despite concerns among some doctors about telemedicine's efficacy, trust between patients and gynecologists remains vital, especially when prescribing low-dose estrogen-progestin because of withdrawal risk caused by pregnancy or severe side effects.
- Investigating abnormal uterine bleeding, a common complication of dysmenorrhea, revealed comparable rates between a combination of telemedicine and in-person consultations vs in-person only, suggesting feasibility in remote management.
- The study highlights the need for further research to assess telemedicine's impact on different diseases and its potential role in enhancing access to gynecological care.
Until 2015, telemedicine was mainly prohibited in Japan, and strict conditions afterward reduced its practicality. However, restrictions were relaxed during the COVID-19 pandemic, increasing the use of telemedicine.
Recent use of telemedicine in obstetrics and gynecology to prescribe low-dose pills for managing dysmenorrhea has been observed. Low-dose pills approved in Japan include oral contraceptives and low-dose estrogen-progestin (LEP).
Trust between the patient and gynecologist is vital when prescribing LEP because of the risk of discontinuation caused by pregnancy or severe side effects. Some doctors have indicated they believe telemedicine will present issues for patients.
To compare the differences in abnormal uterine bleeding, the most common complication of dysmenorrhea, between a combination of in-person and telemedicine visits vs in-person visits only, investigators conducted a retrospective observational study. Study groups included an in-person group and a combination group referred to as the telemedicine group.
The odds of experiencing abnormal uterine bleeding within 6 months of LEP treatment was reported as the primary outcome of the analysis. Patients with petechia or breakthrough bleeding were reported as bleeding, while those without these characteristics were reported as no bleeding.
Data collected from medical records include basic patient data, organic dysmenorrhea diagnosis presence or absence, LEP types used, blood pressure, side-effects, dosing method, patient cost burden, visit continuation status, and patient efficacy records presence. Patients aged 20 years or older prescribed LEP for dysmenorrhea were included.
Patients in the telemedicine group were treated between February 1, 2020, and October 31, 2021, while those in the in-person group were treated between September 1, 2017, and January 31, 2020. The margin of noninferiority was 20%.
There were 89 patients in the telemedicine group and 83 in the in-person group, with 53 cases in both groups after propensity score matching. Similar characteristics were observed between groups, though there were slight differences in smoking history, organic dysmenorrhea presence, LEP type, and dosing method.
Comorbidities were reported in 21% of the telemedicine group and 23% of the in-person group, with pollen allergy being the most common reported comorbidity. Medical history was reported in 21% and 0%, respectively, and the use of concomitant medications in 15% and 17%, respectively.
Abnormal uterine bleeding was reported in 25% of the telemedicine and 43% of the in-person group. The difference between the 2 groups was not significant when evaluated using Fisher's exact test.
Both groups had a side effects probability of 38%. The odds of abnormal uterine bleeding after 6 months were 7.6% in the telemedicine group and 11% in the in-person group. Additional side effects included headache, nausea, emotional instability, and abdominal pain.
Withdrawal at 6 months was reported in 13% of the telemedicine group and 0% of the in-person group, indicating a significant difference. A 30% copayment rate was reported in 91% and 96%, respectively. Treatment efficacy was reported in 32% and 43%, respectively, which was not a significant difference.
These results indicated similar outcomes between a combination of telemedicine and in-person vs in-person visits alone for low-dose pill prescriptions in patients with dysmenorrhea. Investigators recommended further research about the impact of telemedicine on various diseases.
Reference
Inoo Y, Iida H, Yoshioka N, et al. A Retrospective observational study on telemedicine in prescribing low-dose pills for patients with dysmenorrhea. Telemed Rep. 2024;5(1):2-11. doi:10.1089/tmr.2023.0063
