Reproductive Health Treatments

Reproductive Health Treatments – Amid the current COVID-19 public health crisis, patients continue to face many of the same sexual and reproductive health problems they have always had (Figure 1). About 47 million women use contraception each year in the US, 20 million new sexually transmitted infections (STIs), 3.8 million births, 1 million pregnancy losses, 6.5 million women with endometriosis, 862,000 miscarriages, and 94, newly diagnosed gynecologic cancers. 000 women. This does not mention the millions of patients each year who access preventive services for reproductive health (eg STI and cancer screening, HPV vaccines). The difference now, however, is that much of this concern has been delayed due to the COVID-19 crisis.

After decades of public health campaigns urging people not to delay or forgo many forms of care, we are now experiencing a paradigm shift in response to COVID-19. In exceptional circumstances, the US government, states, health centers and providers are responsible for determining which health services are “essential,” and which are “elective” or “inevitable,” and thus affect the care available to patients at this time. Beginning in March 2020, the CDC’s guidelines urged providers to cancel emergency outpatient visits and health care unless it could be done via telehealth. Additionally, CDC and CMS recommend deferring “elective” and “unnecessary” surgeries and procedures, using a tiered framework that balances severity and sensitivity according to patient needs, with trade-offs related to personal care (eg, coronavirus exposure, PPE degradation). On May 21, 2020, the CDC removed that language from its published guidance about delaying non-emergency visits and “elective” procedures. However, during that time, there has been a significant decrease in patients seeking reproductive health care and health care in general.Reproductive H ealth Treatments

Reproductive Health Treatments

Reproductive Health Treatments

A Strata Decision Technology study of 228 hospitals across 40 states showed a significant year-over-year decrease in patient encounters for various reproductive health services (Figure 2). While the largest declines in patient numbers were for preventive health services, infertility care and abortion, gynecological cancers and pregnancy encounters were smaller, but still significant. A study by IQVIA showed an 83% drop in the number of Pap smears in April compared to February 2020.

Exploring Patient Preferences Toward Telehealth Sexual And Reproductive Health Care

Figure 2: Patient visits to hospitals and doctors’ offices decreased in the early months of the COVID-19 pandemic

Reproductive Health Treatments

Various medical associations have issued guidelines to help providers determine which reproductive health services require immediate, in-person care, may be appropriate for telehealth, and may be delayed altogether (Appendix). In general, most pregnancy-related services (prenatal care, labor and delivery, ectopic pregnancy, pregnancy loss, abortion) are considered necessary apart from most treatments for gynecological cancer. At the same time, some contraceptive methods require personal care (eg sterilization, IUD removal), as well as more preventive health care (eg STI and breast cancer screening, HPV vaccines). Family Planning Association guidelines emphasize the use of telehealth to assess whether an in-person visit is necessary or whether contraception can be administered through a virtual visit. It said recommendations for care during the COVID-19 crisis are changing rapidly; For example, as of March 2020, the American Society for Reproductive Medicine recommended canceling all new infertility treatments and diagnostic procedures, but they relaxed these recommendations as of May 2020.

Reproductive Health Treatments.

Some states specifically consider certain reproductive health services to be essential or non-essential. This is more common when it comes to abortion services. At least 12 states (AK, AL, AR, IA, LA, MI, OH, OK, TN, TX, WV) have issued policies to ban abortion during the COVID-19 crisis; Most prohibitions are no longer in place because states have removed restrictions on ongoing litigation or settlement or “non-essential” services. Meanwhile, 5 states (MA, NJ, NM, VA, WA) have included language in their executive orders or public health guidelines to clarify that abortion is considered necessary or specifically protect the “full suite of family planning services.”Reproductive Health Treatments

Reproductive Health Treatments

More To Be Done: Individuals’ Needs For Sexual And Reproductive Health Coverage And Care

For pregnancy-related care, New Mexico and Tennessee specifically exclude pregnancy-related visits or procedures from the definition of “unnecessary” care. In the case of gynecological cancer, some states clarify that delays in elective procedures do not apply if there is a risk of cancer progression or spread (AR, IA) or if the treatment is to remove a cancerous tumor (FL, NM, TN, WA). ), meanwhile, Massachusetts specifically included colposcopies (to detect breast cancer) and endometrial biopsies (to detect uterine cancer) as examples of “unnecessary, elective” procedures.Reproductive Health Treatments

