Telehealth Care Protocols

Agreement and Acknowledgment of Telehealth Care Protocols

This document outlines the telehealth-specific protocols for managing menopause care remotely through the Moonah Health digital platform. By signing below, the practitioner acknowledges receipt of these guidelines, understands their content, and agrees to comply with the protocols as part of their role with Moonah Health.

Understanding the Stages of Menopause

  1. Perimenopause
    • Definition: The transition period leading up to menopause, when hormone levels (estrogen and progesterone) begin to fluctuate.
    • Symptoms: Irregular periods, hot flashes, night sweats, mood swings, and sleep disturbances.
    • Care Focus: Patients in perimenopause may require symptom management, which could include both hormonal and non-hormonal therapies.
  2. Menopause
    • Definition: Officially marked when a woman has gone 12 consecutive months without a menstrual period.
    • Symptoms: Hot flashes, vaginal dryness, mood swings, insomnia, and decreased bone density.
    • Care Focus: Hormone Replacement Therapy (HRT) is often prescribed during this phase to manage symptoms and prevent conditions such as osteoporosis.
  3. Postmenopause
    • Definition: The years following menopause, when hormone production has stabilized at lower levels.
    • Symptoms: Continued hot flashes, vaginal dryness, and increased risk of bone density loss.
    • Care Focus: Ongoing management of symptoms and long-term prevention of complications, particularly osteoporosis and heart disease.
  1. Patient Intake via Questionnaire
  1. Medical History Collection
    • Gather information on menopause symptoms (hot flashes, night sweats, mood swings, etc.), family history of breast cancer, cardiovascular disease, and lifestyle factors.
    • Mandatory fields include: Smoking status, alcohol use, and exercise habits.
  2. Hormonal Levels
    • Hormone levels (estradiol, progesterone, testosterone) must be collected either via at-home testing kits provided by Moonah Health or from previous lab results.
    • If patients decline hormone testing, proceed based on their symptom assessment from the questionnaire.
  3. Lifestyle and Psychological Health
    • Assess stress levels, sleep patterns, and screen for depression or anxiety. These assessments are mandatory in each evaluation.
  1. Hormone Replacement Therapy (HRT) Guidelines
  1. Indications for HRT
    • HRT should be prescribed in the following cases unless contraindicated:
      • Moderate to severe hot flashes.
      • Early menopause or premature ovarian insufficiency.
      • Prevention of osteoporosis in at-risk patients.
  2. Contraindications for HRT
    • Do not prescribe HRT if:
      • The patient has a history of breast cancer, hormone-sensitive cancers, thromboembolic disorders, or unexplained vaginal bleeding.
  3. HRT Prescription Options
    Moonah Health offers various HRT forms to suit patient preferences and needs:
    • Estrogen-only therapy: For women without a uterus.
    • Combination estrogen-progestin therapy: For women with an intact uterus.
    • HRT Forms Available:
      • Patches (transdermal estradiol patch).
      • Creams (topical estrogen therapy).
      • Injectables (intramuscular or subcutaneous hormone injections).
      • Pills (oral hormone therapy).
  4. Protocol for Creams:
    • Usage: Estrogen creams are applied topically and primarily prescribed for vaginal dryness, atrophy, and related symptoms.
    • Starting Dosage: Typically, 0.625 mg per gram of cream is applied to the vaginal area daily for 1-2 weeks, then reduced to 2-3 times per week based on patient response.
    • Patient Instructions:
      • Educate patients on proper application techniques.
      • Advise patients to apply cream at night to reduce mess and allow for better absorption.
      • Follow up after 4 weeks to assess improvement in symptoms and adjust dosage if necessary.
    • Potential Side Effects: Include local irritation or discomfort. Patients must be informed about the potential risks of systemic absorption if overused.
  5. Protocol for Injectables:
    • Usage: Hormone injections (e.g., estradiol valerate or cypionate) are typically used for patients who prefer infrequent dosing or who have had issues with adherence to other HRT forms.
    • Starting Dosage: Begin with estradiol valerate 10-20 mg intramuscularly every 4 weeks.
    • Patient Instructions:
      • Injections are typically administered by a healthcare provider or trained patient. Provide training for self-administration if needed.
      • Patients should be informed about potential side effects such as injection site reactions, mood swings, or breast tenderness.
      • Monitor patients for any adverse effects and schedule follow-up injections every 4-6 weeks.
    • Safety Monitoring: Include a check on cardiovascular health (blood pressure and lipid panel) at the 3-month mark, as injectables have higher systemic hormone levels.
    • Potential Side Effects: Educate patients about signs of cardiovascular risks (e.g., blood clots, hypertension) and how to manage injection site reactions.
  6. Follow-Up for Creams and Injectables:
    • Follow up after the first 4-6 weeks of starting either therapy to evaluate patient response and assess for any side effects. Adjust treatment as necessary.
    • Document all follow-ups, adjustments, and any adverse events in the patient’s record.

