8 RESEARCH UPDATE
The role of telemedicine in termination , and ethnicity as a factor in treatment uptake
An investigation into the potential of telemedicine in pregnancy termination , and an analysis of disparities in arthritis therapy uptake among ethnic groups
Remote consultations for medical terminations ‘ safe and acceptable ’
The Covid-19 pandemic has changed the dynamics of the healthcare services in primary care , including medical termination of pregnancy ( MTOP ). In March last year , the Royal College of Obstetricians and Gynaecologists issued guidelines for MTOP during the pandemic .
The change from reviewing patients face to face to doing so via telemedicine can make some clinicians and patients feel apprehensive .
But Aiken and colleagues ( 2021 ) have provided data that should offer reassurance that remote MTOP without an ultrasound can be safe , effective and acceptable to women . They gathered data from three abortion providers to compare two cohorts who had aborted at home at 69 days ’ gestation or earlier .
Data from electronic records were used to analyse a total of 52,142 abortions in England and Wales . Women in the fi rst cohort ( n = 22,158 ) were seen face to face in the traditional way , with ultrasound , between January and March 2020 . The second group ( n = 29,984 ) were seen via a telemedicine-hybrid model , without ultrasound , between April and June 2020 ; 61 % were seen in person and 39 % via telemedicine .
Mean waiting time for referral to treatment for the hybrid model was 4.2 days shorter and more abortions were provided at six weeks or earlier ( 40 % vs 25 % in the traditional group ). Rates of successful completion were similar ( 98.8 % in the hybrid model versus 98.2 % in the traditional model , as were serious adverse incident rates ). In the hybrid model , 0.04 % of women were past 10 weeks ’ gestation at termination , but all procedures were safely completed . Effectiveness was higher in the hybrid model ( 99.2 % vs 98.1 %); 96 % of this group found telemedicine acceptable , with 80 % expressing a preference for the model in the case of future termination .
The main limitations were it was not possible to follow up patients or to review all communications between providers and the NHS . Covid restrictions played a part , and also may have made patients less likely to report complications .
This study demonstrates that incorporating telemedicine is safe and effective , and improves access for vulnerable groups . It suggests the model could become a routine part of MTOP .
References Royal College of Obstetricians and Gynaecologists . Coronavirus Infection and Abortion Care . London : RCOG , 2020 . bit . ly / 2V2uh83 Aiken A et al . Effectiveness , safety and acceptability of no-test medical abortion provided via telemedicine . BJOG 2021 ; 128 ( 9 ): 1464-74 . bit . ly / 2WAgAgT
Reena Patel is a practice nurse in Leicester
Ethnic differences contribute to disparity in uptake of arthritis drugs
It is not always possible to review behavioural patterns across ethnicities when advocating a treatment plan . However , attitudes to treatment are important , especially in long-term conditions such as rheumatic disease . Identifying barriers to acceptance of therapies among ethnic groups has the potential to reduce health inequalities . Selvaskandan and Moorthy conducted a retrospective cross-sectional study at an NHS outpatient biologic therapy counselling clinic in Leicester , an ethnically diverse city . A total of 91 patient cases were reviewed via clinic letters and medical records .
The study shows signifi cant differences in uptake of biological disease-modifying anti-rheumatic drugs ( DMARDs ) between ethic groups . Of the patients who declined treatment , almost 68 % were from minority ethnic groups – equating to one in four patients from these groups offered a DMARD ). Socio-economic factors , cultural differences and language barriers and are all likely reasons , the researchers argue .
Outcomes for rheumatological diseases vary with ethnicity , and while physiological factors have a role , the study suggests attitudes to drugs are important in long-term conditions .
It is vital to understand what lies behind these disparities if we are to close gaps in outcomes . This will require an insight to patients ’ health beliefs , social status , family dynamics , or even their reluctance to ask clinicians questions about a treatment they are not familiar with – especially if English is not their fi rst spoken language .
This study was limited by its small sample size but there is the potential to broaden the research to provide more detailed analysis of the factors infl uencing treatment acceptance .
Reference Selvaskandan H and Moorthy A . An ethnic variation in the acceptance of biological disease-modifying therapies . Cureus 2021 ; 13 ( 5 ): e15270 . bit . ly / 38yiy3X nursinginpractice . com Autumn 2021