CARE Women’s Health publishes on telehealth for pandemic contraceptive care

Kate Beatty, faculty in East Tennessee State University College of Public Health, is lead author of an article in the Journal of Public Health Management & Practice. The article, Telehealth for Contraceptive Care During the Initial Months of the COVID-19 Pandemic at Local Health Departments in 2 US States: A Mixed-Methods Approach, examined implementation of telehealth for contraceptive care among health departments (HDs) in two Southern US states with centralized/largely centralized governance structures during the early phase of the COVID-19 pandemic.

Additional College of Public Health faculty, students, and alumni co-authors include Michael Smith, Amal Khoury, Liane Ventura, Tosin Ariyo, Jordan de Jong, Kristen Surles, Aurin Rahman, and Deborah Slawson.

People across the nation reported delaying or cancelling visits for reproductive health care, or had difficulty obtaining contraceptives during the COVID-19 pandemic. Economic hardship, pandemic-related job loss, and fear of contracting COVID-19 contributed to delayed care. Delays and cancellations disproportionately affected lower-income, Black, and Hispanic women. These limitations in access to contraceptive services may widen preexisting disparities in women's health.  

This study examined contraceptive service provision via telehealth during the initial months of the COVID-19 pandemic among health departments in two southern US states to identify any facilitators and barriers. The team examined factors including patient volume, staffing capacity, and plans to maintain telehealth services beyond the pandemic.

“COVID-19 has changed the landscape of telehealth in medicine,” stated Dr. Beatty.  “Developing system-level policies and supportive electronic and billing infrastructure are key to increasing access to services via telehealth.”

A cross-sectional survey of health department clinic administrators in the two states was conducted from July-November 2020. The team assessed clinic characteristics and contraceptive provision. The survey included questions related to the scope of contraceptive provision, clinic policies and practices, and organizational characteristics. Telehealth implementation for contraceptive care was assessed and measured by the percentage of clinics reporting telehealth service provision during the pandemic. Facilitators and barriers to telehealth implementation for contraceptive care were assessed by key informant interviews.

The researchers found 60% of health department clinics in state 1 and 81% in state 2 reported a decrease in contraceptive care patient volume during March-June 2020 compared with the average volume in 2019. More clinics in state 1 implemented telehealth for contraceptive services, including contraceptive counseling, initial and refill hormonal contraception, emergency contraception and sexually transmitted infection care, and reported facilitators of telehealth compared to state 2. Medicaid reimbursement was a predominant facilitator of telehealth, whereas lack of implementation policies and procedures and reduced staffing capacity were predominant barriers. Electronic infrastructure and technology also played a role.  Implementation of telehealth for contraceptive services varied between state health department agencies in the early phase of the pandemic. Medicaid reimbursement policy and directives from agency leadership are key to telehealth service provision among health departments in centralized states.