An evaluation of menopause service delivery during the COVID-19 pandemic

Hugo Pedder https://orcid.org/0000-0002-7813-3749 hugo.pedder@bristol.ac.uk, Lynne Robinson, […], and Jo Marsden https://orcid.org/0000-0001-8452-1548+2View all authors and affiliations

Abstract

Objective

To investigate the experience of remote outpatient menopause service delivery by clinicians and patients during the COVID-19 pandemic.

Methods

Two surveys explored the experiences of patients and clinicians separately. Patients attending menopause clinics in the UK were directed to an online survey which included questions on demographics and on their experience of their most recent appointment. A clinician survey was shared to members of the British Menopause Society (BMS) via email and was made available on the BMS website. It contained questions on clinic characteristics and clinicians’ experience of delivering remote menopause consultations. Surveys were available for completion between 01/12/2020 and 10/02/2021.

Results

Of 180 patients who completed the patient survey, 52% felt remote consultations were the same or better than face-to-face consultations, and 90% of patients felt a choice between remote and face-to-face consultations should be offered. Patients overall were satisfied with many aspects of care, though numerous problems were highlighted with appointment administration. Of 76 clinicians who completed the clinician survey, most found remote patient consultations either no different or a bit worse than face-to face consultations but found that they offered more flexibility. In some cases, significant rescheduling was necessary to accommodate for the clinical needs of the consultation.

Conclusion

A ‘one-size-fits-all’ approach to managing the delivery of menopause care is not supported by patients or clinicians. There must be a robust process in place to avoid problems with appointment scheduling and associated communications. Lessons learned from the pandemic can help to provide holistic menopause care.

Key points and recommendations

Patients

• 52% felt remote consultations the same or better than face to face consultations.

• 90% of patients felt a choice between remote and face-to-face consultations should be offered.

• Patients overall were satisfied with the convenience, duration and feeling of involvement in decisions about their care.

• Satisfaction with the quality of service appeared to be higher in NHS hospital or private clinics than with GP review.

• Irrespective of whether consultations took place in primary or secondary care, there were numerous problems with appointment administration (e.g. scheduling. cancellation, waiting times).

Clinicians

• Most clinicians found remote patient consultations, which were mostly by telephone (fewer via video), either no different, or a bit worse than face-to face consultations but to offer more flexibility.

• In a small minority, however, significant rescheduling was necessary to accommodate for the clinical needs of the consultation (e.g. clinical examination, patient language and hearing difficulties).

• There is a perception that remote consultations are associated with lower DNA rates.

Recommendations/conclusions

• A ‘one-size-fits-all’ approach to managing the delivery of menopause care is not supported by patients or clinicians.

• Patient triage would enable a service tailored to medical and social need. Ideally this requires a nationally agreed consensus.

• There must be a robust process in place, with sufficient administrative support, to avoid problems with appointment scheduling and associated communications.

• Educational support for menopause management in primary care is required.