III. Non-Hormonal Treatment Guidelines

  1. Indications for Non-Hormonal Treatments
    • Use non-hormonal treatments for:
      • Patients with contraindications to HRT.
      • Patients who prefer non-hormonal options.
      • Patients with mild menopause symptoms, identified through the questionnaire.
  2. Non-Hormonal Medications
    • Paroxetine (7.5 mg/day): First-line treatment for hot flashes.
    • Gabapentin (300 mg at bedtime): For managing night sweats.
    • Clonidine (0.1 mg twice daily): For vasomotor symptoms (hot flashes) if other options are not effective.
  3. Moonah Health Daily Vitamin Packs
    • Patients may be prescribed Moonah Health’s vitamin packs, which include 8 key vitamins to support daily nutritional needs during menopause.
  1. Monitoring and Follow-Up
  1. Follow-Up Protocol
    • Patients must complete follow-up questionnaires every 3 months to evaluate symptom control, medication adherence, and any side effects.
    • Adjust treatment based on follow-up responses.
  2. Adverse Event Response Protocol
    • If a patient reports side effects or complications during follow-up, Moonah Health staff will:
      • Immediately review the patient’s symptoms: A nurse practitioner or physician must review the patient’s symptom report within 24 hours.
      • Follow-Up Consultation: Schedule a telehealth consultation with a provider within 48 hours to discuss symptoms, treatment adjustments, and whether further care is needed.
      • Emergency Protocol: If symptoms are severe (e.g., chest pain, difficulty breathing), the provider will direct the patient to seek immediate emergency care.
      • Documentation: The provider will document the adverse event and all steps taken.
  3. Emergency Situations
    • In case of serious symptoms or side effects (e.g., chest pain, shortness of breath), patients are advised to seek emergency care immediately.
  1. Approved White-Label Generic Medications
  1. Hormone Replacement Therapy (HRT)
    • Estradiol Patch (Generic for Estrace or Climara): Starting dose: 0.025 mg/day.
    • Medroxyprogesterone Acetate (Generic for Provera): 5-10 mg/day for 10-14 days per month for women with an intact uterus.
    • Topical Creams (Generic estrogen creams).
    • Injectables (Generic estrogen or progestin injectables).
  2. Non-Hormonal Options
    • Venlafaxine (Generic for Effexor): Start at 37.5 mg/day, increasing as needed.
    • Clonidine (Generic for Catapres): 0.1 mg twice daily.
  3. Bone Health Supplements
    • Alendronate (Generic for Fosamax): 70 mg once weekly for osteoporosis prevention.
  1. Special Populations
  1. Premature Menopause
    • HRT is recommended until the average age of natural menopause unless contraindicated.
  2. Spanish-Speaking Patients
    • All educational materials, questionnaires, and consultations must be available in Spanish.

VII. Documentation and Compliance

  1. HIPAA Compliance
    • Each telehealth session must be documented, including patient consent, prescriptions, and follow-ups.
  2. Licensing and Telehealth Law Compliance
    • Practitioners must maintain valid licenses in the states where the patients reside. Moonah Health will ensure compliance with state-specific telehealth regulations and licensing requirements.

VIII. Patient Education and Informed Consent

  1. Pre-Treatment Education
    • All patients must receive detailed educational materials about their treatment options, including risks, benefits, and potential side effects of HRT, non-hormonal treatments, and lifestyle changes.
  2. Informed Consent
    • Patients must electronically sign a consent form acknowledging their understanding of the risks associated with HRT, the need for emergency care when necessary, and the limitations of telehealth care.

Agreement and Acknowledgment

By signing this document, I acknowledge that I have read, understood, and agree to follow the Moonah Health Telehealth Care Guidelines as outlined. I commit to adhering to all protocols, ensuring patient safety, and maintaining compliance with all state-specific telehealth regulations.