Remote consultations in sexual and reproductive health services: a systematic review of evidence on effectiveness, cost-effectiveness, experiences, access and equity

Objectives: Timely access to sexual health screening and contraception is an important public health issue. Substantial funding reductions for sexual and reproductive health services (SRHS) and COVID-19 have led to significant changes in service delivery, including the rapid introduction of remote consultations, as a substitute for in-person contact. There is limited evidence relating to the barriers to remote consultations and how these may impact sexual health outcomes and wider health inequalities. This study synthesises existing evidence on remote consultations to examine effectiveness, cost-effectiveness, experiences, access and equity.

Methods: Eighteen electronic databases were systematically searched to locate relevant studies published from OECD (Organisation for Economic Co-operation and Development) countries after 2010. The Mixed Methods Appraisal Tool was used to evaluate the quality of the studies.

Results: Out of 8690 studies identified, 48 met the inclusion criteria. The included studies were heterogeneous and covered a range of topics; however, few focused on health inequalities and remote consultations, with satisfaction and quality of care being the most common outcome measures. Many of the studies were completed post-2020 in response to COVID-19 and were of medium to low quality. Access to technology and communication challenges were found to impact inequality when accessing SRHS via remote consultations, although they enhance convenience for service users and service providers.

Conclusions: Overall, the review shows that a range of studies have investigated remote consultations in SRHS, but there remains limited evidence on the impact on health inequalities and sexual health outcomes. The surge in post-2020 research, spurred by COVID-19, indicates the necessity for further high-quality research into equitable SRHS delivery in the post-COVID era, particularly in addressing technological and communication barriers. There is a need to further optimise access and the delivery of remote consultations in SRHS, considering the needs of service users, and minimising inequality (observed differences) and inequity (unfair differences).