Patient-focused care in women's health during the Covid-19 pandemic

The authors received no funding from an external source to support the publication of this editorial.

Abortion care is an area of women's health facing complex challenges with care delivery as a result of the Covid-19 pandemic. Ultimately, the provision of safe and timely abortions relies on both equitable and reliable access to services and the pandemic has potential implications for abortion accessibility. The increasing shift to telehealth reviews during this time [ 1 ] has several implications. It offers a potential advantage, particularly for those women in rural or regional areas where access to abortion services is generally more limited. However, to actualise this advantage formal telehealth pathways must exist for safe and efficient referral, counselling, pharmacological administration or surgical referral and follow-up. These pathways have not been formally established within our health service and are an important consideration for future care modelling. The corollary to this is the potential delay in diagnosis of pregnancy when a face-to-face consultation involving a physical examination does not occur [ 2 ]. With a resulting increase in gestation at presentation for termination, there is additional strain on the system. For surgical termination, there is increasing pressure placed on those providers who specialise in later-gestation termination as well as surgical risk for patients. For medical termination, there is an appreciable impact on both patients and providers as gestation increases significantly. Optimisation of resource allocation to ensure safe and reliable access to contraception and abortion care is an important priority in women's health [ 3 ], particularly in the wake of the physical, mental, financial and social implications of the Covid-19 pandemic.

The disruption to elective surgeries and the burden of surgical triage has also had ongoing effects since the start of the pandemic. Emergency surgeries for conditions such as ovarian torsion and ectopic pregnancies continued, as did, thankfully, surgeries pertaining to a cancer diagnosis. But for those women with pelvic pain due to endometriosis awaiting their laparoscopy, or women managing their menorrhagia with regular iron infusions whilst they awaited a hysterectomy, their surgeries were considered non-urgent and were postponed indefinitely whilst staffing and theatre resources were reallocated to managing the surge of Covid-19-positive patients. Whilst there was an understanding amongst medical staff and patients alike of the need for this reallocation of resources, there was also a sense of deep dissatisfaction in providing these women with interim sub-optimal care. Ongoing staffing shortages nationwide have further complicated the resumption of elective surgery at full capacity. Through a combination of staff furlough, sick leave, burnout, and resumption of annual leave, there have been inadequate staff to undertake elective surgery at full capacity. Despite best intentions and adequate planning for elective surgeries, full theatre lists are often cancelled at late notice due to unforeseen staff leave.

As our government eased lockdown restrictions late last year, the number of Covid-19-positive patients presenting acutely to hospital magnified, as did the number of Covid-19-positive staff members, who were subsequently placed in isolation. Those left behind were tasked with keeping our hospitals running, an increasingly difficult task to achieve safely in our limited capacity. Women with chronic health conditions presented to hospitals in acute distress due to clinical neglect of their long-term symptomatology management, a result of two years of postponed clinics and state-mandated cancellations of elective surgery. The ability to provide adequate multidisciplinary care was left to the wayside as resources were reallocated to manage the influx of Covid-19-positive women presenting to hospital. On the maternity ward, doctors and midwives were tasked with supporting deliveries in full PPE; where the first few minutes in an obstetric emergency are critical to positive outcomes, there was perpetual fear that time delays in applying PPE could lead to increased morbidity for our patients. In some regional centres, lack of adequate staffing led to the closure of smaller maternity services. Larger regional centres were expected to swiftly accommodate these women into their health service, leading to increased patient ratios for our midwifery and nursing staff. Patients were likewise given little warning to changes, some of whom were quite late into their pregnancies.

This editorial was commissioned and not externally peer reviewed.

Tara Krishnan wrote and edited the manuscript. Annabelle Huguenin wrote and edited the manuscript. Both authors approved the final submitted manuscript.

The authors declare that they have no conflict of interest regarding the publication of this editorial.

The role that many women play as family caregivers has been exacerbated during the Covid-19 pandemic, with the impact of increasing illness, school closures and care of the elderly some of the relevant issues. Combined with the triage and accessibility issues discussed above, the health-seeking behaviour of women during this time has been affected. In particular, a de-prioritisation of their issues, such as menopause symptoms, pelvic organ prolapse and incontinence and menstrual disturbance, may be reflected in missed appointments or lack of attendance. It raises concerns for increasing severity of symptoms or disease at presentation, which may have further treatment implications, especially in the context of gynaecological malignancy. The Covid-19 pandemic has raised several challenges in delivering safe and timely healthcare for women, particularly when the provision of care is further impeded by increasing pressures placed on those who are primary carers to their families. The expectations of both clinicians and patients as to what constitutes exemplary healthcare has been challenged during the pandemic. However, it is imperative that our care remain patient-focused and we use our recent experiences to examine the efficacy and sustainability of the quality of care we provide.