Family planning centers across the United States focused on telehealth and found creative ways to serve their clients after the COVID-19 pandemic rolled across North America in the winter and spring of 2020.
Contraceptive Technology Update (CTU) asked clinic leaders to participate in a Q&A about their operations during the pandemic.
CTU: How did your family planning facility weather the pandemic as it evolved after the national shutdown ended (i.e., did all contraceptive services resume at a pre-pandemic level)? For instance, did your center return to in-person visits for all or some services? How much did additional infection prevention activities affect your resources? Which — if any — telehealth services have continued?
Catriona Reynolds: In-person services resumed in May, limited to visits that require in-person care. The first day of in-person services, we saw someone with a breast lump, removed an IUD [intrauterine device], and placed a Nexplanon [arm implant]. We continue to use telehealth for all visits that do not require an in-person examination. The conversation, education, and counseling elements of in-person visits are performed by telehealth. The client only enters the building for the physical exam/procedure portion of the visit. We installed air extraction in the exam rooms and provide reusable fabric masks to any client or visitor who needs one.
Interestingly, emergency contraception has been more frequent than before the pandemic. We’re still trying to figure that one out.
Whitney Howell: The Georgia Department of Public Health is the lead agency responsible for responding to the COVID-19 pandemic. As a result, significant numbers of public health staff have been diverted from their normal roles to support testing for COVID-19 as well as case investigation and contact tracing efforts. To support this response, county health departments and clinics in our district are operating under a continuity of operations plan, which identifies essential services to be provided during emergencies.
Family planning and contraceptive services are considered essential, and our clinics have continued to provide in-person services at all of our locations. Early in the pandemic, there was a stark decline in the number of clients coming to the health department for in-person visits. When compared to last year, we have experienced a 25% decrease in the number of our clients seeking family planning services.
More recently, patients have begun seeking care again, and demand for services is high. We continue to adapt to meet this need; for example, by calling in prescriptions to local pharmacies to allow third parties to pick up for individuals who may be quarantining or isolating.
Evelyn Kieltyka: Maine Family Planning (nor our sub-recipients) never completely closed to in-person visits at the beginning of the pandemic. We have been fortunate in Maine to have a very progressive and data-driven public health response to COVID-19. In August 2020, in consultation with our medical director and staff, we began giving patients the option of telehealth and in-person office visits. What we were hearing from patients was “I just want to come in to the office to be seen. I’ve been putting this off, but I have an issue that needs an in-person visit.”
We are doing all the COVID-19 screening questions and only allowing the patient in the office. In addition, patient appointments are spaced out so no two people are in the office at the same time. Rooms are cleaned after each visit, and patients must wear a mask — no exceptions. Screening questions are asked while the patient is in their car so that the time in the office in minimized. So far, things are going well.
Jennifer Howell and Kelly Verling: Our Sexual Health Program is an integrated program offering family planning, STI [sexually transmitted infection], and HIV prevention services. At the beginning of the COVID-19 pandemic, the sexual health clinic had visits available for clients experiencing STI symptoms, and we facilitated syphilis treatment for community providers. We provided all family planning services, including method refills, partner delivered therapy [PDT], and family planning emergencies.
Method refills and condom distribution, along with PDT, were available for curbside pickup. Clients called the clinic from the parking lot upon arrival to ensure social distancing between clients. Screening for COVID symptoms, including temperature, occurred prior to entry into the clinic. If they were experiencing COVID symptoms, staff actively referred clients for COVID testing.
As our state moved to the next phase of opening, the clinic expanded to a full offering of services on June 1. Because our clinic was open during the pandemic, telehealth appointments were limited to triaging client concerns.
COVID transmission prevention efforts started in March and continue to present. Staff were fit-tested for N95 mask use. PPE [personal protective equipment] was provided to include gowns and face shields. The level of PPE used depends on the staff member’s preference, with a minimum amount of PPE required. When in common areas or sharing offices, staff are required to wear a face covering. Meetings have been modified to allow for online meetings or in-person meetings with social distancing and required face covering. Environmental protections include a vigorous cleaning schedule of commonly touched items and exam rooms. Staff have been required to participate in a training covering COVID transmission prevention methods.
Amy Paris: We were fortunate that we never had to close down our clinic or hospital to time-sensitive contraceptive services. We continued to offer those in person. We converted anything that could safely be a telehealth visit to telehealth, and we resumed full, in-person visits in the hospital and clinic, including contraceptives.
We have maintained telehealth options. For any gynecological issue that does not require an in-person physical exam or vital signs, we continue to offer patients telehealth visits where we have a platform that is friendly. If [patients] are unable to download it, we offer a phone visit. We offer birth control counseling over telehealth. Any troubleshooting of issues that do not require an in-person exam, we offer telehealth.
Our clinic is open, so all new patient visits and consults are offered in person. Our established patients are seen in person. Most contraceptive visits are in person because of the nature of their needs for a physical exam.
When a patient has been seen in the last year, they have a contraceptive in record, and they don’t need an in-person visit, so we might consider telehealth. The decision between in-person and telehealth is very patient-driven: No one gets a telehealth visit if they don’t want one.
Dartmouth-Hitchcock serves a large geographic area, from eastern Vermont and New Hampshire, and some patients drive far to get here. If they prefer telehealth, we can offer that. Before the pandemic, we did not have a telehealth option. This has been a completely new development, and our hospital was very responsive and quick to come up with a good platform and implement it. Patient feedback has been very positive. Even though patients don’t need telehealth, because we’re fully open for in-person visits, we still offer telehealth. Some patients prefer telehealth, and that’s been a silver lining of the pandemic.
Jean Smith: It was a slow return, as many college students finished their year early and returned home. We didn’t see college students this spring and summer — as we normally would have pre-pandemic. Now, starting in September, we have increased our telemedicine visits for new college students coming in, including many first-year students. We’ve offered telemed visits for many, if not all, college students to accommodate their class schedules.
In July, we had a full schedule for in-person clinic visits, but rescheduled due to a death in my family. Starting in August, we have had a full schedule for appointments needing an in-person visit, such as annuals with Pap tests, or problem visits. We screen them for COVID prior to letting them in the facility and ask that they fill out the paperwork prior to the appointment. We allow an hour for all appointments, allowing time to adequately disinfect all areas used.
All telemed/telehealth services have resumed, effective in May. We schedule the telemed visits on demand or when it works for the clients’ and providers’ schedules.
Pre-pandemic, a provider would see clients in person one day per month with some appointments via telemed. But now clients are requesting the telemed visits, and if appropriate, we would rather conduct the appointment via a telemed visit.
Our telemed appointments are not conducted from a client’s dorm room or home. They still have to come to the family planning clinic, and from that point we dial up for the telemed appointment with our offsite provider. We still can perform the vitals and either start their contraceptive injection that day or send them home with a three-month pill supply.
Also, pre-pandemic, there wasn’t a lot of interest from ND Family Planning clinics in doing telemed visits. But since the pandemic, I’ve helped two family planning clinics get up and running with a telemed program, and they report being very busy.