EXECUTIVE SUMMARY

Family planning centers employ various telehealth tactics to continue to provide contraception and reproductive healthcare to their clients.

  • A common telemedicine method involves consent, screening, and counseling through a phone call or videoconference.
  • Facilities also could extend prescriptions via telehealth.
  • Less commonly, clinics have provided telehealth counseling for use of medication abortion and test kits for sexually transmitted infections.

Family planning clinics and other reproductive health providers have discovered creative ways to continue to provide contraception services to women during the COVID-19 pandemic.

Telehealth is one of the most important methods, although each facility has its own way of using remote services.

Here are some of the successful methods clinics are using:

• Telehealth consent, counseling, and screening. “Our contraceptive patients are very welcoming of any care that can be provided by telemedicine,” says Amy Paris, MD, MS, director of family planning at Dartmouth-Hitchcock in Lebanon, NH.

When a family planning practitioner calls a patient for screening, counseling, or other services, they first obtain consent. The consent includes mention that a telemedicine visit may be appropriate, says Jean Smith, RN, BSN, PHN, family planning director at Richland County Health Department in Wahpeton, ND.

“We’ve added a telemedicine piece into contracts with our providers, since we do not have a provider on staff,” Smith says.

The clinic bills insurers for telemedicine using a GT modifier, a billing code that indicates interactive audio and video telecommunications systems were used, she adds.

“There are certain criteria that have to be mentioned, identifying where the client is, where the provider is, and who is with the client,” Smith says. “When a client calls and wants to start a contraceptive method, we screen her over the phone and decide whether this is an appropriate telemedicine visit. Then we contact our provider and get a time to do a telemedicine visit.”

Patients are screened by phone prior to in-person visits, as well. “Before a woman comes in to the clinic, we’ve screened her and made sure she was asymptomatic [for COVID-19] and wants to start a contraceptive method,” Smith says. “All of that is done over the phone.” COVID-19 screening includes asking patients about fever, cough, and other symptoms associated with the disease.

The clinic has shortened the time the client has to be face-to-face with staff, Smith adds. “The consultation can be through telemedicine. We explain how it works and explain billing, all on the screening visit.”

• Delaying services when feasible. “We have built some guidelines for our clinic, where — just like everyone else during the pandemic — we are trying to avoid sending patients to the clinic when they do not need to be there in person,” Paris says. “We have postponed many types of office visits in obstetrics and gynecology, but not contraceptive visits.”

Dartmouth-Hitchcock is trying to provide the same access to contraception that would have been possible without the pandemic. This is performed through telemedicine visits when feasible, she adds.

Maine Family Planning in Augusta, ME, deferred many in-person appointments during the spring of 2020, says Evelyn Kieltyka, MSN, MS, FNP-BC, senior vice president of program services at Maine Family Planning.

“If someone needed more medication, we could do that, but we’re not seeing anyone for nonessential reasons,” Kieltyka says. “We push everyone to a telehealth visit, if possible.”

Foot traffic was cut in half, at least. “We’re finding that people are sheltering in place and not going anywhere, unless they absolutely need something,” Kieltyka says. “We’re not seeing folks come in for routine things.”

Some family planning centers also are helping patients delay replacing long-term contraceptives. For example, if a patient had planned to have their five-year intrauterine device (IUD) replaced in year five, clinicians now are explaining how the contraceptive will be effective for another two years, and they can delay the replacement until after the pandemic ends, Kieltyka explains.

Dartmouth-Hitchcock also advises patients to extend use of an IUD. “If a patient calls because they want to switch out their implant because it is of three-year FDA-approved duration, we are telling them there is excellent evidence the implant is effective for at least four years, and it might even be appropriate to leave it in place for five years,” Paris says.

At first, Maine Family Planning postponed appointments for insertion of new IUDs. Women were offered a bridge method, such as birth control pills or a contraceptive injection. “We were thinking this was for a few weeks, and now we know it’s much longer,” Kieltyka says.

The center decided to make long-acting reversible contraception (LARC) available as an essential service for women starting this form of contraceptive. “If someone calls up and says, ‘I’m having pelvic pain and abnormal bleeding,’ we’ll see them [in person] to figure out what’s going on,” she explains. “Anyone who needs to be seen based on symptoms, we consider that essential. We set up a protocol to screen people over the phone, make sure they are asymptomatic for COVID-19, and we do pre-counseling about LARC.”

During the appointment for inserting the IUD, everyone wears a mask in the exam room, she adds. “We wipe down everything afterward.”

• Extending prescriptions automatically. “If someone is already established as a patient, we automatically extend their prescription for three months, not requiring a physical, and possibly longer,” Kieltyka says. “The last thing we want anyone to experience is not having access to birth control, and unintended pregnancy.”

Contraception cannot be postponed until the end of the pandemic, Paris notes.

“Contraception is not something that can be postponed for a couple of weeks or a couple of months, or until the peak of the pandemic has passed,” Paris says. “Contraception is urgent, an abiding principle. Not all visits need to be done in person.”

Telemedicine and automatically extending prescriptions are sound tactics for ensuring contraception access during the pandemic. “Now, more than ever, it’s important for patients to have the tools they need to protect themselves against unwanted pregnancies,” Paris says.