However, for the most part, states have not specified specific procedures or diagnoses in their executive orders regarding COVID-19. Instead, they more broadly describe “non-essential” procedures that can be safely postponed for a certain period of time without causing significant harm to the patient. As of mid-2020, 32 states had issued formal orders to ban “elective” and “non-essential” surgeries and procedures, but by mid-2020, most had rolled back these restrictions to allow some procedures. Proceed under certain conditions. At the federal level, in June 2020 CMS recommended that patients no longer delay preventive care such as cancer screenings and vaccinations. As the COVID-19 pandemic progresses in the coming months, regular outbreaks of SARS CoV2 are likely to lead some regions to consider reinstating restrictions on “non-essential” services.

Reproductive Health Treatments

Reproductive Health Treatments

For years, public health officials and providers have urged the public to actively seek reproductive health care, knowing the negative health consequences of not doing so. We know that limited access to contraception puts women at risk of pregnancy, and that unrecognized and untreated STIs can lead to complications such as infertility, pelvic inflammatory disease, and pregnancy ectopics. We know that prenatal care can lead to poor maternal and infant outcomes, and that stopping time-sensitive fertility care can reduce the chance of having a family for 10-15% of infertile couples. Meanwhile, untreated conditions such as endometriosis and fibroids can cause significant morbidity, and delays in the diagnosis and treatment of gynecological cancers can lead to cancer progression and increased mortality. Even though reproductive health conditions are not life-threatening, we know that they threaten to reduce a person’s quality of life and overall well-being, so they deserve care and attention.

Reproductive Health Treatments .

Potential Impacts Of Delaying “non Essential” Reproductive Health Care

Reproductive Health Treatments. Healthcare systems and providers have had to adapt to an evolving landscape during the coronavirus pandemic, and many have quickly adopted telehealth solutions to continue seeing patients; Many reproductive health services can be delivered through telehealth, including hormonal contraceptive prescribing and prenatal/postnatal visits. Innovations have been found in using telehealth for medical contraception during the pandemic and in helping patients with self-insertion of IUDs and self-administration of Depo-Provera injections. That said, many services still require personal care, including many highly effective contraceptive methods (e.g. sterilization, IUD and implant placement), many preventive services (e.g. HPV vaccination, cervical cancer screening), procedural abortion, and the host. Procedures and surgeries used to diagnose and treat many gynecological conditions (eg infertility, endometriosis, gynecological cancer). Services requiring personal attention are at risk of being delayed during the COVID-19 pandemic. Reproductive Health Treatments .

Reproductive Health Treatments

Data from a May 2020 Health Administration survey indicates that more than half of US women reported that they or a family member avoided or postponed seeking medical care during the coronavirus outbreak. Most of those who delayed care reported that their condition did not worsen at that time and intended to seek care within the next 1 to 3 months (Figure 3). Therefore, it appears that most people are planning to return to care in the near future. That said, many people fear accessing personal health services; A Gallup poll (conducted March 28 to April 2, 2020) found that 88% of US women reported being very worried or moderately worried about being exposed to the novel coronavirus at a doctor’s office or hospital; This dropped to 70% when the survey was repeated from May 14 to 24, 2020. Patients may forgo care because of the cost, half of the workforce is out of a job or lost wages, and some may have lost their health insurance.

Reproductive Health Treatments

Figure 3: Many women have postponed care due to the COVID-19 outbreak, with many planning to seek care in the coming months. Reproductive Health Treatments

Reproductive Health Treatments

Simple Ways To Jump Start Women’s Health Month

When and if patients decide to seek in-person care, it’s important to note that providers may be operating at reduced clinic capacity compared to before the coronavirus outbreak. A survey of primary care providers in 48 states (conducted May 22-26, 2020) revealed that many practices are struggling financially; 14% of provider practices are temporarily closed and 77% reported negative net income in April 2020. Many had to lay off or lay off staff, and it was uncertain whether they would stay open in the coming weeks. It remains to be seen whether the financial impact on medical practices will allow these sites to operate at pre-COVID-19 patient volumes in the coming months. Given the existing financial challenges associated with Title X changes, this will be especially difficult for publicly funded family planning clinics.Reproductive Health Treatments

Even in the midst of the coronavirus pandemic, millions of patients still need sexual and reproductive health care

Reproductive Health Treatments

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