Telemedicine: the future of family planning care
July 7th, 2020 | Viewpoint
July 7th, 2020 | Viewpoint
During the COVID-19 public health emergency (PHE), the use of telemedicine (providing services via audio/audio-visual communication) for the delivery of family planning services increased dramatically. In one poll conducted in May 2020—three months into the PHE—87% of Title X-funded family planning providers reported they were providing some services using telemedicine, a dramatic increase from the 11% who reported using it just over a year before. The PHE created a natural experiment as family planning providers were in many cases forced to adopt telemedicine rapidly for the safety of their clients, staff, and selves. JSI, through the Family Planning National Training Center, has developed resources, including a toolkit, prioritization guide, and answers to frequently asked questions, for family planning providers during COVID-19.
Before the PHE, family planning provider attitudes about providing services by telemedicine were tepid: one 2018 study of OB/GYNs found that 73% of providers were skeptical about it. Also in 2018, only one-third of Title X family planning providers expressed interest in telemedicine. When asked why they were not interested, they expressed concerns about: 1) funding and a lack of clarity from funders and third-party payers; 2) the cost, complexity, and reliability of technology; and 3) fear of providing sub-quality services.
Yet in-person visits to a clinic can be inconvenient and time-consuming: clients may have to take time off work or find transportation and childcare. These barriers are even more significant for women who are poor, of color, have disabilities, or live in rural areas. Clinics report ‘no-show rates’ between 25% and 50%, and for several years, the most common complaint on patient satisfaction surveys has been long wait-time. Because telemedicine does not incur these costs or inconveniences, it has the potential to vastly improve access to care—a key component of reproductive justice.
For telemedicine to continue after the PHE, however, the health care system will have to mitigate providers’ concerns. Funders and third-party payers will have to issue clear guidelines and widespread reimbursement for services delivered virtually. Providers will need a range of technological options to remain available, and training to provide high-quality care virtually. Systems to ensure that clinical guidelines for preventive health screening and quality indicators with personal and public health implications must be established. Research is needed to ensure that contraceptive counseling by telemedicine is patient-centered, principles of high-quality counseling are used, federally mandated counseling is included, and that patients feel listened to and respected.
These challenges are surmountable. Obviously not all services can be provided by telemedicine, but many can. Telemedicine can provide broad and equitable access to services and should remain an option when the PHE is over.